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Spiekerkoetter U, Bick D, Scott R, Hopkins H, Krones T, Gross ES, Bonham JR. Genomic newborn screening: Are we entering a new era of screening? J Inherit Metab Dis 2023; 46:778-795. [PMID: 37403863 DOI: 10.1002/jimd.12650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/01/2023] [Accepted: 06/13/2023] [Indexed: 07/06/2023]
Abstract
Population newborn screening (NBS) for phenylketonuria began in the United States in 1963. In the 1990s electrospray ionization mass spectrometry permitted an array of pathognomonic metabolites to be identified simultaneously, enabling up to 60 disorders to be recognized with a single test. In response, differing approaches to the assessment of the harms and benefits of screening have resulted in variable screening panels worldwide. Thirty years on and another screening revolution has emerged with the potential for first line genomic testing extending the range of screening conditions recognized after birth to many hundreds. At the annual SSIEM conference in 2022 in Freiburg, Germany, an interactive plenary discussion on genomic screening strategies and their challenges and opportunities was conducted. The Genomics England Research project proposes the use of Whole Genome Sequencing to offer extended NBS to 100 000 babies for defined conditions with a clear benefit for the child. The European Organization for Rare Diseases seeks to include "actionable" conditions considering also other types of benefits. Hopkins Van Mil, a private UK research institute, determined the views of citizens and revealed as a precondition that families are provided with adequate information, qualified support, and that autonomy and data are protected. From an ethical standpoint, the benefits ascribed to screening and early treatment need to be considered in relation to asymptomatic, phenotypically mild or late-onset presentations, where presymptomatic treatment may not be required. The different perspectives and arguments demonstrate the unique burden of responsibility on those proposing new and far-reaching developments in NBS programs and the need to carefully consider both harms and benefits.
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Affiliation(s)
- Ute Spiekerkoetter
- Department of Pediatrics, Adolescent Medicine and Neonatology, Faculty of Medicine, University Children's Hospital, Freiburg, Germany
| | | | | | | | - Tanja Krones
- URPP Human Reproduction Reloaded - H2R and Institute of Biomedical Ethics and History of Medicine, University Hospital/University of Zurich, Zurich, Switzerland
| | | | - James R Bonham
- International Society of Neonatal Screening, Maarssen, The Netherlands
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Return of comprehensive tumour genomic profiling results to advanced cancer patients: a qualitative study. Support Care Cancer 2022; 30:8201-8210. [PMID: 35809119 PMCID: PMC9512748 DOI: 10.1007/s00520-022-07272-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/29/2022] [Indexed: 11/05/2022]
Abstract
Purpose The introduction of comprehensive tumour genomic profiling (CGP) into clinical oncology allows the identification of molecular therapeutic targets. However, the potential complexity of genomic results and their implications may cause confusion and distress for patients undergoing CGP. We investigated the experience of advanced cancer patients receiving CGP results in a research setting. Methods Semi-structured interviews with 37 advanced cancer patients were conducted within two weeks of patients receiving CGP results. Interviewees were purposively sampled based on CGP result, cancer type, age and gender to ensure diversity. Themes were derived from interview transcripts using a framework analysis approach. Results We identified six themes: (1) hoping against the odds; (2) managing expectations; (3) understanding is cursory; (4) communication of results is cursory; (5) genomics and incurable cancer; and (6) decisions about treatment. Conclusion Despite enthusiasm regarding CGP about the hope it provides for new treatments, participants experienced challenges in understanding results, and acceptance of identified treatments was not automatic. Support is needed for patients undergoing CGP to understand the implications of testing and cope with non-actionable results.
