1
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Adi-Wauran E, Clausen M, Shickh S, Gagliardi AR, Denburg A, Oldfield LE, Sam J, Reble E, Krishnapillai S, Regier DA, Baxter NN, Dawson L, Penney LS, Foulkes W, Basik M, Sun S, Schrader KA, Karsan A, Pollett A, Pugh TJ, Kim RH, Bombard Y. "I just wanted more": Hereditary cancer syndromes patients' perspectives on the utility of circulating tumour DNA testing for cancer screening. Eur J Hum Genet 2024; 32:176-181. [PMID: 37821757 PMCID: PMC10853540 DOI: 10.1038/s41431-023-01473-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/17/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023] Open
Abstract
Hereditary cancer syndromes (HCS) predispose individuals to a higher risk of developing multiple cancers. However, current screening strategies have limited ability to screen for all cancer risks. Circulating tumour DNA (ctDNA) detects DNA fragments shed by tumour cells in the bloodstream and can potentially detect cancers early. This study aimed to explore patients' perspectives on ctDNA's utility to help inform its clinical adoption and implementation. We conducted a qualitative interpretive description study using semi-structured phone interviews. Participants were purposively sampled adult HCS patients recruited from a Canadian HCS research consortium. Thirty HCS patients were interviewed (n = 19 women, age range 20s-70s, n = 25 were white). Participants were highly concerned about developing cancers, particularly those without reliable screening options for early detection. They "just wanted more" than their current screening strategies. Participants were enthusiastic about ctDNA's potential to be comprehensive (detect multiple cancers), predictive (detect cancers early) and tailored (lead to personalized clinical management). Participants also acknowledged ctDNA's potential limitations, including false positives/negatives risks and experiencing additional anxiety. However, they saw ctDNA's potential benefits outweighing its limitations. In conclusion, participants' belief in ctDNA's potential to improve their care overshadowed its limitations, indicating patients' support for using ctDNA in HCS care.
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Affiliation(s)
- Ella Adi-Wauran
- Genomics Health Services Research Program, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Marc Clausen
- Genomics Health Services Research Program, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Salma Shickh
- Genomics Health Services Research Program, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Anna R Gagliardi
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Avram Denburg
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Leslie E Oldfield
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Jordan Sam
- Genomics Health Services Research Program, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Emma Reble
- Genomics Health Services Research Program, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Suvetha Krishnapillai
- Genomics Health Services Research Program, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Dean A Regier
- BC Cancer, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Nancy N Baxter
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- University of Toronto, Toronto, Canada
| | - Lesa Dawson
- Memorial University, St. John's, Canada
- Eastern Health Authority, St. John's, Canada
| | | | - William Foulkes
- McGill University, Montréal, Canada
- Jewish General Hospital, Montréal, Canada
| | - Mark Basik
- McGill University, Montréal, Canada
- Jewish General Hospital, Montréal, Canada
| | - Sophie Sun
- BC Cancer, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | | | - Aly Karsan
- BC Cancer, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | | | - Trevor J Pugh
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
| | - Raymond H Kim
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
- University of Toronto, Toronto, Canada.
- Mount Sinai Hospital, Toronto, Canada.
- Ontario Institute for Cancer Research, Toronto, Canada.
| | - Yvonne Bombard
- Genomics Health Services Research Program, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.
- Ontario Institute for Cancer Research, Toronto, Canada.
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2
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Husereau D, Bombard Y, Stockley T, Carter M, Davey S, Lemaire D, Nohr E, Park P, Spatz A, Williams C, Pollett A, Lo B, Yip S, El Hallani S, Feilotter H. Future Role of Health Technology Assessment for Genomic Medicine in Oncology: A Canadian Laboratory Perspective. Curr Oncol 2023; 30:9660-9669. [PMID: 37999120 PMCID: PMC10670221 DOI: 10.3390/curroncol30110700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/23/2023] [Accepted: 10/28/2023] [Indexed: 11/25/2023] Open
Abstract
Genome-based testing in oncology is a rapidly expanding area of health care that is the basis of the emerging area of precision medicine. The efficient and considered adoption of novel genomic medicine testing is hampered in Canada by the fragmented nature of health care oversight as well as by lack of clear and transparent processes to support rapid evaluation, assessment, and implementation of genomic tests. This article provides an overview of some key barriers and proposes approaches to addressing these challenges as a potential pathway to developing a national approach to genomic medicine in oncology.
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Affiliation(s)
- Don Husereau
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
| | - Yvonne Bombard
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada;
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1T8, Canada
| | - Tracy Stockley
- Division of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada;
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
| | - Michael Carter
- Department of Pathology and Laboratory Medicine, Nova Scotia Health (Central Zone), Halifax, NS B3H 1V8, Canada;
| | - Scott Davey
- Department of Pathology and Molecular Medicine, Queen’s University, Kingston, ON K7L 3N6, Canada; (S.D.); (C.W.); (H.F.)
- Division of Cancer Biology and Genetics, Queen’s University Cancer Research Institute, Queen’s University, Kingston, ON K7L 3N6, Canada
- Departments of Oncology and Biomedical and Molecular Sciences, Queen’s University Cancer Research Institute, Queen’s University, Kingston, ON K7L 2V7, Canada
| | - Diana Lemaire
- Ontario Institute for Cancer Research, 661 University Ave, Toronto, ON M5G 0A3, Canada
| | - Erik Nohr
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada;
- Alberta Precision Laboratories, Foothills Medical Center, 1403 29 St NW, Calgary, AB T2N 2T9, Canada
| | - Paul Park
- Department of Pathology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3A 1R9, Canada;
| | - Alan Spatz
- Division of Pathology, McGill University Health Center, 1001 Decarie Blvd., Montreal, QC H4A 3J, Canada;
- OPTILAB-MUHC & Department of Laboratory Medicine, 1001 Decarie Blvd., Montreal, QC H4A 3J, Canada
- Research Molecular Pathology Center, Lady Davis Institute, 3755 Côte Ste-Catherine Road, Montreal, QC H3T 1E2, Canada
| | - Christine Williams
- Department of Pathology and Molecular Medicine, Queen’s University, Kingston, ON K7L 3N6, Canada; (S.D.); (C.W.); (H.F.)
