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Bergerot CD, Philip EJ, Malhotra J, Bergerot PG, Castro DV, Govindarajan A, Salgia S, Salgia M, Salgia N, Hsu J, Meza L, Zengin ZB, Liu S, Chehrazi-Raffle A, Tripathi A, Dorff T, Pal S. Racial and ethnic differences in perceptions of germline or somatic DNA sequencing among patients with advanced prostate, urothelial, or kidney cancer. J Genet Couns 2024; 33:911-915. [PMID: 37697864 DOI: 10.1002/jgc4.1786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/13/2023]
Abstract
We sought to determine racial and ethnic differences in perceptions (quality of communication, expectations, and concerns) of germline or somatic DNA sequencing (genomic profiling). Patients with prostate, urothelial, or kidney cancer were surveyed using a questionnaire that assessed previous experience, beliefs, expectations, and concerns regarding genomic profiling. Descriptive statistics and chi-square tests were used to identify factors associated with patients' perceptions of genomic profiling. A total of 150 consecutive patients were enrolled. The majority were male (74%) with a mean age of 68 years old. Most patients underwent somatic testing (54%), 24% undertook germline testing, and 21% undertook both tests. Significant differences were found across racial and/or ethnicity concerning factors that could have influenced patients' decision to pursue genomic profiling, including ability to guide the type of treatment (White: 54.1% vs. other ethnic groups: 43.9%, p = 0.04) and potential to improve treatment response (White: 10.1% vs. other ethnic groups: 22.0%, p = 0.04). Other ethnic group of patients were more concerned about learning that the cancer was less treatable or aggressive (43.8% vs. 27.7%, p = 0.01) and anxious about what would be learnt from genomic profiling (34.4% vs. 21.3, p = 0.01) as compared to White patients. Our findings reinforce the importance of developing culturally tailored education to help patients participate actively in decisions about genomic profiling.
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Affiliation(s)
| | - Errol J Philip
- University of California San Francisco, San Francisco, California, USA
| | - Jasnoor Malhotra
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | | | - Daniela V Castro
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Ameish Govindarajan
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Sabrina Salgia
- Western University of Health Sciences, Pomona, California, USA
| | - Meghan Salgia
- University of Miami School of Medicine, Miami, Florida, USA
| | - Nicholas Salgia
- Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - JoAnn Hsu
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Luis Meza
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Zeynep B Zengin
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Sandy Liu
- Department of Medical Oncology, City of Hope Orange County Medical Center, Irvine, California, USA
| | - Alex Chehrazi-Raffle
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Abhishek Tripathi
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Tanya Dorff
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Sumanta Pal
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
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2
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Williams LS, Williams KM, Gillis N, Bolton K, Damm F, Deuitch NT, Farhadfar N, Gergis U, Keel SB, Michelis FV, Panch SR, Porter CC, Sucheston-Campbell L, Tamari R, Stefanski HE, Godley LA, Lai C. Donor-Derived Malignancy and Transplantation Morbidity: Risks of Patient and Donor Genetics in Allogeneic Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2024; 30:255-267. [PMID: 37913908 PMCID: PMC10947964 DOI: 10.1016/j.jtct.2023.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/18/2023] [Accepted: 10/26/2023] [Indexed: 11/03/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains a key treatment option for hematologic malignancies (HMs), although it carries significant risks. Up to 30% of patients relapse after allo-HSCT, of which up to 2% to 5% are donor-derived malignancies (DDMs). DDMs can arise from a germline genetic predisposition allele or clonal hematopoiesis (CH) in the donor. Increasingly, genetic testing reveals that patient and donor genetic factors contribute to the development of DDM and other allo-HSCT complications. Deleterious germline variants in CEBPA, DDX41, GATA2, and RUNX1 predispose to inferior allo-HSCT outcomes. DDM has been linked to donor-acquired somatic CH variants in DNMT3A, ASXL1, JAK2, and IDH2, often with additional new variants. We do not yet have evidence to standardize donor genetic sequencing prior to allo-HSCT. The presence of hereditary HM disorders should be considered in patients with myeloid malignancies and their related donors, and screening of unrelated donors should include family and personal history of cytopenia and HMs. Excellent multidisciplinary care is critical to ensure efficient timelines for screening and necessary discussions among medical oncologists, genetic counselors, recipients, and potential donors. After allo-HSCT, HM relapse monitoring with genetic testing effectively results in genetic sequencing of the donor, as the transplanted hematopoietic system is donor-derived, which presents ethical challenges for disclosure to patients and donors. We encourage consideration of the recent National Marrow Donor Program policy that allows donors to opt-in for notification about detection of their genetic variants after allo-HSCT, with appropriate genetic counseling when feasible. We look forward to prospective investigation of the impact of germline and acquired somatic genetic variants on hematopoietic stem cell mobilization/engraftment, graft-versus-host disease, and DDM to facilitate improved outcomes through knowledge of genetic risk.
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Affiliation(s)
- Lacey S Williams
- Lombardi Clinical Cancer Center, Georgetown University, Washington, District of Columbia.
| | - Kirsten M Williams
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Nancy Gillis
- Department of Cancer Epidemiology and Department of Malignant Hematology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kelly Bolton
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri
| | - Frederik Damm
- Hematology, Oncology, and Cancer Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Natalie T Deuitch
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Nosha Farhadfar
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Usama Gergis
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Siobán B Keel
- Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | | | - Sandhya R Panch
- Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Christopher C Porter
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | | | - Roni Tamari
- Memorial Sloan Kettering, New York, New York
| | - Heather E Stefanski
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Lucy A Godley
- Division of Hematology/Oncology and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Catherine Lai
- Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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3
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Veney D, Wei L, Toland AE, Presley CJ, Hampel H, Padamsee TJ, Lee CN, Irvin WJ, Bishop M, Kim J, Hovick SR, Senter L, Stover DG. A Video Intervention to Improve Patient Understanding of Tumor Genomic Testing in Patients with Cancer. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.05.23299443. [PMID: 38106014 PMCID: PMC10723483 DOI: 10.1101/2023.12.05.23299443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Background Tumor genomic testing (TGT) has become standard-of-care for most patients with advanced/metastatic cancer. Despite established guidelines, patient education prior to TGT is variable or frequently omitted. The purpose of this study was to evaluate the impact of a concise (3-4 minute) video for patient education prior to TGT. Methods Based on a quality improvement cycle, an animated video was created to be applicable to any cancer type, incorporating culturally diverse images, available in English and Spanish. Patients undergoing standard-of care TGT were enrolled at a tertiary academic institution and completed validated survey instruments immediately prior to video viewing (T1) and immediately post-viewing (T2). Instruments included: 1) 10-question objective genomic knowledge/understanding; 2) 10-question video message-specific knowledge/recall; 3) 11-question Trust in Physician/Provider; 4) attitudes regarding TGT. The primary objective was change in outcomes from before to after the video was assessed with Wilcoxon signed rank test. Results From April 2022 to May 2023, a total of 150 participants were enrolled (MBC n=53, LC n=38, OC n=59). For the primary endpoint, there was a significant increase in video message-specific knowledge (median 10 point increase; p<0.0001) with no significant change in genomic knowledge/understanding (p=0.89) or Trust in Physician/Provider (p=0.59). Results for five questions significantly improved, including the likelihood of TGT impact on treatment decision, incidental germline findings, and cost of testing. Improvement in video message-specific knowledge was consistent across demographic groups, including age, income, and education. Individuals with less educational attainment had had greater improvement from before to after video viewing. Conclusions A concise, 3-4 minute, broadly applicable video incorporating culturally diverse images administered prior to TGT significantly improved video message-specific knowledge across all demographic groups. This resource is publicly available at http://www.tumor-testing.com, with a goal to efficiently educate and empower patients regarding TGT while addressing guidelines within the flow of clinical practice. Clinical Trial Registration ClinicalTrials.gov NCT05215769.