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Kisiangani I, Mohamed SF, Kyobutungi C, Tindana P, Ghansah A, Ramsay M, Asiki G. Perspectives on returning individual and aggregate genomic research results to study participants and communities in Kenya: a qualitative study. BMC Med Ethics 2022; 23:27. [PMID: 35300680 PMCID: PMC8932129 DOI: 10.1186/s12910-022-00767-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A fundamental ethical challenge in conducting genomics research is the question of what and how individual level genetic findings and aggregate genomic results should be conveyed to research participants and communities. This is within the context of minimal guidance, policies, and experiences, particularly in Africa. The aim of this study was to explore the perspectives of key stakeholders' on returning genomics research results to participants in Kenya. METHODS This qualitative study involved focus group discussions (FGDs) and in-depth interviews (IDIs) with 69 stakeholders. The purposively selected participants, included research ethics committee (REC) members (8), community members (44), community resource persons (8), and researchers (9). A semi-structured interview guide was used to facilitate discussions. Six FGDs and twenty-five (IDIs) were conducted among the different stakeholders. The issues explored in the interviews included: (1) views on returning results, (2) kind of results to be returned, (3) value of returning results to participants, and (4) challenges anticipated in returning results to participants and communities. The interviews were audio-recorded, transcribed verbatim, and coded in Nvivo 12 pro. Thematic and content analysis was conducted. RESULTS Participants agreed on the importance of returning genomic results either as individual or aggregate results. The most cited reasons for returning of genomic results included recognizing participants' contribution to research, encouraging participation in future research, and increasing the awareness of scientific progress. Other aspects on how genomic research results should be shared included sharing easy to understand results in the shortest time possible and maintaining confidentiality when sharing sensitive results. CONCLUSIONS This study identified key stakeholders' perspectives on returning genomic results at the individual and community levels in two urban informal settlements of Nairobi. The majority of the participants expect to receive feedback about their genomic results, and it is an obligation for researchers to see how to best fulfil it.
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Affiliation(s)
- Isaac Kisiangani
- African Population and Health Research Center (APHRC), P.O. Box 10787, Nairobi, 00100, Kenya.
| | - Shukri F Mohamed
- African Population and Health Research Center (APHRC), P.O. Box 10787, Nairobi, 00100, Kenya
| | - Catherine Kyobutungi
- African Population and Health Research Center (APHRC), P.O. Box 10787, Nairobi, 00100, Kenya
| | - Paulina Tindana
- School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Anita Ghansah
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Michele Ramsay
- Sydney Brenner Institute for Molecular Bioscience, The University of Witwatersrand, The Mount, 9 Jubilee Rd, Parktown, Johannesburg, 2193, South Africa
| | - Gershim Asiki
- African Population and Health Research Center (APHRC), P.O. Box 10787, Nairobi, 00100, Kenya
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Anderson EC, DiPalazzo J, Edelman E, Helbig P, Reed K, Miesfeldt S, Thomas C, Lucas FL, Fenton ATHR, Antov A, Hall MJ, Roberts JS, Rueter J, Han PKJ. Patients' Expectations of Benefits From Large-Panel Genomic Tumor Testing in Rural Community Oncology Practices. JCO Precis Oncol 2021; 5:PO.21.00235. [PMID: 34632254 PMCID: PMC8492376 DOI: 10.1200/po.21.00235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/19/2021] [Accepted: 08/20/2021] [Indexed: 02/01/2023] Open
Abstract
Large-panel genomic tumor testing (GTT) is an emerging technology that promises to make cancer treatment more precise. Because GTT is novel and complex, patients may have unrealistic expectations and limited knowledge of its benefits. These problems may limit the clinical value of GTT, but their prevalence and associated factors have not been explored. METHODS Patients with cancer enrolled in a large initiative to disseminate GTT in community oncology practices completed surveys assessing their expectations, knowledge, and attitudes about GTT. The study sample (N = 1,139) consisted of patients with a range of cancer types (22% gynecologic, 14% lung, 10% colon, 10% breast, and 46% other malignancies) and cancer stages (4% stage I, 3% stage II, 15% stage III, and 74% stage IV). Mean age was 64 years (standard deviation = 11); 668 (59%) were women; 71% had no college degree; 57% came from households with less than $50,000 US dollars household income; and 73% lived in a rural area. RESULTS Generally, patients had high expectations that they would benefit from GTT (M = 2.81 on 0-4 scale) and positive attitudes toward it (M = 2.98 on 0-4 scale). Patients also had relatively poor knowledge about GTT (48% correct answers on an objective test of GTT knowledge). Greater expectations for GTT were associated with lower knowledge (b = -0.46; P < .001), more positive attitudes (b = 0.40; P < .001), and lower education (b = -0.53; P < .001). CONCLUSION This research suggests patients have high expectations that they will benefit from GTT, which is associated with low knowledge, positive attitudes, and low education. More research is needed to understand the concordance between expectations and actual clinical outcomes.