- Ontario Institute for Cancer Research, 661 University Ave, Toronto, ON M5G 0A3, Canada
| | - Aaron Pollett
- Pathology & Laboratory Medicine, Sinai Health System, Toronto, ON M5G 1X5, Canada;
- Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Bryan Lo
- The Ottawa General Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada;
| | - Stephen Yip
- Department of Pathology & Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z7, Canada;
| | - Soufiane El Hallani
- Alberta Precision Laboratory, Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R7, Canada;
| | - Harriet Feilotter
- Department of Pathology and Molecular Medicine, Queen’s University, Kingston, ON K7L 3N6, Canada; (S.D.); (C.W.); (H.F.)
- Ontario Institute for Cancer Research, 661 University Ave, Toronto, ON M5G 0A3, Canada
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3
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Best MC, Butow P, Savard J, Jacobs C, Bartley N, Davies G, Napier CE, Ballinger ML, Thomas DM, Biesecker B, Tucker KM, Juraskova I, Meiser B, Schlub T, Newson AJ. Preferences for return of germline genome sequencing results for cancer patients and their genetic relatives in a research setting. Eur J Hum Genet 2022; 30:930-937. [PMID: 35277654 PMCID: PMC9349221 DOI: 10.1038/s41431-022-01069-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/14/2021] [Accepted: 02/08/2022] [Indexed: 11/09/2022] Open
Abstract
Germline genome sequencing (GS) holds great promise for cancer prevention by identifying cancer risk and guiding prevention strategies, however research evidence is mixed regarding patient preferences for receiving GS results. The aim of this study was to discern preferences for return of results by cancer patients who have actually undergone GS. We conducted a mixed methods study with a cohort of cancer probands (n = 335) and their genetic relatives (n = 199) undergoing GS in a research setting. Both groups completed surveys when giving consent. A subset of participants (n = 40) completed semi-structured interviews. A significantly higher percentage of probands thought people would like to be informed about genetic conditions for which there is prevention or treatment that can change cancer risk compared to conditions for which there is no prevention or treatment (93% [311] versus 65% [216]; p < 0.001). Similar results were obtained for relatives (91% [180] versus 61% [121]; p < 0.001). Themes identified in the analysis of interviews were: (1) Recognised benefits of GS, (2) Balancing benefits with risks, (3) Uncertain results are perceived as unhelpful and (4) Competing obligations. While utility was an important discriminator in what was seen as valuable for this cohort, there was a variety of responses. In view of varied participant preferences regarding return of results, it is important to ensure patient understanding of test validity and identify individual choices at the time of consent to GS. The nature and value of the information, and a contextual understanding of researcher obligations should guide result return.
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Affiliation(s)
- Megan C Best
- Faculty of Science, University of Sydney, Sydney, NSW, Australia. .,Institute for Ethics and Society, University of Notre Dame Australia, Sydney, WA, Australia.
| | - Phyllis Butow
- Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | | | - Chris Jacobs
- Graduate School of Health, University of Technology, Sydney, NSW, Australia
| | - Nicole Bartley
- Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - Grace Davies
- Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - Christine E Napier
- Cancer Division, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Mandy L Ballinger
- Cancer Division, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - David M Thomas
- Cancer Division, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | | | - Katherine M Tucker
- Hereditary Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Ilona Juraskova
- Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - Bettina Meiser
- Psychosocial Research Group, University of NSW, Sydney, NSW, Australia
| | - Timothy Schlub
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Ainsley J Newson
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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4
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Botham J, Shilling V, Jones J. Patient and public understanding of the concept of 'personalised medicine' in relation to cancer treatment: a systematic review. Future Healthc J 2021; 8:e703-e708. [PMID: 34888471 DOI: 10.7861/fhj.2021-0063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Personalised medicine (PM) is becoming increasingly integrated into standard clinical practice for treating numerous diseases, including cancer. Implementing PM into healthcare systems will only be successful with the acceptance and input of both patients' and public opinion. This review, therefore, aimed to identify both patients' and public understanding, and perceived benefits and concerns of PM in cancer treatment. A literature search was conducted using MEDLINE, EMBASE, PsycINFO and CINAHL databases. The eligibility criteria specified that papers must explore the public or patients' understanding of PM or pharmacogenomic (PGx) testing in relation to cancer treatment. Patients have a greater understanding of, and trust in, PM compared with members of the public, but often misunderstand how genomic testing in PM works. Key areas that can be targeted to inform future health literacy interventions include genetic literacy for the public and understanding of how PM testing and treatment works for patients.
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Affiliation(s)
- Jed Botham
- Brighton and Sussex Medical School, Brighton, UK
| | - Valerie Shilling
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton, UK
| | - John Jones
- Brighton and Sussex Medical School, Brighton, UK
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5
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Meiser B, Butow P, Davies G, Napier CE, Schlub TE, Bartley N, Juraskova I, Ballinger ML, Thomas DM, Tucker K, Goldstein D, Biesecker BB, Best MC. Psychological predictors of advanced cancer patients' preferences for return of results from comprehensive tumor genomic profiling. Am J Med Genet A 2021; 188:725-734. [PMID: 34755933 DOI: 10.1002/ajmg.a.62563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/28/2021] [Accepted: 10/13/2021] [Indexed: 01/30/2023]
Abstract
This study assessed the psychological predictors of preferences for return of comprehensive tumor genomic profiling (CTGP) results in patients with advanced cancers, enrolled in the Molecular Screening and Therapeutics Program. Patients completed a questionnaire prior to undergoing CTGP. Of the 1434 who completed a questionnaire, 96% would like to receive results that can guide treatment for their cancer, and preference for receiving this type of result was associated with lower tolerance of uncertainty. Sixty-four percent would like to receive results that cannot guide treatment, and lower tolerance of uncertainty, self-efficacy, and perceived importance were associated with this preference. Fifty-nine percent would like to receive variants of unknown significance, which was associated with lower tolerance of uncertainty, higher self-efficacy, and perceived importance. Eighty-six percent wanted to receive germline results that could inform family risk. This was associated with higher self-efficacy, perceived importance, and perceived susceptibility. Although most patients wanted to receive all types of results, given the differing patient preferences regarding the return of results depending on the utility of the different types of results, it appears critical to safeguard patient understanding of result utility to achieve informed patient choices. This should be accompanied by appropriate consent processes.