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Affiliation(s)
- Deloris Veney
- Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210 USA
| | - Lai Wei
- Department of Biomedical Informatics, Ohio State University, Columbus, OH, 43210 USA
| | - Amanda E. Toland
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210 USA
- Department of Cancer Biology and Genetics, The Ohio State University, Columbus, OH, 43210 USA
| | - Carolyn J. Presley
- Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210 USA
| | - Heather Hampel
- Division of Clinical Cancer Genomics, Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA 91010
| | - Tasleem J. Padamsee
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, 43210, USA
| | - Clara N. Lee
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, 43210, USA
| | - William J. Irvin
- Bon Secours Cancer Institute at St. Francis, Richmond, Virginia, USA
| | | | - James Kim
- Bon Secours-Mercy Health St. Elizabeth, Youngstown, Ohio, USA
| | - Shelly R. Hovick
- School of Communication, Ohio State University, Columbus, OH, 43210 USA
| | - Leigha Senter
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210 USA
| | - Daniel G. Stover
- Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210 USA
- Department of Biomedical Informatics, Ohio State University, Columbus, OH, 43210 USA
- Pelotonia Institute for Immuno-Oncology, Ohio State University Comprehensive Cancer, Columbus, OH, 43210 USA
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Myers RE, Hallman MH, Shimada A, DiCarlo M, Davis K, Leach WT, Jackson H, Indictor A, Chambers CV. Primary Care Patient Interest in Multi-Cancer Early Detection for Cancer Screening. J Pers Med 2023; 13:1613. [PMID: 38003928 PMCID: PMC10671850 DOI: 10.3390/jpm13111613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/27/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Multi-cancer early detection (MCED) tests are being developed, but little is known about patient receptivity to their use for cancer screening. The current study assessed patient interest in such testing. Our team conducted a prospective, observational study among primary care patients in a large, urban health system. They were asked to complete a telephone survey that briefly described a new blood test in development to identify multiple types of cancer, but was not currently recommended or covered by insurance. The survey included items to assess respondent background characteristics, perceptions about MCED testing, and interest in having such an MCED test. We also used multivariable analyses to identify factors associated with patient interest in test use. In 2023, we surveyed 159 (32%) of 500 identified patients. Among respondents, 125 (79%) reported a high level of interest in having an MCED test. Interest was not associated with personal background characteristics, but was positively associated with the following expectations: testing would be recommended for cancer screening, be convenient, and be effective in finding early-stage disease (OR = 11.70, 95% CI: 4.02, 34.04, p < 0.001). Research is needed to assess patient interest and actual uptake when detailed information on testing is presented in routine care.
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Affiliation(s)
- Ronald E. Myers
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA 19107, USA (M.D.); (H.J.); (A.I.)
| | - Mie H. Hallman
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA 19107, USA (M.D.); (H.J.); (A.I.)
| | - Ayako Shimada
- Division of Biostatistics, Department of Pharmacology, Physiology, and Cancer Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA;
| | - Melissa DiCarlo
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA 19107, USA (M.D.); (H.J.); (A.I.)
| | - Kaitlyn Davis
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA; (K.D.); (W.T.L.); (C.V.C.)
| | - William T. Leach
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA; (K.D.); (W.T.L.); (C.V.C.)
| | - Hattie Jackson
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA 19107, USA (M.D.); (H.J.); (A.I.)
| | - Amanda Indictor
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA 19107, USA (M.D.); (H.J.); (A.I.)
| | - Christopher V. Chambers
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA; (K.D.); (W.T.L.); (C.V.C.)
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Hazimeh D, Younes R, Telvizian T, Mahfouz R, Mukherji D. The Impact of an Educational Video in Arabic Language on Patients' Knowledge and Attitudes Towards Genetic Testing for Cancer Therapy. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1641-1648. [PMID: 37249757 DOI: 10.1007/s13187-023-02316-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 05/31/2023]
Abstract
Rapid advances in cancer genetics are paving the way towards personalized cancer management, and genetic testing is now an important decision-making tool. Despite the advantages, genetic testing adds a layer of complexity in the management which is difficult to communicate with patients. The variability health literacy among patients may restrict their engagement in genetic procedures. Improving the language and presentation of genomic concepts can influence patients' risk assessment and willingness to undergo testing. The study aimed to compare the knowledge and attitudes of cancer patients presenting to oncology clinics at The American University of Beirut Medical Center before and after watching a short educational video that clarifies the concepts of genetic mutations, genetic testing technique, and its purposes.Twenty-nine adult patients presenting to the oncology clinics and due to receive somatic or germline genetic testing filled a questionnaire which assesses their knowledge and attitudes before and after the educational video was played. The majority of patients had poor baseline knowledge before the intervention. After watching the video, the percentage of patients with poor knowledge decreased to a minimum of 3.4% and a maximum of 39% for each concept. Mean score for attitude questions also increased significantly. Effective patient education and counseling programs in the patients' native language prior to genetic testing can increase knowledge, decrease hesitancy, and improve clinical decision making. A short educational video is an example of a simple intervention towards an inclusive approach in patient care all over the world.
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Affiliation(s)
- Dana Hazimeh
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Reem Younes
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Talar Telvizian
- Department of Hematology and Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rami Mahfouz
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Deborah Mukherji
- Department of Hematology and Oncology, American University of Beirut Medical Center, Beirut, Lebanon.
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Fortune EE, Zaleta AK, Saxton MC. Biomarker testing communication, familiarity, and informational needs among people living with breast, colorectal, and lung cancer. PATIENT EDUCATION AND COUNSELING 2023; 112:107720. [PMID: 37062167 DOI: 10.1016/j.pec.2023.107720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/06/2023] [Accepted: 03/29/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVES This study aims to characterize patient experiences with biomarker testing, including history of biomarker testing, related communication and education, self-perceived familiarity and informational needs. METHODS 436 U.S. adults diagnosed with lung (38%), colorectal (35%) or breast cancer (27%) from 2018 to 2022 completed a survey. Two logistic regressions were conducted to predict patients' familiarity with biomarker testing and informational needs. RESULTS Despite high biomarker testing rates (85%), half of respondents reported low familiarity with biomarker testing and three-quarters reported outstanding informational needs. Regression models indicate those patients who have greater health literacy and report having conversations with their oncologists about biomarker testing have more familiarity with biomarker testing and less informational needs, even after controlling for important sociodemographic factors. CONCLUSIONS There is an opportunity to improve patients' familiarity with biomarker testing and decrease outstanding informational needs by focusing on factors such as health literacy and patient-provider communication, which could further cultivate patients' understanding of the importance of biomarker testing in cancer care. PRACTICE IMPLICATIONS These findings underscore the importance of patient-provider relationships and the need for additional tools that assist providers in assessing patients' health literacy and facilitating conversations with patients, especially those focused on complex topics such as biomarker testing.
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Affiliation(s)
- Erica E Fortune
- Cancer Support Community, Research and Training Institute, Philadelphia, PA, USA.
| | - Alexandra K Zaleta
- Cancer Support Community, Research and Training Institute, Philadelphia, PA, USA
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Burns L, Jani C, Radwan A, Omari OA, Patel M, Oxnard GR, Tapan U. Implementation Challenges and Disparities in Molecular Testing for Patients With Stage IV NSCLC: Perspectives from an Urban Safety-Net Hospital. Clin Lung Cancer 2023; 24:e69-e77. [PMID: 36464575 DOI: 10.1016/j.cllc.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/27/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022]
Abstract
The advent of next-generation sequencing (NGS), including both tissue assays and circulating tumor DNA (ct-DNA), has been pivotal in improving outcomes for patients with non-small cell lung cancer (NSCLC). Although molecular testing is standard of care for advanced NSCLC, challenges still exist in its implementation. This Perspective examines barriers to the widespread implementation of NGS from the vantage point of a single urban safety-net institution, with a particular focus on examining racial disparities in NGS completion. We conducted a review of patients at our institution from January 2015 through January 2022 and examined molecular testing patterns before and after the publication of updated molecular testing guidelines from the International Association for the Study of Lung Cancer (IASLC), Association for Molecular Pathology (AMP), and College of American Pathologists (CAP) in March of 2018. While NGS increased over time, we found that 43% of patients in the March 2018 through January 2022 group still did not receive NGS, and the most common reasons for the absence of testing included a lack of physician ordering and insufficient tissue on biopsy. We did not note any racial disparities in completion or time-to-adoption of NGS. Patients with squamous cell carcinoma (SCC) histology were noted to receive liquid NGS markedly less often than patients with non-squamous histology in the March 2018 through January 2022 period. Based on our own data and a review of findings from colleagues in the field, we advocate for additional physician educational programming, increased use of ct-DNA biopsy, automated (reflexive) NGS tissue testing on receipt of biopsy, and consideration for the broader molecular profiling of patients with SCC histology.