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Affiliation(s)
- Eric C. Anderson
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME
- Tufts University School of Medicine, Boston, MA
| | - John DiPalazzo
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME
| | | | | | | | | | | | - F. Lee Lucas
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME
| | - Anny T. H. R. Fenton
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME
| | | | | | | | | | - Paul K. J. Han
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME
- Tufts University School of Medicine, Boston, MA
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
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Álvarez-Alegret R, Rojo Todo F, Garrido P, Bellosillo B, Rodríguez-Lescure Á, Rodríguez-Peralto JL, Vera R, de Álava E, García-Campelo R, Remon J. [Liquid biopsy in oncology: A consensus statement of the Spanish Society of Pathology and the Spanish Society of Medical Oncology]. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2020; 53:234-245. [PMID: 33012494 DOI: 10.1016/j.patol.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/27/2019] [Accepted: 12/09/2019] [Indexed: 11/18/2022]
Abstract
The proportion of cancer patients with tumours that harbour a potentially targetable genomic alteration is increasing considerably. The diagnosis of these genomic alterations can lead to tailoring of treatment, at the onset of disease or during progression, as well as providing additional, predictive information on the efficacy of immunotherapy. However, in up to 25% of cases, the initial tissue biopsy is inadequate for precision oncology and, in many cases, tumour genomic profiling at progression is not possible due to technical limitations of obtaining new tumour tissue specimens. Efficient diagnostic alternatives are therefore required for molecular stratification, such as liquid biopsy. This technique enables the evaluation of the tumour genomic profile dynamically and as well as capturing intra-patient genomic heterogeneity. To date, there are several diagnostic techniques available for use in liquid biopsy, each with different precision and performance levels. The objective of this consensus statement of the Spanish Society of Pathology (SEAP) and the Spanish Society of Medical Oncology (SEOM) is to evaluate the viability and effectiveness of the different methodological approaches of liquid biopsy in cancer patients, and the potential application of this method to current clinical practice. The experts contributing to this consensus statement agree that, according to current evidence, liquid biopsy is an acceptable alternative to tumour tissue biopsy for the study of biomarkers in various clinical settings. It is therefore important to standardise pre-analytical and analytical procedures to ensure reproducibility and to generate structured and accessible clinical reports. It is essential to appoint multidisciplinary tumour molecular committees to oversee these processes and to enable the most suitable therapeutic decisions for each patient according to the genomic profile.
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Affiliation(s)
| | - Federico Rojo Todo
- Departamento de Patología, Fundación Universitaria Jiménez Díaz, CIBERONC, Madrid, España
| | - Pilar Garrido
- Universidad de Alcalá; Departamento de Oncología Médica, IRYCIS, Hospital Universitario Ramón y Cajal, CIBERONC, Madrid, España
| | - Beatriz Bellosillo
- Departamento de Patología, Hospital del Mar, CIBERONC, Barcelona, España
| | - Álvaro Rodríguez-Lescure
- Departamento de Oncología Médica, Hospital General Universitario de Elche y Vega Baja, GEICAM, Elche, España
| | | | - Ruth Vera
- Departamento de Oncología Médica, Complejo Hospitalario de Navarra, Navarra Institute for health research (IdiSNA), Pamplona, España
| | - Enrique de Álava
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, CIBERONC, Departamento de Citología e Histología Normal y Patológica, Sevilla, España
| | - Rosario García-Campelo
- Departamento de Oncología Médica, Complexo Hospitalario Universitario A Coruña, A Coruña, España
| | - Jordi Remon
- Departamento de Oncología Médica, Centro Integral Oncológico Clara Campal Barcelona (CIOCCB), HM Delfos, Barcelona, España
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Muller C, Yurgelun M, Kupfer SS. Precision Treatment and Prevention of Colorectal Cancer-Hope or Hype? Gastroenterology 2020; 158:441-446. [PMID: 31622623 PMCID: PMC6957699 DOI: 10.1053/j.gastro.2019.09.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 09/24/2019] [Accepted: 09/30/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Charles Muller
- Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, Illinois
| | | | - Sonia S Kupfer
- Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, Illinois.