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Affiliation(s)
- Bettina Meiser
- Prince of Wales Clinical School, University of NSW, Kensington, New South Wales, Australia
| | - Phyllis Butow
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Grace Davies
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Christine E Napier
- Cancer Theme, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Timothy E Schlub
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Nicci Bartley
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Ilona Juraskova
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Mandy L Ballinger
- Cancer Theme, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,St Vincent's Clinical School, Faculty of Medicine, University of NSW, Sydney, New South Wales, Australia
| | - David M Thomas
- Cancer Theme, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,St Vincent's Clinical School, Faculty of Medicine, University of NSW, Sydney, New South Wales, Australia
| | - Kathy Tucker
- Prince of Wales Clinical School, University of NSW, Kensington, New South Wales, Australia.,Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - David Goldstein
- Prince of Wales Clinical School, University of NSW, Kensington, New South Wales, Australia.,Department of Medical Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | | | - Megan C Best
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, Sydney, New South Wales, Australia.,Institute for Ethics and Society, University of Notre Dame Australia, Broadway, New South Wales, Australia
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6
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Varnier R, Sajous C, de Talhouet S, Smentek C, Péron J, You B, Reverdy T, Freyer G. Using Breast Cancer Gene Expression Signatures in Clinical Practice: Unsolved Issues, Ongoing Trials and Future Perspectives. Cancers (Basel) 2021; 13:4840. [PMID: 34638325 PMCID: PMC8508256 DOI: 10.3390/cancers13194840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 09/14/2021] [Accepted: 09/24/2021] [Indexed: 12/11/2022] Open
Abstract
The development of gene expression signatures since the early 2000's has offered standardized assays to evaluate the prognosis of early breast cancer. Five signatures are currently commercially available and recommended by several international guidelines to individualize adjuvant chemotherapy decisions in hormone receptors-positive/HER2-negative early breast cancer. However, many questions remain unanswered about their predictive ability, reproducibility and external validity in specific populations. They also represent a new hope to tailor (neo)adjuvant systemic treatment, adjuvant radiation therapy, hormone therapy duration and to identify a subset of patients who might benefit from CDK4/6 inhibitor adjuvant treatment. This review will highlight these particular issues, address the remaining questions and discuss the ongoing and future trials.
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Affiliation(s)
- Romain Varnier
- Medical Oncology Department, Hôpital Lyon Sud, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), Université Claude Bernard Lyon 1, 69310 Lyon, France; (C.S.); (S.d.T.); (J.P.); (B.Y.) ; (T.R.); (G.F.)
| | - Christophe Sajous
- Medical Oncology Department, Hôpital Lyon Sud, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), Université Claude Bernard Lyon 1, 69310 Lyon, France; (C.S.); (S.d.T.); (J.P.); (B.Y.) ; (T.R.); (G.F.)
| | - Solène de Talhouet
- Medical Oncology Department, Hôpital Lyon Sud, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), Université Claude Bernard Lyon 1, 69310 Lyon, France; (C.S.); (S.d.T.); (J.P.); (B.Y.) ; (T.R.); (G.F.)
| | - Colette Smentek
- Laboratoire Parcours Santé Systémique, EA 4129, Université Claude Bernard Lyon 1, 69372 Lyon, France;
| | - Julien Péron
- Medical Oncology Department, Hôpital Lyon Sud, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), Université Claude Bernard Lyon 1, 69310 Lyon, France; (C.S.); (S.d.T.); (J.P.); (B.Y.) ; (T.R.); (G.F.)
- Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, CNRS UMR 5558, Université Claude Bernard Lyon 1, 69622 Villeurbanne, France
| | - Benoît You
- Medical Oncology Department, Hôpital Lyon Sud, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), Université Claude Bernard Lyon 1, 69310 Lyon, France; (C.S.); (S.d.T.); (J.P.); (B.Y.) ; (T.R.); (G.F.)
- EA3738, CICLY & CITOHL, Université Claude Bernard Lyon 1, 69310 Lyon, France
| | - Thibaut Reverdy
- Medical Oncology Department, Hôpital Lyon Sud, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), Université Claude Bernard Lyon 1, 69310 Lyon, France; (C.S.); (S.d.T.); (J.P.); (B.Y.) ; (T.R.); (G.F.)
| | - Gilles Freyer
- Medical Oncology Department, Hôpital Lyon Sud, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), Université Claude Bernard Lyon 1, 69310 Lyon, France; (C.S.); (S.d.T.); (J.P.); (B.Y.) ; (T.R.); (G.F.)
- EA3738, CICLY & CITOHL, Université Claude Bernard Lyon 1, 69310 Lyon, France
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7
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Crumpei-Tanasă I, Crumpei I. A Machine Learning Approach to Predict Stress Hormones and Inflammatory Markers Using Illness Perception and Quality of Life in Breast Cancer Patients. ACTA ACUST UNITED AC 2021; 28:3150-3171. [PMID: 34436041 PMCID: PMC8395480 DOI: 10.3390/curroncol28040275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/15/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022]
Abstract
Psychosocial factors have become central concepts in oncology research. However, their role in the prognosis of the disease is not yet well established. Studies on this subject report contradictory findings. We examine if illness perception and quality of life reports measured at baseline could predict the stress hormones and inflammatory markers in breast cancer survivors, one year later. We use statistics and machine learning methods to analyze our data and find the best prediction model. Patients with stage I to III breast cancer (N = 70) were assessed twice, at baseline and one year later, and completed scales assessing quality of life and illness perception. Blood and urine samples were obtained to measure stress hormones (cortisol and adrenocorticotropic hormone (ACTH) and inflammatory markers (c-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and fibrinogen). Family quality of life is a strong predictor for ACTH. Women who perceive their illness as being more chronic at baseline have higher ESR and fibrinogen values one year later. The artificial intelligence (AI) data analysis yields the highest prediction score of 81.2% for the ACTH stress hormone, and 70% for the inflammatory marker ESR. A chronic timeline, illness control, health and family quality of life were important features associated with the best predictive results.