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Affiliation(s)
- Laura Burns
- Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA.
| | - Chinmay Jani
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
| | - Amr Radwan
- Section of Hematology & Medical Oncology, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA
| | - Omar Al Omari
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
| | - Mohini Patel
- Boston University School of Public Health and Boston Medical Center, Boston, MA
| | - Geoffrey R Oxnard
- Section of Hematology & Medical Oncology, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA
| | - Umit Tapan
- Section of Hematology & Medical Oncology, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA
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8
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Dehar N, Abedin T, Tang P, Bebb G, Cheung WY. A Comparison of Patients' and Physicians' Knowledge and Expectations Regarding Precision Oncology Tests. Curr Oncol 2022; 29:9916-9927. [PMID: 36547194 PMCID: PMC9776922 DOI: 10.3390/curroncol29120780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
(1) Background: As genomic testing is becoming a part of the mainstream oncology practice, it is vital to ensure that our patients fully understand the implications of these tests. This study aimed to compare the attitudes and expectations of cancer patients with those of their physicians regarding the role of biomarker testing in clinical decision making. (2) Methods: Two separate, complimentary, self-administered questionnaires for patients with cancer and their physicians, respectively, were collected in Calgary, Alberta, Canada. Out of 117, 113 completed patient surveys were included in the statistical analysis, constituting a 96.4% response rate. These surveys were subsequently matched with those of their corresponding oncologists to determine the concordance rates. (3) Results: Overall, patients demonstrated a good understanding of general cancer biology (80.0%) and diagnostic processes (90.0%) associated with precision oncology. Most patients wanted their tumours to be tested to guide treatment, and the oncologists broadly shared these views (concordance 65.1%). However, there were discrepancies between the knowledge and expectations regarding the applications of test results on actual diagnosis and prognosis between patients and their oncologists (concordance 26.1% and 36.0%, respectively). While only 28.0% of patients thought they had enough knowledge to make informed decisions, the majority (68.0%) said they needed more information. (4) Conclusion: Our study shows that patients and cancer physicians do not always agree with the roles and applications of genomic tests, which could lead to misplaced expectations and poor health outcomes. More research is needed to devise strategies to improve education and communication to align these expectations and improve the quality of clinical decision making.
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Affiliation(s)
- Navdeep Dehar
- Department of Medical Oncology, Queen’s University, Kingston, ON K7L 5P9, Canada
- Correspondence:
| | - Tasnima Abedin
- Clinical Research Unit, Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
| | - Patricia Tang
- Department of Medical Oncology, Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
| | - Gwyn Bebb
- Department of Medical Oncology, Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
| | - Winson Y. Cheung
- Department of Medical Oncology, Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
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Carlsson L, Thain E, Gillies B, Metcalfe K. Psychological and health behaviour outcomes following multi-gene panel testing for hereditary breast and ovarian cancer risk: a mini-review of the literature. Hered Cancer Clin Pract 2022; 20:25. [PMID: 35733200 PMCID: PMC9215075 DOI: 10.1186/s13053-022-00229-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/24/2022] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Knowledge of the genetic mechanisms driving hereditary breast and ovarian cancer (HBOC) has recently expanded due to advances in gene sequencing technologies. Genetic testing for HBOC risk now involves multi-gene panel testing, which includes well characterized high-penetrance genes (e.g. BRCA1 and BRCA2), as well as moderate- and low-penetrance genes. Certain moderate and low penetrance genes are associated with limited data to inform cancer risk estimates and clinical management recommendations, which create new sources of genetic and clinical uncertainty for patients. PURPOSE The aim of this review is to evaluate the psychological and health behaviour outcomes associated with multi-gene panel testing for HBOC risk. The search was developed in collaboration with an Information Specialist (Princess Margaret Cancer Centre) and conducted in the following databases: MEDLINE, EMBASE, EMCare, PsycINFO, Epub Ahead of Publication. RESULTS Similar to the BRCA1/2 literature, individuals with a pathogenic variant (PV) reported higher levels of testing-related concerns and cancer-specific distress, as well as higher uptake of prophylactic surgery in both affected and unaffected individuals compared to those with variant of uncertain significance (VUS) or negative result. A single study demonstrated that individuals with a PV in a moderate penetrance gene reported higher rates of cancer worry, genetic testing concerns and cancer-related distress when compared to women with high penetrance PV. Analysis of cancer screening and prevention outcomes based upon gene penetrance were limited to two studies, with conflicting findings. CONCLUSION The findings in this review emphasize the need for studies examining psychological and health behavior outcomes associated with panel testing to include between group differences based upon both variant pathogenicity and gene penetrance. Future studies evaluating the impact of gene penetrance on patient-reported and clinical outcomes will require large samples to be powered for these analyses given that a limited number of tested individuals are found to have a PV.
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Affiliation(s)
- Lindsay Carlsson
- Drug Development Program, Princess Margaret Cancer Centre, 620 University Avenue, 8-132, Toronto, ON, Canada. .,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
| | - Emily Thain
- Bhalwani Familial Cancer Clinic, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Brittany Gillies
- Bhalwani Familial Cancer Clinic, Princess Margaret Cancer Centre, Toronto, Canada
| | - Kelly Metcalfe
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute , Toronto, ON, Canada
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Waldman L, Hancock K, Gallinger B, Johnstone B, Brunga L, Malkin D, Barrera M, Villani A. Perspectives and Experiences of Parents and Adolescents Who Participate in a Pediatric Precision Oncology Program: "When You Feel Helpless, This Kind of Thing Is Very Helpful". JCO Precis Oncol 2022; 6:e2100444. [PMID: 35357906 DOI: 10.1200/po.21.00444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The SickKids Cancer Sequencing (KiCS) Program, launched in 2016, evaluates the clinical utility of paired tumor/germline Next-Generation Sequencing (NGS) in pediatric oncology patients with hard-to-cure and rare cancers. In anticipation of further widespread adoption of NGS, we aimed to characterize the experiences and perspectives of adolescents and parents of patients who have already undergone NGS evaluation, focusing on the psychosocial impact and personal utility. METHODS Parents of patients with pediatric cancer and adolescent patients who have participated in KiCS were invited to participate in semistructured interviews. Transcripts were analyzed using an inductive content analytic approach. RESULTS Of 45 individuals invited, 22 parents and 10 adolescents were interviewed (71% response rate). Prominent psychosocial themes were low distress, relief, and sense of control; some expressed fear of the unknown. In exploring constructs of personal utility, parents highlighted hope for treatment options despite low expectations for results with clinical impact, whereas adolescents articulated altruistic motivations and less hope for personal clinical benefit. Bringing closure and answering the question of why the cancer occurred was a salient theme among both groups. Both parents and adolescents find benefit and clear decisional satisfaction with participation. No participants expressed regret. CONCLUSION This study suggests that parents and adolescents benefit from NGS evaluation beyond the return of clinically relevant results. Our findings lay the framework for future work evaluating the value of NGS in pediatric precision oncology care through assessment of patient-reported outcomes and experiences. These results also guide provision of pre- and post-test education and support, which will facilitate patient-centered delivery of NGS practices.
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Affiliation(s)
- Larissa Waldman
- Cancer Genetics and High Risk Program, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada.,Department of Molecular Genetics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kelly Hancock
- Department of Psychology, Hospital for Sick Children, Toronto, ON, Canada
| | - Bailey Gallinger
- Department of Molecular Genetics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Genetic Counselling, Hospital for Sick Children, Toronto, ON, Canada
| | - Brittney Johnstone
- Cancer Genetics and High Risk Program, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada.,Department of Molecular Genetics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ledia Brunga
- Genetics and Genome Biology, Hospital for Sick Children, Toronto, ON, Canada
| | - David Malkin
- Genetics and Genome Biology, Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Maru Barrera
- Department of Psychology, Hospital for Sick Children, Toronto, ON, Canada
| | - Anita Villani
- Department of Pediatrics, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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11
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Napier CE, Davies G, Butow PN, Schlub TE, Best MC, Bartley N, Juraskova I, Meiser B, Tucker KM, Biesecker BB, Thomas DM, Ballinger ML. Cancer patient knowledge about and behavioral intentions after germline genome sequencing. PATIENT EDUCATION AND COUNSELING 2022; 105:707-718. [PMID: 34247865 DOI: 10.1016/j.pec.2021.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 06/08/2021] [Accepted: 07/03/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Germline genome sequencing (GS) is becoming mainstream in cancer diagnosis and risk management. Identifying knowledge gaps and determinants of health behavior change intentions will enable effective targeting of educational and management strategies to translate genomic findings into improved cancer outcomes. METHODS Probands diagnosed with cancer of likely genetic origin that consented to but not yet undergone GS, and their biological relatives, completed a cross-sectional questionnaire assessing GS knowledge and hypothetical intention to change behaviors. RESULTS Probands (n = 348; 57% university educated) and relatives (n = 213; 38% university educated) had moderate GS knowledge levels, with greater knowledge associated with higher education. Both populations reported high behavioral change intentions, significantly associated with being female (p = 0.01) and greater perceived importance of GS (p < 0.001), and for probands: being from English-speaking households (p = 0.003), higher socio-economic status (p = 0.01) and greater self-efficacy (p = 0.02). CONCLUSIONS Increasing GS knowledge will enable realistic participant expectations surrounding germline GS. Actual behavior change should be monitored to determine whether increased cancer risk knowledge results in altered cancer-related behavior and ultimately, cancer outcomes. PRACTICE IMPLICATIONS Educational resources should target specific populations to ensure informed decision-making and expectation management. Support tools facilitating and maintaining behavioral change may be needed to achieve improved cancer patient outcomes.