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Liquid biopsy in oncology: a consensus statement of the Spanish Society of Pathology and the Spanish Society of Medical Oncology. Clin Transl Oncol 2019; 22:823-834. [PMID: 31559582 PMCID: PMC7854395 DOI: 10.1007/s12094-019-02211-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/13/2019] [Indexed: 02/06/2023]
Abstract
The proportion of cancer patients with tumours that harbour a potentially targetable genomic alteration is growing considerably. The diagnosis of these genomic alterations can lead to tailored treatment at the onset of disease or on progression and to obtaining additional predictive information on immunotherapy efficacy. However, in up to 25% of cases, the initial tissue biopsy is inadequate for precision oncology and, in many cases, tumour genomic profiling at progression is not possible due to technical limitations of obtaining new tumour tissue specimens. Efficient diagnostic alternatives are therefore required for molecular stratification, which includes liquid biopsy. This technique enables the evaluation of the tumour genomic profile dynamically and captures intra-patient genomic heterogeneity as well. To date, there are several diagnostic techniques available for use in liquid biopsy, each one of them with different precision and performance levels. The objective of this consensus statement of the Spanish Society of Pathology and the Spanish Society of Medical Oncology is to evaluate the viability and effectiveness of the different methodological approaches in liquid biopsy in cancer patients and the potential application of this method to current clinical practice. The experts contributing to this consensus statement agree that, according to current evidence, liquid biopsy is an acceptable alternative to tumour tissue biopsy for the study of biomarkers in various clinical settings. It is therefore important to standardise pre-analytical and analytical procedures, to ensure reproducibility and generate structured and accessible clinical reports. It is essential to appoint multidisciplinary tumour molecular boards to oversee these processes and to enable the most suitable therapeutic decisions for each patient according to the genomic profile.
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Childerhose JE, Finnila CH, Yu JH, Koenig BA, McEwen J, Berg SL, Wilfond BS, Appelbaum PS, Brothers KB. Participant Engagement in Translational Genomics Research: Respect for Persons-and Then Some. Ethics Hum Res 2019; 41:2-15. [PMID: 31541538 PMCID: PMC7199158 DOI: 10.1002/eahr.500029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The expansion of both formal and informal frameworks of "engaged" research in translational research settings raises emerging and substantial normative concerns. In this article, we draw on findings from a focus group study with members of a national consortium of translational genomic research sites. The goals were to catalog informal participant engagement practices, to explore the perceived roots of these practices and the motivations of research staff members for adopting them, and to reflect on their ethical implications. We learned that participant engagement is a deliberate strategy by research staff members both to achieve instrumental research goals and to "do research differently" in response to past research injustices. While many of the participant engagement practices used in translational genomic research are not new, important insights can be gained through a closer examination of the specific contours of participant engagement in this context. These practices appear to have been shaped by the professional training of genetic counselors and by the interests and needs of participants who enroll in clinical genomics studies. The contours of this contemporary application of engaged research principles have relevance not only to clinical genomics research but also to translational research broadly, particularly for how communities of clinical researchers are interpreting the principle of respect for persons. Our findings invite normative questions about the governance of these practices and sociological questions about whether and how clinical researchers in other professions are also engaging participants in translational research settings.