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Affiliation(s)
- Irina Crumpei-Tanasă
- Department of Psychology, Faculty of Psychology and Educational Sciences, Alexandru Ioan Cuza University, 700554 Iași, Romania
- Correspondence:
| | - Iulia Crumpei
- Faculty of Medicine, Grigore T. Popa University, 700115 Iași, Romania;
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8
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Patients' perceptions of 70-gene signature testing: commonly changing the initial inclination to undergo or forego chemotherapy and reducing decisional conflict. Breast Cancer Res Treat 2020; 182:107-115. [PMID: 32430679 PMCID: PMC7275022 DOI: 10.1007/s10549-020-05683-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/11/2020] [Indexed: 11/29/2022]
Abstract
Purpose Little is known about the impact of 70-gene signature (70-GS) use on patients’ chemotherapy decision-making. The primary aim of this study was to evaluate the impact of 70-GS use on patients’ decisions to undergo chemotherapy. The perceived decision conflict during decision-making was a secondary objective of the study. Methods Patients operated for estrogen receptor positive early breast cancer were asked to fill out a questionnaire probing their inclination to undergo chemotherapy before deployment of the 70-GS test. After disclosure of the 70-GS result patients were asked about their decision regarding chemotherapy. Patients’ decisional conflict was measured using the 16-item decisional conflict scale (DCS); scores < 25 are associated with a persuaded decision while a score > 37.5 implies that one feels unsure about a choice. Results Between January 1th 2017 and December 31th 2018, 106 patients completed both questionnaires. Before deployment of the 70-GS, 58% of patients (n = 62) formulated a clear treatment preference, of whom 21 patients (34%) changed their opinion on treatment with chemotherapy following the 70-GS. The final decision regarding chemotherapy was in line with the 70-GS result in 90% of patients. The percentage of patients who felt unsure about their preference to be treated with chemotherapy decreased from 42 to 5% after disclosure of the 70-GS. The mean total DCS significantly decreased from pre-test to post-test from 35 to 23, irrespective of the risk estimate (p < 0.001). Conclusion Deployment of the 70-GS changed patients’ inclination to undergo adjuvant chemotherapy in one third of patients and decreased patients’ decisional conflict. Electronic supplementary material The online version of this article (10.1007/s10549-020-05683-6) contains supplementary material, which is available to authorized users.
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9
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O'Brien MA, Makuwaza T, Graham ID, Barbera L, Earle CC, Brouwers MC, Grunfeld E. Lessons learned from a cancer knowledge translation grants program: results of an evaluation. ACTA ACUST UNITED AC 2019; 26:272-284. [PMID: 31548808 DOI: 10.3747/co.26.5531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background A novel way to build capacity in knowledge translation (kt) is through kt-focused grant competitions. Since 2009, the Knowledge Translation Research Network (KT-Net) has had a cancer-related kt grants program. We undertook an evaluation of the program to determine if KT-Net was achieving its aims of building capacity in cancer kt, advancing the science of kt, building partnerships, and leveraging funding. Methods An adapted framework guided the evaluation. Nine funded studies from 4 competitions were included. Semi-structured telephone interviews were held with researchers, stakeholders (including knowledge users), members of grant review panels, and experts in kt. Interview transcripts were audio-recorded, transcribed, and analyzed thematically. A review of proposal and report documents was also conducted. Results Funded researchers indicated that the grant competition was an essential funding program for cancer kt research. Competitions were perceived to build capacity in cancer kt among early-career researchers and to encourage innovative cancer kt research for which alternative funding sources are limited. The grants program resulted in incremental gains in advancing the science of kt. Suggestions to improve the program included stronger partnerships between the funder and the provincial cancer-system organization to optimize the application of research that is relevant to the organization's strategic objectives. Conclusions The grants program met many of its aims by providing cancer researchers with an opportunity to gain capacity in cancer kt and by making incremental advances in kt science. Suggestions to improve the program included closer partnerships between the funder and the cancer-system organization.
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Affiliation(s)
- M A O'Brien
- Department of Family and Community Medicine, University of Toronto, Toronto, ON
| | - T Makuwaza
- Department of Family and Community Medicine, University of Toronto, Toronto, ON.,Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON
| | - I D Graham
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON.,The Ottawa Hospital Research Institute, Ottawa, ON
| | - L Barbera
- Tom Baker Cancer Centre, Calgary, AB.,University of Calgary, Calgary, AB.,ices, Toronto, ON
| | - C C Earle
- Ontario Institute for Cancer Research, Toronto, ON
| | - M C Brouwers
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON.,Department of Oncology, McMaster University, Hamilton, ON
| | - E Grunfeld
- Department of Family and Community Medicine, University of Toronto, Toronto, ON.,Ontario Institute for Cancer Research, Toronto, ON
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10
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Prospective, multicenter study on the economic and clinical impact of gene-expression assays in early-stage breast cancer from a single region: the PREGECAM registry experience. Clin Transl Oncol 2019; 22:717-724. [DOI: 10.1007/s12094-019-02176-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 07/01/2019] [Indexed: 01/09/2023]
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11
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Yanes T, Willis AM, Meiser B, Tucker KM, Best M. Psychosocial and behavioral outcomes of genomic testing in cancer: a systematic review. Eur J Hum Genet 2019; 27:28-35. [PMID: 30206354 PMCID: PMC6303287 DOI: 10.1038/s41431-018-0257-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/26/2018] [Accepted: 08/09/2018] [Indexed: 01/23/2023] Open
Abstract
Psychosocial and behavioral outcomes of genetic testing in oncology are well known, however, it is unclear how these findings will generalize to more complex genomic testing. The aim of this systematic review was to assess the psychosocial and behavioral outcomes of cancer genomic testing. Studies were selected for inclusion if they were published from January 2003 to January 2017 and addressed psychological and behavioral outcomes of cancer genomic testing in adults. A review of four databases identified 9620 abstracts, with 22 publications meeting the inclusion criteria. Of the included articles, 11 studies reported on outcomes of germline testing, with three articles assessing panel testing and eight SNP testing. No studies assessed the outcomes of WGS or WES. Eleven articles assessed the outcomes of somatic testing, including testing for cancer prognosis and for personalized therapies. Studies were biased toward breast cancer and Caucasian women with high education and socioeconomic status. While studies demonstrated limited adverse psychological outcomes associated with genomic testing, a lack of consistency in psychosocial measures precluded any meta-analysis. Changes in health behavior following positive results were limited, and in some cases risk perception was not altered following genomic testing. There is limited evidence of adverse psychosocial outcomes and changes in health behavior following genomic testing to assess cancer risk. Findings from this review highlight the need for longitudinal research with superior methodological and theoretical design.