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Affiliation(s)
- Christine E Napier
- Cancer Theme, Garvan Institute of Medical Research, Darlinghurst, Australia
| | - Grace Davies
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, Australia
| | - Phyllis N Butow
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, Australia; The University of Sydney, School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney, Australia
| | - Timothy E Schlub
- The University of Sydney, Sydney School of Public Health, Sydney, Australia
| | - Megan C Best
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, Australia; University of Notre Dame Australia, Sydney, Australia
| | - Nicci Bartley
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, Australia
| | - Ilona Juraskova
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, Australia; The University of Sydney, School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney, Australia
| | - Bettina Meiser
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Katherine M Tucker
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, Australia
| | - Barbara B Biesecker
- Newborn Screening, Ethics and Disability Studies, RTI International, Washington, DC, USA
| | - David M Thomas
- Cancer Theme, Garvan Institute of Medical Research, Darlinghurst, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Mandy L Ballinger
- Cancer Theme, Garvan Institute of Medical Research, Darlinghurst, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, Australia.
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12
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Hoadley A, Bass SB, Chertock Y, Brajuha J, D’Avanzo P, Kelly PJ, Hall MJ. The Role of Medical Mistrust in Concerns about Tumor Genomic Profiling among Black and African American Cancer Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052598. [PMID: 35270290 PMCID: PMC8909390 DOI: 10.3390/ijerph19052598] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 12/13/2022]
Abstract
Tumor genomic profiling (TGP) is used in oncology practice to optimize cancer treatment and improve survival rates. However, TGP is underutilized among Black and African American (AA) patients, creating potential disparities in cancer treatment outcomes. Cost, accuracy, and privacy are barriers to genetic testing, but medical mistrust (MM) may also influence how Black and AA cancer patients perceive TGP. From December 2019 to February 2020, 112 Black and AA adults from two outpatient oncology sites in Philadelphia, PA without a known history of having TGP testing conducted completed a cross-sectional survey. Items queried included sociodemographic characteristics, clinical factors, patient-oncologist relationship quality, medical mistrust, and concerns about TGP. A k-means cluster analysis revealed two distinct psychographic clusters: high (MM-H) versus low (MM-L) medical mistrust. Clusters were not associated with any sociodemographic or clinical factors, except for age (MM-H patients older than MM-L patients, p = 0.006). Eleven TGP concerns were assessed; MM-H patients expressed greater concerns than MM-L patients, including distrust of the government, insurance carriers, and pharmaceutical companies. TGP concerns varied significantly based on level of medical mistrust, irrespective of sociodemographic characteristics. Targeted communications addressing TGP concerns may mitigate disparities in TGP uptake among those with medical mistrust.
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Affiliation(s)
- Ariel Hoadley
- Risk Communication Laboratory, Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B Moore Ave, Rm 947, Philadelphia, PA 19122, USA; (S.B.B.); (J.B.); (P.D.); (P.J.K.)
- Correspondence:
| | - Sarah Bauerle Bass
- Risk Communication Laboratory, Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B Moore Ave, Rm 947, Philadelphia, PA 19122, USA; (S.B.B.); (J.B.); (P.D.); (P.J.K.)
| | - Yana Chertock
- Fox Chase Cancer Center, Cancer Prevention and Control Program, Department of Clinical Genetics, 333 Cottman Avenue, Philadelphia, PA 19111, USA; (Y.C.); (M.J.H.)
| | - Jesse Brajuha
- Risk Communication Laboratory, Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B Moore Ave, Rm 947, Philadelphia, PA 19122, USA; (S.B.B.); (J.B.); (P.D.); (P.J.K.)
| | - Paul D’Avanzo
- Risk Communication Laboratory, Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B Moore Ave, Rm 947, Philadelphia, PA 19122, USA; (S.B.B.); (J.B.); (P.D.); (P.J.K.)
| | - Patrick J. Kelly
- Risk Communication Laboratory, Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B Moore Ave, Rm 947, Philadelphia, PA 19122, USA; (S.B.B.); (J.B.); (P.D.); (P.J.K.)
| | - Michael J. Hall
- Fox Chase Cancer Center, Cancer Prevention and Control Program, Department of Clinical Genetics, 333 Cottman Avenue, Philadelphia, PA 19111, USA; (Y.C.); (M.J.H.)
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13
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Physicians' perceptions of the factors influencing disclosure of secondary findings in tumour genomic profiling in Japan: a qualitative study. Eur J Hum Genet 2022; 30:88-94. [PMID: 34400810 PMCID: PMC8738764 DOI: 10.1038/s41431-021-00944-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/18/2021] [Accepted: 08/05/2021] [Indexed: 01/03/2023] Open
Abstract
Tumour genomic profiling (TGP), conducted in search of therapeutics, sometimes reveals potentially pathogenic germline variants as secondary findings (SFs). Physicians involved in TGP are often specialised in oncology and not in clinical genetics. To better utilise SFs, we explored issues physicians have during disclosure and the potential for collaborations with clinical genetics professionals. Semi-structured interviews were conducted with 14 physicians who had experience in handling outpatient TGP at designated core hospitals for cancer genomic medicine in Japan. The data were analysed thematically. The difficulties physicians experienced during informed consent (IC) included educating patients about SFs, providing detailed information on SFs, and explaining the impact of SFs on patients' family members. When SFs were detected, physicians had reservations regarding the relevance of the disclosure criteria. Confirmatory germline tests were performed using peripheral blood when tumour-only tests detected suspected SFs. Some physicians had reservations about the necessity of confirmatory tests when they did not affect the patients' treatment options. To encourage patients to receive confirmatory tests, improvements are necessary in the healthcare system, such as insurance reimbursements, education for physicians so that they can provide a better explanation to their patients, and genetic literacy of physicians and patients. The physicians offered insights into the challenges they experienced related to IC, disclosure of SFs, and expectations for active collaborations with clinical genetics professionals. Wider healthcare insurance coverage and better genetic literacy of the population may lead to more patients taking confirmatory tests when SFs are suspected.
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14
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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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15
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Marwa B, Krueger J, Stephenson EA, Davidson S, Allan D, Knoppers B, Zawati M, Sullivan P, Shlien A, Malkin D, Fernandez CV, Villani A. Ethical and Analytic Challenges With Genomic Sequencing of Relapsed Hematologic Malignancies Following Allogeneic Hematopoietic Stem-Cell Transplantation. JCO Precis Oncol 2021; 5:1339-1347. [DOI: 10.1200/po.20.00489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The implementation of precision medicine and next-generation sequencing technologies in the field of oncology is a novel approach being more widely studied and used in cases of high-risk primary and recurrent malignancies. Leukemias are the second most common cause of cancer-related mortality in children and the sixth most in adults. Relapsed leukemia represents a major component of the population that may benefit from genomic sequencing. However, ethical and analytic challenges arise when considering sequencing of biologic samples obtained from patients with relapsed leukemia following allogeneic hematopoietic stem-cell transplantation. Blood from the recipient after transplantation would include donor-derived cells and thus, genomic sequencing of recipient blood will interrogate the donor germline in addition to the somatic genetic profile of the leukemia cells and the recipient germline. This is a situation for which the donor will not have typically provided consent and may be particularly problematic if actionable secondary or incidental findings related to the donor are uncovered. We present the challenges raised in this scenario and provide strategies to mitigate this risk.