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Affiliation(s)
- Janet E. Childerhose
- Division of Pediatric Clinical and Translational Research, University of Louisville School of Medicine, 231 East Chestnut Street, N-97, Louisville, KY 40202
| | - Candice H. Finnila
- HudsonAlpha Institute for Biotechnology, 601 Genome Way, Huntsville, AL 35806
| | - Joon-Ho Yu
- Department of Pediatrics, University of Washington School of Medicine, Box 357371, 1959 NE Pacific St. HSB I607Q, Seattle, WA 98195
| | - Barbara A. Koenig
- Institute for Health and Aging, University of California San Francisco, 3333 California St., Suite 340, San Francisco, CA 94118
| | - Jean McEwen
- The Ethical, Legal and Social Implications Research Program, National Human Genome Research Institute, National Institutes of Health, 5635 Fishers Lane, Suite 4076, MSC 9305, Bethesda, MD 20892
| | - Stacey L. Berg
- Texas Children’s Cancer Center, Department of Pediatrics, Baylor College of Medicine, 6701 Fannin St #1400, Houston, Texas 77030
- Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Suite 450A, Houston, Texas 77030
| | - Benjamin S. Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital, 1900 Ninth Ave., M/S JMB-6, Seattle, WA 98101
| | - Paul S. Appelbaum
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032
| | - Kyle B. Brothers
- Division of Pediatric Clinical and Translational Research, University of Louisville School of Medicine, 231 East Chestnut Street, N-97, Louisville, KY 40202
- Institute for Bioethics, Health Policy, and Law, University of Louisville, 501 E. Broadway, Ste 310, Louisville, KY 40202
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Gornick MC, Ryan KA, Scherer AM, Roberts JS, De Vries RG, Uhlmann WR. Interpretations of the Term "Actionable" when Discussing Genetic Test Results: What you Mean Is Not What I Heard. J Genet Couns 2019; 28:334-342. [PMID: 30964581 PMCID: PMC10558004 DOI: 10.1007/s10897-018-0289-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 08/02/2018] [Indexed: 12/11/2022]
Abstract
In genomic medicine, the familiarity and inexactness of the term "actionable" can lead to multiple interpretations and mistaken beliefs about realistic treatment options. As part of a larger study focusing on public attitudes toward policies for the return of secondary genomic results, we looked at how members of the lay public interpret the term "medically actionable" in the context of genetic testing. We also surveyed a convenience sample of oncologists as part of a separate study and asked them to define the term "medically actionable." After being provided with a definition of the term, 21 out of 60 (35%) layperson respondents wrote an additional action not specified in the provided definition (12 mentioned "cure" and 9 mentioned environment or behavioral change) and 17 (28%) indicated "something can be done" with no action specified. In contrast, 52 surveyed oncologists did not mention environment, behavioral change, or cure. Based on our findings, we propose that rather than using the term "actionable" alone, providers should also say "what they mean" to reduce miscommunication and confusion that could negatively impact medical decision-making. Lastly, to guide clinicians during patient- provider discussion about genetic test results, we provide examples of phrasing to facilitate clearer communication and understanding of the term "actionable."
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Affiliation(s)
- Michele C. Gornick
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Kerry A. Ryan
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Aaron M. Scherer
- University of Iowa Carver College of Medicine, Department of Internal Medicine, Iowa City, IA
| | - J. Scott Roberts
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Raymond G. De Vries
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI
| | - Wendy R. Uhlmann
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI
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Roberts JS, Gornick MC, Le LQ, Bartnik NJ, Zikmund-Fisher BJ, Chinnaiyan AM. Next-generation sequencing in precision oncology: Patient understanding and expectations. Cancer Med 2019; 8:227-237. [PMID: 30600607 PMCID: PMC6346219 DOI: 10.1002/cam4.1947] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Implementation of precision oncology interventions poses several challenges to informed consent and patient education. This study assessed cancer patients' understanding, expectations, and outcomes regarding participation in research examining the impact of matched tumor and germline sequencing on their clinical care. METHODS A total of 297 patients (mean age: 59 years; 50% female; 96% white) with refractory, metastatic cancer were surveyed, including 217 who completed surveys both before and after undergoing integrated whole exome and transcriptome sequencing as part of a larger clinical research study. RESULTS At baseline, the vast majority of patients expected to receive several potential direct benefits from study participation, including written reports of sequencing findings (88%), greater understanding of the causes of their cancer (74%), and participation in clinical trials for which sequencing results would make them eligible (84%). In most cases, these benefits were not realized by study completion. Despite explanations from study personnel to the contrary, most participants (67%-76%) presumed that incidental germline sequencing findings relevant to noncancerous health conditions (eg, diabetes) would automatically be disclosed to them. Patients reported low levels of concern about study risks at baseline and low levels of regret about study participation at follow-up. CONCLUSIONS Findings suggest that cancer patients participating in precision oncology intervention research have largely unfulfilled expectations of direct benefits related to their study participation. Increased focus on patient education to supplement the informed consent process may help manage patients' expectations regarding the extent and likelihood of benefits received as a result of undergoing genomic sequencing.