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Affiliation(s)
- Tatiane Yanes
- Prince of Wales Clinical School, Faculty of Medicine, UNSW, Sydney, Australia.
- School of Psychiatry, Faculty of Medicine, UNSW, Sydney, Australia.
| | - Amanda M Willis
- Prince of Wales Clinical School, Faculty of Medicine, UNSW, Sydney, Australia
| | - Bettina Meiser
- Prince of Wales Clinical School, Faculty of Medicine, UNSW, Sydney, Australia
| | - Katherine M Tucker
- Prince of Wales Clinical School, Faculty of Medicine, UNSW, Sydney, Australia
- Hereditary Cancer Clinic, Prince of Wales Hospital, Sydney, Australia
| | - Megan Best
- Psycho-oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
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12
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Abe J, Lobo JM, Trifiletti DM, Showalter TN. Providing guidance for genomics-based cancer treatment decisions: insights from stakeholder engagement for post-prostatectomy radiation therapy. BMC Med Inform Decis Mak 2017; 17:128. [PMID: 28836985 PMCID: PMC5571582 DOI: 10.1186/s12911-017-0526-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 08/18/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Despite the emergence of genomics-based risk prediction tools in oncology, there is not yet an established framework for communication of test results to cancer patients to support shared decision-making. We report findings from a stakeholder engagement program that aimed to develop a framework for using Markov models with individualized model inputs, including genomics-based estimates of cancer recurrence probability, to generate personalized decision aids for prostate cancer patients faced with radiation therapy treatment decisions after prostatectomy. METHODS We engaged a total of 22 stakeholders, including: prostate cancer patients, urological surgeons, radiation oncologists, genomic testing industry representatives, and biomedical informatics faculty. Slides were at each meeting to provide background information regarding the analytical framework. Participants were invited to provide feedback during the meeting, including revising the overall project aims. Stakeholder meeting content was reviewed and summarized by stakeholder group and by theme. RESULTS The majority of stakeholder suggestions focused on aspects of decision aid design and formatting. Stakeholders were enthusiastic about the potential value of using decision analysis modeling with personalized model inputs for cancer recurrence risk, as well as competing risks from age and comorbidities, to generate a patient-centered tool to assist decision-making. Stakeholders did not view privacy considerations as a major barrier to the proposed decision aid program. A common theme was that decision aids should be portable across multiple platforms (electronic and paper), should allow for interaction by the user to adjust model inputs iteratively, and available to patients both before and during consult appointments. Emphasis was placed on the challenge of explaining the model's composite result of quality-adjusted life years. CONCLUSIONS A range of stakeholders provided valuable insights regarding the design of a personalized decision aid program, based upon Markov modeling with individualized model inputs, to provide a patient-centered framework to support for genomic-based treatment decisions for cancer patients. The guidance provided by our stakeholders may be broadly applicable to the communication of genomic test results to patients in a patient-centered fashion that supports effective shared decision-making that represents a spectrum of personal factors such as age, medical comorbidities, and individual priorities and values.
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Affiliation(s)
- James Abe
- Department of Radiation Oncology, University of Virginia School of Medicine, 1240 Lee Street, Box 800383, Charlottesville, VA 22908 USA
| | - Jennifer M. Lobo
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA USA
| | - Daniel M. Trifiletti
- Department of Radiation Oncology, University of Virginia School of Medicine, 1240 Lee Street, Box 800383, Charlottesville, VA 22908 USA
| | - Timothy N. Showalter
- Department of Radiation Oncology, University of Virginia School of Medicine, 1240 Lee Street, Box 800383, Charlottesville, VA 22908 USA
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13
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Arora NK, Hesse BW, Clauser SB. Walking in the shoes of patients, not just in their genes: a patient-centered approach to genomic medicine. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 8:239-45. [PMID: 25300612 DOI: 10.1007/s40271-014-0089-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Genomic technologies are increasing the precision with which clinicians can assess an individual patient's risk for developing diseases and identify which patients are likely to benefit from specific treatments. Also advocating for a shift away from a one-size-fits-all approach is the growing emphasis on "patient-centered" care. Using examples from breast cancer, we make a case for why, in order to optimize patient health outcomes, genomic medicine will need to be practiced within a patient-centered framework. We present a six-function conceptual framework for patient-centered care and discuss findings from a national survey evaluating the patient-centeredness of care delivered in the USA.
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Affiliation(s)
- Neeraj K Arora
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, 9609 Medical Center Drive, 3E514, MSC 9762, Bethesda, MD, 20892-9762, USA,
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14
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Georgiou G, Wakefield CE, McGill BC, Fardell JE, Signorelli C, Hanlon L, Tucker K, Patenaude AF, Cohn RJ. Genetic testing for the risk of developing late effects among survivors of childhood cancer: Consumer understanding, acceptance, and willingness to pay. Cancer 2016; 122:2876-85. [PMID: 27258553 DOI: 10.1002/cncr.30119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 05/04/2016] [Accepted: 05/04/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Genetic testing to determine cancer survivors' risk of developing late effects from their cancer treatment will be increasingly used in survivorship care. This 2-stage study with 64 survivors of childhood cancer and their parents investigated the preferences and acceptability of testing among those who may be at risk of developing late effects. METHODS The first stage (Stage 1) identified the most commonly perceived benefits and concerns regarding genetic testing for the risk of late effects among 24 participants. In Stage 2, during interviews, 20 survivors (55% of whom were female; mean age, 26.0 years [range, 18-39 years]; standard deviation [SD], 0.80) and 20 parents (55% of whom were male; mean age of child survivor, 14.2 years [range, 10-19 years]; SD, 0.79) rated the 7 most common benefits and concerns from those identified in Stage 1. Interviews were transcribed verbatim and analyzed. Decisional balance ratios were calculated by dividing the participants' average concerns scores with the average benefits scores. RESULTS Genetic testing for late effects was highly acceptable: 95% of participants leaned toward testing, and the majority (65.9%) would pay up to Australian $5000. The majority (97.2%) reported it was acceptable to wait for up to 6 months to receive results, and to be offered testing immediately after treatment or when the survivor reached adulthood (62.9%). Survivors and parents had a highly positive decisional balance (Mean (M), 0.5 [SD, 0.38] and M, 0.5 [SD, 0.39], respectively), indicating that perceived benefits outweighed concerns. CONCLUSIONS Although to our knowledge clinical efficacy has yet to be clearly demonstrated, survivors and parents described positive interest in genetic testing for the risk of developing late effects. Perceived benefits outweighed harms, and the majority of participants would be willing to pay, and wait, for testing. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2876-2885. © 2016 American Cancer Society.