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Affiliation(s)
- Bilal Marwa
- Division of Pediatric Hematology and Oncology, IWK, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joerg Krueger
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth A. Stephenson
- Division of Pediatric Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Scott Davidson
- Genetics and Genome Biology Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - David Allan
- Stem Cells, Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Bartha Knoppers
- Centre of Genomics and Policy, McGill University, Montreal, Quebec, Canada
| | - Ma'n Zawati
- Centre of Genomics and Policy, McGill University, Montreal, Quebec, Canada
| | | | - Adam Shlien
- Genetics and Genome Biology Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - David Malkin
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Genetics and Genome Biology Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Conrad V. Fernandez
- Division of Pediatric Hematology and Oncology, IWK, Dalhousie University, Halifax, Nova Scotia, Canada
- The Department of Bioethics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anita Villani
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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16
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Roth JA, Trivedi MS, Gray SW, Patrick DL, Delaney DM, Watabayashi K, Litwin P, Shah P, Crew KD, Yee M, Redman MW, Unger JM, Papadimitrakopoulou V, Johnson J, Kelly K, Gandara D, Herbst RS, Hershman DL, Ramsey SD. Patient Knowledge and Expectations About Return of Genomic Results in a Biomarker-Driven Master Protocol Trial (SWOG S1400GEN). JCO Oncol Pract 2021; 17:e1821-e1829. [PMID: 33797955 PMCID: PMC9810137 DOI: 10.1200/op.20.00770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Biomarker-driven master protocols represent a new paradigm in oncology clinical trials, but their complex designs and wide-ranging genomic results returned can be difficult to communicate to participants. The objective of this pilot study was to evaluate patient knowledge and expectations related to return of genomic results in the Lung Cancer Master Protocol (Lung-MAP). METHODS Eligible participants with previously treated advanced non-small-cell lung cancer were recruited from patients enrolled in Lung-MAP. Participants completed a 38-item telephone survey ≤ 30 days from Lung-MAP consent. The survey assessed understanding about the benefits and risks of Lung-MAP participation and knowledge of the potential uses of somatic testing results returned. Descriptive statistics and odds ratios for associations between demographic factors and correct responses to survey items were assessed. RESULTS From August 1, 2017, to June 30, 2019, we recruited 207 participants with a median age of 67, 57.3% male, and 94.2% White. Most participants "strongly/somewhat agreed" with statements that they "received enough information to understand" Lung-MAP benefits (82.6%) and risks (69.5%). In items asking about potential uses of Lung-MAP genomic results, 87.0% correctly indicated that the results help to select cancer treatment, but < 20% correctly indicated that the results are not used to confirm cancer diagnosis, would not reveal risk of developing diseases besides cancer, and would not indicate if family members had increased cancer risk. There were no associations between sociodemographic factors and proportions providing correct responses. CONCLUSION In a large National Clinical Trials Network biomarker-driven master protocol, most participants demonstrated incorrect knowledge and expectations about the uses of genomic results provided in the study despite most indicating that they had enough information to understand benefits and risks.
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Affiliation(s)
- Joshua A. Roth
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA,Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA,Joshua A. Roth, PhD, MHA, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, 1101 Fairview Ave North, Seattle, WA 98109; e-mail:
| | - Meghna S. Trivedi
- Division of Hematology/Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY
| | - Stacy W. Gray
- Division of Clinical Cancer Genomics, City of Hope Cancer Center, Duarte, CA
| | - Donald L. Patrick
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA
| | - Debbie M. Delaney
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Kate Watabayashi
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Paul Litwin
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Parth Shah
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA,Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Katherine D. Crew
- Division of Hematology/Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY
| | - Monica Yee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Mary W. Redman
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Joseph M. Unger
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA,Cancer Research and Biostatistics, SWOG Cancer Research Network, Seattle, WA
| | - Vassiliki Papadimitrakopoulou
- Division of Medical Oncology, MD Anderson Cancer Center, University of Texas, Houston, TX,Currently: Pfizer, Inc, New York, NY
| | | | - Karen Kelly
- Department of Internal Medicine, University of California Davis Comprehensive Cancer Center, Sacramento, CA
| | - David Gandara
- Department of Internal Medicine, University of California Davis Comprehensive Cancer Center, Sacramento, CA
| | - Roy S. Herbst
- Department of Medical Oncology, Yale Cancer Center, New Haven, CT
| | - Dawn L. Hershman
- Division of Hematology/Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY
| | - Scott D. Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA,Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA,Department of Health Services, School of Public Health, University of Washington, Seattle, WA
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17
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The Attitude of Patients from a Romanian Tertiary Cardiology Center Regarding Participation in Biomarker-Based Clinical Trials. Medicina (B Aires) 2021; 57:medicina57111180. [PMID: 34833398 PMCID: PMC8625162 DOI: 10.3390/medicina57111180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives: biomarker-based studies are the cornerstone of precision medicine, providing key data for tailored medical care. Enrollment of the planned number of patients is a critical determinant of a successful clinical trial. Moreover, for inclusive medical care, patients from different socio-demographic backgrounds must be recruited. Still, a significant number of trials fail to reach these prerequisites. Designing the informed consent forms based on the patients’ feedback could optimize accrual. We aimed to explore the attitudes of patients from a Romanian tertiary cardiology center towards participation in biomarker-based clinical trials. Materials and Methods: three hundred forty inpatients were interviewed based on a semi-structured questionnaire which included four sections: demographics, personal medical history, attitudes and trust. Results: Roughly, 62.5% of the respondents were interested in enrolling, while altruistic reasons were the most frequently expressed. Clear exposure of the possible risks was most valued (37.78%), followed by the possibility of directly communicating with the research team (23.78%). The most frequently chosen answer by acutely ill patients was improvement of their health, whereas chronically ill individuals indicated the possibility of withdrawal without affecting the quality of medical care. Importantly, the participation rate could be improved if the invitation to enrollment were made by both the current physician and the study coordinator (p = 0.0001). The level of trust in researchers was high in more than 50% of the respondents, and was correlated with therapeutic compliance and with the desire to join a biomarker study. Conclusions: the information gained will facilitate a tailored approach to patient enrollment in future biomarker-based studies in our clinic.
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18
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Blee SM, Shah RP, Pinheiro APM, Switchenko J, Dixon M, Owonikoko TK, Hill CE, Szabo SM, Pentz RD. Physician Communication and Patient Understanding of Molecular Testing Terminology. Oncologist 2021; 26:934-940. [PMID: 34369626 DOI: 10.1002/onco.13930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/02/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The use of molecular testing in oncology is rapidly expanding. The aim of this study was to determine how oncologists describe molecular testing and whether patients understand the terminology being used. MATERIALS AND METHODS Sixty conversations between oncologists and patients about molecular testing were observed, and the used technical terms were noted by the researcher. Patients were interviewed post-conversation to assess their understanding of the noted technical terms. A patient understanding score was calculated for each participant. Comparisons of the terms were conducted using χ2 tests, Fisher's exact tests, or ANOVA when appropriate. RESULTS Sixty-one unique technical terms were used by oncologists, to describe seven topics. "Mutation" was a challenging term for patients to understand with 48.8% (21/43 mentions) of participants correctly defining the term. "Genetic testing" and "Gene" were understood a little more than half the time (53.3%; 8/15 and 56.4%; 22/39 respectively). "DNA" was well understood (80%; 12/15). There was no correlation between the terms being defined by the oncologist in the conversation, and the likelihood of the patient providing a correct definition. White participants were significantly more likely to understand both "mutation" and "genetic testing" than non-White participants. Forty-two percent (n = 25) of participants had an understanding score below 50%, and a higher family income was significantly correlated with a higher score. CONCLUSION Our results show that oncologists use variable terminology to describe molecular testing, which is often not understood. Because oncologists defining the terms did not correlate with understanding, it is imperative to develop new, improved methods to explain molecular testing. IMPLICATIONS FOR PRACTICE The use of molecular testing is expanding in oncology, yet little is known about how effectively clinicians are communicating information about molecular testing and whether patients understand the terminology used. The results of this study indicate that patients do not understand some of the terminology used by their clinicians and that clinicians tend to use highly variable terminology to describe molecular testing. These results highlight the need to develop and implement effective methods to explain molecular testing terminology to patients to ensure that patients have the tools to make autonomous and informed decisions about their treatment.
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Affiliation(s)
- Shannon M Blee
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | | | - Ana P M Pinheiro
- Emory University School of Medicine, Atlanta, Georgia, USA.,Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Jeffrey Switchenko
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Margie Dixon
- Emory University School of Medicine, Atlanta, Georgia, USA.,Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Taofeek K Owonikoko
- Emory University School of Medicine, Atlanta, Georgia, USA.,Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Charles E Hill
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Stephen M Szabo
- Emory University School of Medicine, Atlanta, Georgia, USA.,Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Rebecca D Pentz
- Emory University School of Medicine, Atlanta, Georgia, USA.,Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
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19
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Wing SE, Hu H, Lopez L, Solomon I, Shen J, Raquel C, Sur M, Chao J, Cristea M, Fakih M, Mortimer J, Pal S, Reckamp K, Yuan Y, Gray SW. Recall of genomic testing results among cancer patients. Oncologist 2021; 26:e2302-e2305. [PMID: 34355454 PMCID: PMC8649013 DOI: 10.1002/onco.13928] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/23/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Genomic testing of somatic and germline DNA has transformed cancer care. However, low genetic knowledge among patients may compromise care and health outcomes. Given the rise in genomic testing, we sought to understand patients' knowledge of their genetic test results. MATERIALS AND METHODS We conducted a survey-based study with 85 patients at a comprehensive cancer center. We compared self-reported recall of 1) having had somatic/germline testing and 2) their specific somatic/germline results to the genomic test results documented in the medical record. RESULTS Approximately 30% of patients did not recall having had testing. Of those who recalled having testing, 44% of patients with pathogenic/likely pathogenic germline mutations and 57% of patients with reported somatic alterations did not accurately recall their specific gene or variant-level results. CONCLUSION Given significant knowledge gaps in patients' recall of genomic testing, there is a critical need to improve patient-directed education and return-of-results strategies.