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Affiliation(s)
- J. Scott Roberts
- Department of Health Behavior and Health EducationUniversity of Michigan School of Public HealthAnn ArborMichigan
- Center for Bioethics & Social Sciences in MedicineUniversity of Michigan Medical SchoolAnn ArborMichigan
- Rogel Cancer CenterUniversity of Michigan Medical SchoolAnn ArborMichigan
| | - Michele C. Gornick
- Center for Bioethics & Social Sciences in MedicineUniversity of Michigan Medical SchoolAnn ArborMichigan
- Rogel Cancer CenterUniversity of Michigan Medical SchoolAnn ArborMichigan
- Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMichigan
| | - Lan Q. Le
- Department of Health Behavior and Health EducationUniversity of Michigan School of Public HealthAnn ArborMichigan
| | - Natalie J. Bartnik
- Department of Health Behavior and Health EducationUniversity of Michigan School of Public HealthAnn ArborMichigan
| | - Brian J. Zikmund-Fisher
- Department of Health Behavior and Health EducationUniversity of Michigan School of Public HealthAnn ArborMichigan
- Center for Bioethics & Social Sciences in MedicineUniversity of Michigan Medical SchoolAnn ArborMichigan
- Rogel Cancer CenterUniversity of Michigan Medical SchoolAnn ArborMichigan
- Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMichigan
| | - Arul M. Chinnaiyan
- Rogel Cancer CenterUniversity of Michigan Medical SchoolAnn ArborMichigan
- Department of PathologyUniversity of Michigan Medical SchoolAnn ArborMichigan
- Michigan Center for Translational PathologyUniversity of Michigan Medical SchoolAnn ArborMichigan
- Department of UrologyUniversity of Michigan Medical SchoolAnn ArborMichigan
- Howard Hughes Medical InstituteUniversity of Michigan Medical SchoolAnn ArborMichigan
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11
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Remon J, Dienstmann R. Precision oncology: separating the wheat from the chaff. ESMO Open 2018; 3:e000446. [PMID: 30425845 PMCID: PMC6212683 DOI: 10.1136/esmoopen-2018-000446] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 01/09/2023] Open
Abstract
Precision oncology based on next-generation sequencing (NGS) test is growing in daily clinical practice. However, the real impact of this strategy in patients' outcome on a large scale remains uncertain. In this review, we summarise existing literature on this topic, limitations for broad NGS implementation, bottlenecks in genomic variant interpretation and the role of molecular tumour boards.