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Affiliation(s)
- Gabrielle Georgiou
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Behavioral Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Claire E Wakefield
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Behavioral Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Brittany C McGill
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Behavioral Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Joanna E Fardell
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Behavioral Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Christina Signorelli
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Behavioral Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Lucy Hanlon
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Behavioral Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Kathy Tucker
- Hereditary Cancer Clinic, Department of Medical Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrea F Patenaude
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Richard J Cohn
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Behavioral Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
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15
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Marshall DA, Deal K, Bombard Y, Leighl N, MacDonald KV, Trudeau M. How do women trade-off benefits and risks in chemotherapy treatment decisions based on gene expression profiling for early-stage breast cancer? A discrete choice experiment. BMJ Open 2016; 6:e010981. [PMID: 27256091 PMCID: PMC4893875 DOI: 10.1136/bmjopen-2015-010981] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 03/01/2016] [Accepted: 03/30/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Gene expression profiling (GEP) of tumours informs baseline risk prediction, potentially affecting adjuvant chemotherapy decisions for women with early-stage breast cancer. Since only 15% will experience a recurrence, concerns have been raised about potential harms from overtreatment and high GEP costs in publicly funded healthcare systems. We aimed to estimate preferences and personal utility of GEP testing information and benefit-risk trade-offs in chemotherapy treatment decisions. DESIGN, SETTING AND INTERVENTION Based on literature review and findings from our qualitative research (focus groups, interviews with patients with breast cancer and medical oncologists), we developed a discrete choice experiment (DCE) survey and administered it via an internet panel. The DCE included 12 choice tasks with 5 attributes and 3 alternatives considering orthogonality, D-efficiency and level balance. PARTICIPANTS The DCE survey was administered to 1004 Canadian women from the general population. MAIN OUTCOME MEASURES Preferences were analysed using conditional logit and hierarchical Bayes and evaluated for goodness of fit. We conducted simulation analyses for alternative scenarios. RESULTS GEP test score indicating likely benefit from chemotherapy was the most important attribute. Doctor's clinical estimate of the risk of cancer returning, trust in your cancer doctor and side effects of chemotherapy (temporary and permanent) were relatively less important but showed significant differences among levels. In the scenario analyses, 78% were likely to choose chemotherapy in a high-risk scenario, 55% in a moderate-risk scenario and 33% in a low-risk scenario, with the other attributes held constant. A high GEP score was more important in influencing the choice of chemotherapy for those at intermediate clinical risk. CONCLUSIONS GEP testing information influences chemotherapy treatment decisions in early-stage breast cancer and varies depending on clinical risk. Clinicians should be aware of these differences and tailor the use of GEP testing accordingly.
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Affiliation(s)
- Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Ken Deal
- DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada
| | - Yvonne Bombard
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Natasha Leighl
- Department of Medicine, University of Toronto,Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Karen V MacDonald
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Maureen Trudeau
- University of Toronto,Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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16
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DECIDE: a Decision Support Tool to Facilitate Parents’ Choices Regarding Genome-Wide Sequencing. J Genet Couns 2016; 25:1298-1308. [DOI: 10.1007/s10897-016-9971-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
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MacDonald KV, Bombard Y, Deal K, Trudeau M, Leighl N, Marshall DA. The influence of gene expression profiling on decisional conflict in decision making for early-stage breast cancer chemotherapy. Eur J Cancer 2016; 61:85-93. [PMID: 27155447 DOI: 10.1016/j.ejca.2016.03.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/04/2016] [Accepted: 03/21/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Women with early-stage breast cancer, of whom only 15% will experience a recurrence, are often conflicted or uncertain about taking chemotherapy. Gene expression profiling (GEP) of tumours informs risk prediction, potentially affecting treatment decisions. We examined whether receiving a GEP test score reduces decisional conflict in chemotherapy treatment decision making. METHODS A general population sample of 200 women completed the decisional conflict scale (DCS) at baseline (no GEP test score scenario) and after (scenario with GEP test score added) completing a discrete choice experiment survey for early-stage breast cancer chemotherapy. We scaled the 16-item DCS total scores and subscores from 0 to 100 and calculated means, standard deviations and change in scores, with significance (p < 0.05) based on matched pairs t-tests. RESULTS We identified five respondent subgroups based on preferred treatment option; almost 40% did not change their chemotherapy decision after receiving GEP testing information. Total score and all subscores (uncertainty, informed, values clarity, support, and effective decision) decreased significantly in the respondent subgroup who were unsure about taking chemotherapy initially but changed to no chemotherapy (n =33). In the subgroup of respondents (n = 25) who chose chemotherapy initially but changed to unsure, effective decision subscore increased significantly. In the overall sample, changes in total and all subscores were non-significant. CONCLUSIONS GEP testing adds value for women initially unsure about chemotherapy treatment with a decrease in decisional conflict. However, for women who are confident about their treatment decisions, GEP testing may not add value. Decisions to request GEP testing should be personalised based on patient preferences.
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Affiliation(s)
- Karen V MacDonald
- Department of Community Health Sciences, University of Calgary, Room 3C62, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - Yvonne Bombard
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Room 312, Toronto, Ontario M5B 1T8, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 209 Victoria Street, Room 312, Toronto, Ontario M5B 1T8, Canada
| | - Ken Deal
- DeGroote School of Business, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4M4, Canada
| | - Maureen Trudeau
- University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Natasha Leighl
- Department of Medicine, University of Toronto, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada; Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, McMaster University, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada.