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Affiliation(s)
- Sam E Wing
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Hengrui Hu
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Lisa Lopez
- School of Nursing, University of Texas at Austin, Austin, TX
| | - Ilana Solomon
- Center for Precision Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Jenny Shen
- Department of Psychology, Stony Brook University, Stony Brook, NY
| | - Catherine Raquel
- College of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Melissa Sur
- University of South Florida, Morsani College of Medicine, Tampa, FL
| | - Joseph Chao
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Mihaela Cristea
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Marwan Fakih
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Joanne Mortimer
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Sumanta Pal
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Karen Reckamp
- Department of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Yuan Yuan
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Stacy W Gray
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA.,Center for Precision Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA.,Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA
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20
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Smith-Uffen M, Bartley N, Davies G, Best M. Motivations and barriers to pursue cancer genomic testing: A systematic review. PATIENT EDUCATION AND COUNSELING 2021; 104:1325-1334. [PMID: 33390305 DOI: 10.1016/j.pec.2020.12.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 11/21/2020] [Accepted: 12/23/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Single-gene testing is associated with psycho-social challenges for cancer patients. Genomic testing may amplify these. The aim of this study was to understand patients' motivations and barriers to pursue cancer genomic testing, to enable healthcare providers to support their patients throughout the testing process and interpretation of test results. METHODS Five databases were searched for original peer reviewed research articles published between January 2001 and September 2018 addressing motivation for genomic cancer testing. QualSyst was used to assess quality. RESULTS 182 studies were identified and 17 were included for review. Studies were heterogenous. Both somatic and germline testing were included, and 14 studies used hypothetical scenarios. 3249 participants were analyzed, aged 18 to 94. Most were female and white. The most common diagnoses were breast, ovarian, lung and colorectal cancer. Interest in testing was high. Motivations included ability to predict cancer risk, inform disease management, benefit families, and understand cancer. Barriers included concerns about cost, privacy/confidentiality, clinical utility, and psychological harm. CONCLUSIONS Despite concerns, consumers are interested in cancer genomic testing if it can provide actionable results for themselves and their families. PRACTICE IMPLICATIONS Providers must manage understanding and expectations of testing and translate genetic information into health-promoting behaviours.
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Affiliation(s)
- Megan Smith-Uffen
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Nicci Bartley
- Faculty of Science, School of Psychology, University of Sydney, Sydney, Australia
| | - Grace Davies
- Faculty of Science, School of Psychology, University of Sydney, Sydney, Australia
| | - Megan Best
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Faculty of Science, School of Psychology, University of Sydney, Sydney, Australia; University of Notre Dame Australia, Sydney, Australia
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21
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Peckham A, Wright JG, Marani H, Abdelhalim R, Laxer D, Allin S, Alam N, Marchildon G. Putting the Patient First: A Scoping Review of Patient Desires in Canada. Healthc Policy 2021; 16:46-69. [PMID: 34129478 PMCID: PMC8200834 DOI: 10.12927/hcpol.2021.26499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Patient-centred care is a key priority for governments, providers and stakeholders, yet little is known about the care preferences of patient groups. We completed a scoping review that yielded 193 articles for analysis. Five health states were used to account for the diversity of possible preferences based on health needs. Five broad themes were identified and expressed differently across the health states, including personalized care, navigation, choice, holistic care and care continuity. Patients' perspectives must be considered to meet the diverse needs of targeted patient groups, which can inform health system planning, quality improvement initiatives and targeting of investments.
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Affiliation(s)
- Allie Peckham
- Assistant Professor, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ; North American Observatory on Health Systems and Policies, University of Toronto, Toronto, ON
| | - James G Wright
- Chief, Economics, Policy and Research, Ontario Medical Association, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of Toronto, Toronto, ON
| | - Husayn Marani
- Research Assistant, North American Observatory on Health Systems and Policies, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of Toronto, Toronto, ON
| | - Reham Abdelhalim
- Research Assistant, North American Observatory on Health Systems and Policies, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of Toronto, Toronto, ON
| | - Dara Laxer
- Executive Director, Health Policy and Promotion, Ontario Medical Association, Toronto, ON
| | - Sara Allin
- Director of Operations, North American Observatory on Health Systems and Policies; Assistant Professor, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Nadia Alam
- Past President, Ontario Medical Association, Toronto, ON
| | - Greg Marchildon
- Director, North American Observatory on Health Systems and Policies; Professor, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
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22
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Shirdarreh M, Aziza O, Pezo RC, Jerzak KJ, Warner E. Patients' and Oncologists' Knowledge and Expectations Regarding Tumor Multigene Next-Generation Sequencing: A Narrative Review. Oncologist 2021; 26:e1359-e1371. [PMID: 33823080 DOI: 10.1002/onco.13783] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/25/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Tumor multigene next-generation sequencing (NGS) is increasingly being offered to cancer patients to guide clinical management and determine eligibility for clinical trials. We undertook a review of studies examining the knowledge and attitudes of patients and oncologists regarding the primary results and potential secondary findings of such testing. MATERIALS AND METHODS A search was conducted through the MEDLINE database using the following keywords: "neoplasms" and "molecular sequencing / genome sequencing / tumor profiling / NGS / whole exome sequencing" and "patient / oncologist" and "knowledge / attitudes / satisfaction / experience / evaluation / perspective / practice / preference." Articles meeting the inclusion criteria and additional relevant articles from their references were selected. RESULTS From 1,142 publications identified by the search and 9 from references, 21 publications were included in the final review. Patients generally had positive attitudes toward tumor NGS despite relatively little knowledge of test-related genetics concepts, but their expectations often exceeded the reality of low clinical utility. Patients with higher education and greater genetics knowledge had more realistic expectations and a more altruistic view of the role of NGS. Attitudes toward disclosure of secondary findings were highly variable. Oncologists had poor to moderate genomic literacy; they communicated challenges with tempering patient expectations and deciding what information to disclose. CONCLUSION Patients considering undergoing tumor NGS should be provided with easily understandable resources explaining the procedure, goals, and probable outcomes, whenever possible based on evidence-based guidelines. Continuing medical education programs on this topic for oncology health care professionals should strive to improve their genomic literacy and instruct them on how to optimally present this information to their patients. IMPLICATIONS FOR PRACTICE Oncologists are increasingly offering tumor multigene testing to patients with advanced cancers to guide more "personalized" treatment and/or determine eligibility for clinical trials. However, patients often have inadequate understanding and unrealistic expectations. Oncologists must ensure that they themselves have sufficient knowledge of the benefits and limitations of testing and must provide their patients with appropriate educational resources. Prior to testing, patients should be told the likelihood of finding a mutation in their specific tumor type for which a targeted treatment or clinical trial is available. Patients also need clear information about the possibility and implications of secondary findings.
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Affiliation(s)
- Melika Shirdarreh
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Orly Aziza
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Rossanna C Pezo
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Katarzyna J Jerzak
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Ellen Warner
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
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23
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Shin W, Jeong G, Son Y, Seo SS, Kang S, Park SY, Lim MC. The Knowledge and Attitude of Patients Diagnosed with Epithelial Ovarian Cancer towards Genetic Testing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052312. [PMID: 33652933 PMCID: PMC7956717 DOI: 10.3390/ijerph18052312] [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] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 11/16/2022]
Abstract
This study assessed the knowledge and attitude of patients with ovarian cancer (OC) toward OC and next generation sequencing (NGS). The data, including characteristics of patients, their knowledge about OC and their knowledge and attitude of NGS, were collected from June to October 2018. Of the 103 participants, 70.9% (n = 73) had cancer within the second-degree relatives, and 18.4% (n = 19) had BRCA pathogenic mutations. The percentage of right answer for the knowledge about OC and NGS was 64.7% (11/17) and 50% (6/12), respectively. The median number of patients who had positive expectations for the genetic test was 34 (range, 22-44). Based on a first-degree familial history, patients had a different degree of knowledge about OC (11 vs. 8.5, p = 0.026) and NGS (6.5 vs. 5, p = 0.011), but patients with a BRCA pathogenic mutation did not have a different degree of knowledge about OC and NGS panel testing. High-income families had a more positive attitude towards the genetic test than low-income families (p = 0.005). Women with OC do not have enough knowledge about OC (11/17, 64.7%) and NGS (6/12, 50%) but they showed a positive attitude toward the NGS test. These women need OC and NGS educational intervention.