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Affiliation(s)
- Jordi Remon
- Medical Oncology Department, Centro Integral Oncología Clara Campal Barcelona, HM-Delfos, Barcelona, Spain
| | - Rodrigo Dienstmann
- Hospital Vall d’Hebrón, Oncology Data Science (ODysSey) Group, Barcelona, Spain
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12
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Kuderer NM, Burton KA, Blau S, Senecal F, Gadi VK, Parker S, Mahen E, Veenstra D, Carlson JJ, Lyman GH, Blau CA. Participant Attitudes Toward an Intensive Trial of Multiple Biopsies, Multidimensional Molecular Analysis, and Reporting of Results in Metastatic Triple-Negative Breast Cancer. JCO Precis Oncol 2017; 1:1700076. [PMID: 32913975 PMCID: PMC7446457 DOI: 10.1200/po.17.00076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Multidimensional molecular analysis of tumor tissue intensively over space and time can provide insight into how cancers evolve and escape treatment. Attitudes of participants in such trials have not been assessed. We explored patient views regarding an intensive study incorporating multiple biopsies, multidimensional molecular testing, and drug response predictions that are reported to the oncologist and patient. Patients and Methods A structured, self-administered survey was conducted among the first 15 patients enrolled in ITOMIC-001 (Intensive Trial of Omics in Cancer). Patients with metastatic triple-negative breast cancer were accrued at two sites in Washington state. Surveys containing 17 items were administered at enrollment and after the return of results. Surveys explored perceptions regarding risks, personal benefits, benefits to others, uncertainties associated with interpreting complex molecular results, concerns regarding multiple biopsies, and potential loss of confidentiality. At follow-up, three additional unique items explored patient coping. Results All participants expressed a strong desire for their experiences to benefit others, and all perceived a higher likelihood of deriving benefit than described during detailed consent discussions. Loss of confidentiality ranked lowest among patient concerns. Despite acknowledging uncertainties and risks inherent in complex molecular testing for clinical reporting, participants wanted access to findings in evaluating treatment choices, even if the best available evidence was weak. Follow-up surveys demonstrated relatively little change in attitudes, although concern about study biopsies generally declined. Study participation helped several patients cope better with their disease. Conclusion In advanced breast cancer, these findings demonstrate the feasibility of engaging motivated patients in trials that navigate the uncertainties associated with intensive spatial and longitudinal multidimensional molecular testing for the purpose of advancing precision medicine.
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Affiliation(s)
- Nicole M Kuderer
- : University of Washington; and , Fred Hutchinson Cancer Research Center, Seattle; and , , and , Northwest Medical Specialties, Puyallup and Tacoma, WA
| | - Kimberly A Burton
- : University of Washington; and , Fred Hutchinson Cancer Research Center, Seattle; and , , and , Northwest Medical Specialties, Puyallup and Tacoma, WA
| | - Sibel Blau
- : University of Washington; and , Fred Hutchinson Cancer Research Center, Seattle; and , , and , Northwest Medical Specialties, Puyallup and Tacoma, WA
| | - Francis Senecal
- : University of Washington; and , Fred Hutchinson Cancer Research Center, Seattle; and , , and , Northwest Medical Specialties, Puyallup and Tacoma, WA
| | - Vijayakrishna K Gadi
- : University of Washington; and , Fred Hutchinson Cancer Research Center, Seattle; and , , and , Northwest Medical Specialties, Puyallup and Tacoma, WA
| | - Stephanie Parker
- : University of Washington; and , Fred Hutchinson Cancer Research Center, Seattle; and , , and , Northwest Medical Specialties, Puyallup and Tacoma, WA
| | - Elisabeth Mahen
- : University of Washington; and , Fred Hutchinson Cancer Research Center, Seattle; and , , and , Northwest Medical Specialties, Puyallup and Tacoma, WA
| | - David Veenstra
- : University of Washington; and , Fred Hutchinson Cancer Research Center, Seattle; and , , and , Northwest Medical Specialties, Puyallup and Tacoma, WA
| | - Josh J Carlson
- : University of Washington; and , Fred Hutchinson Cancer Research Center, Seattle; and , , and , Northwest Medical Specialties, Puyallup and Tacoma, WA
| | - Gary H Lyman
- : University of Washington; and , Fred Hutchinson Cancer Research Center, Seattle; and , , and , Northwest Medical Specialties, Puyallup and Tacoma, WA
| | - C Anthony Blau
- : University of Washington; and , Fred Hutchinson Cancer Research Center, Seattle; and , , and , Northwest Medical Specialties, Puyallup and Tacoma, WA
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