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Evans CN, Brewer NT, Vadaparampil ST, Boisvert M, Ottaviano Y, Lee MC, Isaacs C, Schwartz MD, O'Neill SC. Impact of genomic testing and patient-reported outcomes on receipt of adjuvant chemotherapy. Breast Cancer Res Treat 2016; 156:549-555. [PMID: 27059031 PMCID: PMC5065914 DOI: 10.1007/s10549-016-3780-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 04/02/2016] [Indexed: 12/18/2022]
Abstract
Practice guidelines incorporate genomic tumor profiling, using results such as the Oncotype DX Recurrence Score (RS), to refine recurrence risk estimates for the large proportion of breast cancer patients with early-stage, estrogen receptor-positive disease. We sought to understand the impact of receiving genomic recurrence risk estimates on breast cancer patients' well-being and the impact of these patient-reported outcomes on receipt of adjuvant chemotherapy. Participants were 193 women (mean age 57) newly diagnosed with early-stage breast cancer. Women were interviewed before and 2-3 weeks after receiving the RS result between 2011 and 2015. We assessed subsequent receipt of chemotherapy from chart review. After receiving their RS, perceived pros (t = 4.27, P < .001) and cons (t = 8.54, P < .001) of chemotherapy increased from pre-test to post-test, while perceived risk of breast cancer recurrence decreased (t = 2.90, P = .004). Women with high RS tumors were more likely to receive chemotherapy than women with low RS tumors (88 vs. 5 %, OR 0.01, 0.00-0.02, P < .001). Higher distress (OR 2.19, 95 % CI 1.05-4.57, P < .05) and lower perceived cons of chemotherapy (OR 0.50, 95 % CI 0.26-0.97, P < .05) also predicted receipt of chemotherapy. Distressed patients who saw few downsides of chemotherapy received this treatment. Clinicians should consider these factors when discussing chemotherapy with breast cancer patients.
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Affiliation(s)
- Chalanda N Evans
- Department of Oncology, Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Noel T Brewer
- Gillings School of Global Public Health, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | | | - Marc Boisvert
- MedStar Washington Hospital Center, Washington, DC, USA
| | | | | | - Claudine Isaacs
- Department of Oncology, Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Marc D Schwartz
- Department of Oncology, Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Suzanne C O'Neill
- Department of Oncology, Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.
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Recommendations from the EGAPP Working Group: does the use of Oncotype DX tumor gene expression profiling to guide treatment decisions improve outcomes in patients with breast cancer? Genet Med 2015; 18:770-9. [PMID: 26681310 DOI: 10.1038/gim.2015.173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 10/21/2015] [Indexed: 12/18/2022] Open
Abstract
UNLABELLED of RECOMMENDATIONS The Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Working Group found insufficient evidence to recommend for or against the use of Oncotype DX testing to guide chemotherapy treatment decisions in women with hormone receptor-positive, lymph node-negative, or lymph node-positive early breast cancer who are receiving endocrine therapy. This recommendation statement updates a 2009 EGAPP statement on the use of gene expression profiling tests in breast cancer. Evidence of clinical validity for Oncotype DX was confirmed as adequate. With regard to clinical utility, although there was evidence from prospective retrospective studies that the Oncotype DX test predicts benefit from chemotherapy, and there was adequate evidence that the use of Oncotype DX gene expression profiling in clinical practice changes treatment decisions regarding chemotherapy, no direct evidence was found that the use of Oncotype DX testing leads to improved clinical outcomes. RATIONALE In women with early-stage invasive breast cancer, gene expression profiling is increasingly being used as an aid to estimate the likely benefit from chemotherapy treatment. In a previous recommendation statement, the EGAPP Working Group (EWG) found adequate evidence for clinical validity of some gene expression profiling tests in predicting distant disease recurrence in women with early-stage, hormone receptor-positive, lymph-node-negative breast cancer who are treated with tamoxifen, but insufficient evidence that use of these tests for decisions about chemotherapy treatment has clinical utility. The current recommendation statement updates these findings for Oncotype DX and extends them to the population of women with lymph node-positive disease, using evidence from recent systematic reviews and other sources. ANALYTIC VALIDITY The previous recommendation statement found that evidence was inadequate to enable quantitative determination of the analytic validity of Oncotype DX. Analytic validity was not reconsidered in the updated recommendation statement because there remains no gold-standard test for comparison. CLINICAL VALIDITY The EWG found that new evidence published since the original evidence review supports the clinical validity of Oncotype DX in predicting risk of distant metastases in women with hormone receptor-positive, early-stage breast cancer that is either node-negative or node-positive. CLINICAL UTILITY No direct evidence was found that use of Oncotype DX tumor gene expression profiling to guide treatment decisions improves clinical outcomes in women with early breast cancer. There is indirect evidence, from prospective retrospective studies on archived tissue samples from randomized controlled trials, that the Oncotype DX test can predict benefit from chemotherapy. Large, prospective, randomized, controlled trials currently in progress may provide evidence of clinical utility. CONTEXTUAL ISSUES Until definitive evidence for clinical utility is available, clinicians must decide on a case-by-case basis whether to offer the test to patients. Although Oncotype DX testing has been reported, on the basis of economic modeling studies, to be cost-effective in several different health-care systems and to save costs in the US health-care setting, studies were based on assumptions regarding the clinical utility of the test that require confirmation by clinical trial results.Genet Med 18 8, 770-779.