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Affiliation(s)
- Wonkyo Shin
- Center for Gynecologic Cancer, National Cancer Center, 323 Ilsan-ro, Goyang 10408, Korea; (W.S.); (G.J.); (S.-S.S.); (S.K.); (S.-Y.P.)
| | - Gowoon Jeong
- Center for Gynecologic Cancer, National Cancer Center, 323 Ilsan-ro, Goyang 10408, Korea; (W.S.); (G.J.); (S.-S.S.); (S.K.); (S.-Y.P.)
| | - Yedong Son
- College of Nursing, Woosuk University, Wanju 55338, Korea;
| | - Sang-Soo Seo
- Center for Gynecologic Cancer, National Cancer Center, 323 Ilsan-ro, Goyang 10408, Korea; (W.S.); (G.J.); (S.-S.S.); (S.K.); (S.-Y.P.)
| | - Sokbom Kang
- Center for Gynecologic Cancer, National Cancer Center, 323 Ilsan-ro, Goyang 10408, Korea; (W.S.); (G.J.); (S.-S.S.); (S.K.); (S.-Y.P.)
- Division of Precision Medicine, Research Institute, National Cancer Center, 323 Ilsan-ro, Goyang 10408, Korea
- Department of Cancer Control & Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Korea
| | - Sang-Yoon Park
- Center for Gynecologic Cancer, National Cancer Center, 323 Ilsan-ro, Goyang 10408, Korea; (W.S.); (G.J.); (S.-S.S.); (S.K.); (S.-Y.P.)
| | - Myong Cheol Lim
- Center for Gynecologic Cancer, National Cancer Center, 323 Ilsan-ro, Goyang 10408, Korea; (W.S.); (G.J.); (S.-S.S.); (S.K.); (S.-Y.P.)
- Department of Cancer Control & Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Korea
- Center for Clinical Trials, Hospital, National Cancer Center, 323 Ilsan-ro, Goyang 10408, Korea
- Division of Tumor Immunology, National Cancer Center, 323 Ilsan-ro, Goyang 10408, Korea
- Correspondence: ; Tel.: +82-31-920-1763
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24
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De S, Tringham M, Hopia A, Tahvonen R, Pietilä AM, Vähäkangas K. Ethical Aspects of Genotype Disclosure: Perceptions of Participants in a Nutrigenetic Study in Finland. Public Health Genomics 2021; 24:33-43. [PMID: 33486491 DOI: 10.1159/000512640] [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] [Received: 03/31/2020] [Accepted: 10/26/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to gain insight into the understanding of genetics and perceptions on the ethical issues related to genotype disclosure of the participants in a nutrigenetic study. METHODS A close-ended questionnaire was developed based on literature and discussions among the research group members. The questionnaire contained a -total of 33 questions, which were divided into 4 categories - demographics, knowledge assessment, concerns related to participation, and opinions on disclosure of information. Majority of the participants (250 out of 281) of a nutrigenetic study, in which effect of disclosing APOE allele status on lifestyle changes was studied, completed the questionnaire online following the informed consent process. The responses from the knowledge assessment and the concern categories were transformed into knowledge and concern scales, respectively, and analysed by descriptive statistical methods. The statistical associations between the categorical variables were determined using χ2 test of independence. The relationship between the continuous variables was assessed using Pearson product-moment correlation coefficient and internal consistency of questions by Cronbach's alpha. RESULTS No correlation was observed between the level of education and knowledge scores. About 10% of the participants thought that the genetic predisposition would be stressful to them and their family members. CONCLUSIONS Careful distribution of information before a nutrigenetic study supports understanding and reduces concerns of genetic susceptibility. In Finland, strong basic education is likely to have strengthened the trust in research process.
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Affiliation(s)
- Suchetana De
- School of Pharmacy/Toxicology, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland,
| | - Maaria Tringham
- Functional Foods Forum, Faculty of Medicine, University of Turku, Turku, Finland
| | - Anu Hopia
- Functional Foods Forum, Faculty of Medicine, University of Turku, Turku, Finland
| | - Raija Tahvonen
- Production Systems/Food Processing and Quality, Natural Resources Institute Finland (Luke), Jokioinen, Finland
| | - Anna-Maija Pietilä
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Kirsi Vähäkangas
- School of Pharmacy/Toxicology, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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25
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Filoche S, Stone P, Cram F, Bacharach S, Dowell A, Sika-Paotonu D, Beard A, Ormandy J, Buchanan C, Thunders M, Dew K. Uncovering social structures and informational prejudices to reduce inequity in delivery and uptake of new molecular technologies. JOURNAL OF MEDICAL ETHICS 2020; 46:763-767. [PMID: 31911498 PMCID: PMC7656149 DOI: 10.1136/medethics-2019-105734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 11/16/2019] [Accepted: 11/19/2019] [Indexed: 05/08/2023]
Abstract
Advances in molecular technologies have the potential to help remedy health inequities through earlier detection and prevention; if, however, their delivery and uptake (and therefore any benefits associated with such testing) are not more carefully considered, there is a very real risk that existing inequities in access and use will be further exacerbated. We argue this risk relates to the way that information and knowledge about the technology is both acquired and shared, or not, between health practitioners and their patients.A healthcare system can be viewed as a complex social network comprising individuals with different worldviews, hierarchies, professional cultures and subcultures and personal beliefs, both for those giving and receiving care. When healthcare practitioners are not perceived as knowledge equals, they would experience informational prejudices, and the result is that knowledge dissemination across and between them would be impeded. The uptake and delivery of a new technology may be inequitable as a result. Patients would also experience informational prejudice when they are viewed as not being able to understand the information that is presented to them, and information may be withheld.Informational prejudices driven by social relations and structures have thus far been underexplored in considering (in)equitable implementation and uptake of new molecular technologies. Every healthcare interaction represents an opportunity for experiencing informational prejudice, and with it the risk of being inappropriately informed for undertaking (or offering) such screening or testing. Making knowledge acquisition and information dissemination, and experiences of informational prejudice, explicit through sociologically framed investigations would extend our understandings of (in)equity, and offer ways to affect network relationships and structures that support equity in delivery and uptake.
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Affiliation(s)
- Sara Filoche
- Department of Obstetrics, Gynaecology and Women's Health and Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand
| | - Peter Stone
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | | | - Sondra Bacharach
- School of History, Philosophy, Political Science and International Relations, Victoria University, Wellington, New Zealand
| | - Anthony Dowell
- Department of Primary Health Care and General Practice, University of Otago Wellington, Wellington, New Zealand
| | - Dianne Sika-Paotonu
- Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand
| | - Angela Beard
- Christchurch Obstetric Associates, Christchurch, New Zealand
| | - Judy Ormandy
- Department of Obstetrics and Gynaecology, University of Otago, Christchurch, New Zealand
| | - Christina Buchanan
- Faculty of Medical and Health Sciences, The University of Auckland, New Zealand
| | - Michelle Thunders
- Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand
| | - Kevin Dew
- School of Social and Cultural Studies, Victoria University, Wellington, New Zealand
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26
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Benezech S, Saintigny P, Attignon V, Pissaloux D, Paindavoine S, Faure-Conter C, Corradini N, Marec-Berard P, Bergeron C, Cassier P, Eberst L, Dufresne A, Wang Q, Agrapart V, De La Fouchardière A, Perol D, Garin G, Corset V, Ben Abdesselem L, Chabaud S, Tredan O, Blay JY, Frappaz D. Tumor Molecular Profiling: Pediatric Results of the ProfiLER Study. JCO Precis Oncol 2020; 4:785-795. [PMID: 35050753 DOI: 10.1200/po.20.00023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The Program to Establish the Genetic and Immunologic Profile of Patient's Tumor for All Types of Advanced Cancer study (ClinicalTrials.gov identifier: NCT01774409) analyzed the genome of refractory cancers to identify a potential molecular-based recommended therapy (MBRT). The objectives of the pediatric substudy were to describe the incidence of genomic mutations, the MBRT, and the treatments undertaken with a molecular-targeted agent in a pediatric cohort. METHODS The tumor genome was analyzed within a 69-gene next-generation sequencing panel and an array comparative genomic hybridization assay. The results were evaluated by a multidisciplinary molecular board, and the targeted therapies were provided in the setting of a clinical trial or through compassionate use programs, when indicated. RESULTS Between November 2013 and June 2017, 50 patients younger than 19 years who were treated for a high-risk or relapsing tumor were included. Sarcomas (n = 24; 47%), CNS tumors (n = 14; 29%), and neuroblastomas (n = 5; 10%) were the most frequent tumor subtypes. Seven patients (14%) were excluded because no DNA could be recovered. Among the 43 remaining patients, 10 exhibited at least one targetable genomic alteration. Ultimately, four patients (8%) were treated with the recommended targeted therapy. CONCLUSION The results of this study confirm treatment with a targeted therapy for pediatric patients with cancer is still limited at present, as also is reported for adults.