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Bombard Y. Translating personalized genomic medicine into clinical practice: evidence, values, and health policy. Genome 2015; 58:491-7. [PMID: 26577841 DOI: 10.1139/gen-2015-0145] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Yvonne Bombard
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Institute of Health Policy, Management & Evaluation, University of Toronto.,Li Ka Shing Knowledge Institute of St. Michael's Hospital, Institute of Health Policy, Management & Evaluation, University of Toronto
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21
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Bombard Y, Rozmovits L, Trudeau M, Leighl NB, Deal K, Marshall DA. The value of personalizing medicine: medical oncologists' views on gene expression profiling in breast cancer treatment. Oncologist 2015; 20:351-6. [PMID: 25746345 DOI: 10.1634/theoncologist.2014-0268] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 12/31/2014] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Guidelines recommend gene-expression profiling (GEP) tests to identify early-stage breast cancer patients who may benefit from chemotherapy. However, variation exists in oncologists' use of GEP. We explored medical oncologists' views of GEP tests and factors impacting its use in clinical practice. METHODS We used a qualitative design, comprising telephone interviews with medical oncologists (n = 14; 10 academic, 4 in the community) recruited through oncology clinics, professional advertisements, and referrals. Interviews were analyzed for anticipated and emergent themes using the constant comparative method including searches for disconfirming evidence. RESULTS Some oncologists considered GEP to be a tool that enhanced confidence in their established approach to risk assessments, whereas others described it as "critical" to resolving their uncertainty about whether to recommend chemotherapy. Some community oncologists also valued the test in interpreting what they considered variable practice and accuracy across pathology reports and testing facilities. However, concerns were also raised about GEP's cost, overuse, inappropriate use, and over-reliance on the results within the medical community. In addition, although many oncologists said it was simple to explain the test to patients, paradoxically, they remained uncertain about patients' understanding of the test results and their treatment implications. CONCLUSION Oncologists valued the test as a treatment-decision support tool despite their concerns about its cost, over-reliance, overuse, and inappropriate use by other oncologists, as well as patients' limited understanding of GEP. The results identify a need for decision aids to support patients' understanding and clinical practice guidelines to facilitate standardized use of the test.
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Affiliation(s)
- Yvonne Bombard
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Insititute of Health Policy, Management and Evaluation, Department of Medicine, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Independent Qualitative Researcher; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada; DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Linda Rozmovits
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Insititute of Health Policy, Management and Evaluation, Department of Medicine, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Independent Qualitative Researcher; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada; DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Maureen Trudeau
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Insititute of Health Policy, Management and Evaluation, Department of Medicine, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Independent Qualitative Researcher; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada; DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Natasha B Leighl
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Insititute of Health Policy, Management and Evaluation, Department of Medicine, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Independent Qualitative Researcher; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada; DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Ken Deal
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Insititute of Health Policy, Management and Evaluation, Department of Medicine, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Independent Qualitative Researcher; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada; DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Deborah A Marshall
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Insititute of Health Policy, Management and Evaluation, Department of Medicine, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Independent Qualitative Researcher; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada; DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Garfeld S, Douglas MP, MacDonald KV, Marshall DA, Phillips KA. Consumer familiarity, perspectives and expected value of personalized medicine with a focus on applications in oncology. Per Med 2015; 12:13-22. [PMID: 25620993 DOI: 10.2217/pme.14.74] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AIMS Knowledge of consumer perspectives of personalized medicine (PM) is limited. Our study assessed consumer perspectives of PM, with a focus on oncology care, to inform industry, clinician and payer stakeholders' programs and policy. MATERIALS & METHODS A nationally representative survey of 602 US consumers' ≥30 years old explored familiarity, perspectives and expected value of PM. RESULTS Most (73%) respondents have not heard of 'personalized medicine,' though after understanding the term most (95%) expect PM to have a positive beneft. Consumer's willingness to pay is associated with products' impact on survival, rather than predicting disease risk. If testing indicates consumers are not candidates for oncology therapies, most (84%) would seek a second opinion or want therapy anyway. CONCLUSIONS Understanding heterogeneity in consumer perspectives of PM can inform program and policy development.
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Affiliation(s)
| | - Michael P Douglas
- Department of Clinical Pharmacy, Center for Translational & Policy Research on Personalized Medicine (TRANSPERS), University of California at San Francisco, 3333 California St, Room 420, Box 0613 San Francisco, CA 94143 USA
| | - Karen V MacDonald
- Health Research Innovation Centre (HRIC) - 3C62, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, USA
| | - Deborah A Marshall
- Health Research Innovation Centre (HRIC) - 3C62, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, USA
| | - Kathryn A Phillips
- Department of Clinical Pharmacy, Center for Translational & Policy Research on Personalized Medicine (TRANSPERS), University of California at San Francisco, 3333 California St, Room 420, Box 0613 San Francisco, CA 94143 USA
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23
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Bombard Y, Rozmovits L, Trudeau M, Leighl NB, Deal K, Marshall DA. Access to personalized medicine: factors influencing the use and value of gene expression profiling in breast cancer treatment. ACTA ACUST UNITED AC 2014; 21:e426-33. [PMID: 24940102 DOI: 10.3747/co.21.1782] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED Genomic information is increasingly being used to personalize health care. One example is gene expression profiling (gep) tests, which estimate recurrence risk to inform chemotherapy decisions in breast cancer. Recently, gep tests were publicly funded in Ontario. We explored the perceived utility of gep tests, focusing on the factors influencing their use and value in treatment decision-making by patients and oncologists. METHODS We conducted interviews with oncologists (n = 14) and interviews and a focus group with early-stage breast cancer patients (n = 28) who underwent gep testing. Both groups were recruited through oncology clinics in Ontario. Data were analyzed using the content analysis and constant comparison techniques. RESULTS Narratives from patients and oncologists provided insights into various factors facilitating and restricting access to gep. First, oncologists are positioned as gatekeepers of gep, providing access in medically appropriate cases. However, varying perceptions of appropriateness led to perceived inequities in access and negative impacts on the doctor-patient relationship. Second, media attention facilitated patient awareness of gep, but also complicated gatekeeping. Third, the dedicated administration attached to gep was burdensome and led to long waits for results and also to increased patient anxiety and delayed treatment. Collectively, because of barriers to access, those factors inadvertently heightened the perceived value of gep for patients relative to other prognostic indicators. CONCLUSIONS Our study delineates the factors facilitating and restricting access to gep, and highlights the roles of media and organization of services in the perceived value and utilization of gep. The results identify a need for administrative changes and practice guidelines to support streamlined and standardized use of gep tests.
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Affiliation(s)
- Y Bombard
- University of Toronto, Toronto, ON. ; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON
| | | | - M Trudeau
- University of Toronto, Toronto, ON. ; Sunnybrook Health Sciences Centre, Toronto, ON
| | - N B Leighl
- University of Toronto, Toronto, ON. ; Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - K Deal
- McMaster University, DeGroote School of Business, Hamilton, ON
| | - D A Marshall
- McMaster University, Department of Clinical Epidemiology and Biostatistics, and St. Joseph's Healthcare, Hamilton, ON; and Department of Community Health Sciences, University of Calgary, Calgary, AB
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