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Affiliation(s)
- Sarah Benezech
- Institut d'Hématologie et Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | - Pierre Saintigny
- Department of Translational Research and Innovation, Centre Léon Bérard, Lyon, France.,Department of Medical Oncology, Centre Léon Bérard, France
| | - Valery Attignon
- Department of Translational Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Daniel Pissaloux
- Department of Translational Research and Innovation, Centre Léon Bérard, Lyon, France
| | | | - Cécile Faure-Conter
- Institut d'Hématologie et Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | - Nadège Corradini
- Institut d'Hématologie et Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | - Perrine Marec-Berard
- Institut d'Hématologie et Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | - Christophe Bergeron
- Institut d'Hématologie et Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | | | | | | | - Qing Wang
- Department of Translational Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Vincent Agrapart
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | | | - David Perol
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Gwenaëlle Garin
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Véronique Corset
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Leila Ben Abdesselem
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Sylvie Chabaud
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Olivier Tredan
- Department of Medical Oncology, Centre Léon Bérard, France.,University Claude Bernard Lyon 1, CNRS 5286, INSERM U1052, Cancer Research Center of Lyon, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, France.,University Claude Bernard Lyon 1, CNRS 5286, INSERM U1052, Cancer Research Center of Lyon, France
| | - Didier Frappaz
- Institut d'Hématologie et Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
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27
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McDaniels BA, Hianik RS, Bellcross C, Shaib WL, Switchenko J, Dixon MD, Meisel JL, Gogineni K, Pentz RD. The Impact of Genetic Counseling Educational Tools on Patients' Knowledge of Molecular Testing Terminology. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:864-870. [PMID: 31062281 PMCID: PMC6834865 DOI: 10.1007/s13187-019-01535-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Molecular testing is increasingly being integrated into cancer management. Despite rapid advancements, little work has been done to explore strategies for communicating with patients undergoing molecular tumor testing. This study evaluated the impact of genetic counseling educational tools on improving patients' understanding of key terms related to molecular testing. A genetic counseling intern designed a picture book to explain six words found in prior research to be difficult to understand (mutation, germline mutation, somatic mutation, biomarker, molecular testing, and targeted therapy). Participants who had previously discussed molecular testing with their oncologist were asked to define the terms. The same participants then received an explanation of each term either from the intern using the picture book in person or from a video presentation of the picture book. They were then asked to redefine each term afterward. The difference between the number of terms defined correctly pre- and post-intervention was compared between presentations. Sixty-three patients with melanoma, colon, lung, or breast cancer were recruited. After both interventions, correct understanding rates improved for all six terms, with significant improvement for germline mutation (p < 0.001), somatic mutation (p < 0.001), biomarker (p < 0.001), and molecular testing (p < 0.001). Understanding of targeted therapy improved significantly (p = 0.011) for the video presentation only. Mean change in knowledge scores did not differ between the two interventions (intern presentation 3.2 vs. video 2.9, p = 0.428). Our data suggest that genetic counseling educational tools can increase patient understanding of terms used to describe molecular testing.
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Affiliation(s)
- Brianna A McDaniels
- Emory University School of Medicine, 201 Dowman Dr., Atlanta, GA, 30322, USA.
| | | | - Cecelia Bellcross
- Emory University School of Medicine, 201 Dowman Dr., Atlanta, GA, 30322, USA
| | - Walid L Shaib
- Emory University School of Medicine, 201 Dowman Dr., Atlanta, GA, 30322, USA
- Winship Cancer Institute, Atlanta, GA, 30322, USA
| | - Jeffrey Switchenko
- Rollins School of Public Health Emory University, Atlanta, GA, 30322, USA
| | - Margie D Dixon
- Emory University School of Medicine, 201 Dowman Dr., Atlanta, GA, 30322, USA
- Winship Cancer Institute, Atlanta, GA, 30322, USA
| | - Jane L Meisel
- Emory University School of Medicine, 201 Dowman Dr., Atlanta, GA, 30322, USA
- Winship Cancer Institute, Atlanta, GA, 30322, USA
| | - Keerthi Gogineni
- Emory University School of Medicine, 201 Dowman Dr., Atlanta, GA, 30322, USA
- Winship Cancer Institute, Atlanta, GA, 30322, USA
| | - Rebecca D Pentz
- Emory University School of Medicine, 201 Dowman Dr., Atlanta, GA, 30322, USA
- Winship Cancer Institute, Atlanta, GA, 30322, USA
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28
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Pichler T, Rohrmoser A, Letsch A, Westphalen CB, Keilholz U, Heinemann V, Lamping M, Jost PJ, Riedmann K, Herschbach P, Goerling U. Information, communication, and cancer patients' trust in the physician: what challenges do we have to face in an era of precision cancer medicine? Support Care Cancer 2020; 29:2171-2178. [PMID: 32885314 PMCID: PMC7892511 DOI: 10.1007/s00520-020-05692-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/19/2020] [Indexed: 01/05/2023]
Abstract
Purpose Despite promising achievements in precision cancer medicine (PCM), participating patients are still faced with manifold uncertainties, especially regarding a potential treatment benefit of molecular diagnostics (MD). Hence, MD poses considerable challenges for patient information and communication. To meet these challenges, healthcare professionals need to gain deeper insight into patients’ subjective experiences. Therefore, this qualitative study examined information aspects of MD programs in cancer patients. Methods In two German Comprehensive Cancer Centers, 30 cancer patients undergoing MD participated in semi-structured interviews on information transfer and information needs regarding MD. Additionally, patients provided sociodemographic and medical data and indicated their subjective level of information (visual analogue scale, VAS, 0–10). Results On average patients had high levels of information (mean = 7, median = 8); nevertheless 20% (n = 6) showed an information level below 5 points. Qualitative analysis revealed that patients show limited understanding of the complex background of MD and have uncertainties regarding their personal benefit. Further, patients described unmet information needs. Existential threat in awaiting the results was experienced as burdensome. To withstand the strains of their situation, patients emphasized the importance of trusting their physician. Conclusion The challenges in PCM consist in providing unambiguous information, especially concerning treatment benefit, and providing guidance and support. Therefore, psycho-oncology needs to develop guidelines for adequate patient communication in order to help healthcare providers and cancer patients to handle these challenges in the developing field of PCM. Electronic supplementary material The online version of this article (10.1007/s00520-020-05692-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Theresia Pichler
- Comprehensive Cancer Center Munich, partner site TUM, Klinikum rechts der Isar, Munich, Germany. .,Comprehensive Cancer Center Munich, partner site LMU, University hospital, LMU Munich, Munich, Germany.
| | - Amy Rohrmoser
- Charité - Universitätsmedizin Berlin, Charité Comprehensive Cancer Center, Berlin, Germany
| | - Anne Letsch
- Charité - Universitätsmedizin Berlin, Charité Comprehensive Cancer Center, Berlin, Germany.,Department of Hematology and Oncology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - C Benedikt Westphalen
- Comprehensive Cancer Center Munich, partner site LMU, University hospital, LMU Munich, Munich, Germany.,Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Ulrich Keilholz
- Charité - Universitätsmedizin Berlin, Charité Comprehensive Cancer Center, Berlin, Germany
| | - Volker Heinemann
- Comprehensive Cancer Center Munich, partner site LMU, University hospital, LMU Munich, Munich, Germany.,Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Mario Lamping
- Charité - Universitätsmedizin Berlin, Charité Comprehensive Cancer Center, Berlin, Germany.,Department of Hematology and Oncology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Philipp J Jost
- Center for Personalized Oncology (ZPO), Comprehensive Cancer Center Munich, partner site TUM, Munich, Germany.,Medical Department III for Hematology and Oncology, Klinikum rechts der Isar, TUM, Munich, Germany
| | - Kristina Riedmann
- Center for Personalized Oncology (ZPO), Comprehensive Cancer Center Munich, partner site TUM, Munich, Germany.,Medical Department III for Hematology and Oncology, Klinikum rechts der Isar, TUM, Munich, Germany
| | | | - Ute Goerling
- Charité - Universitätsmedizin Berlin, Charité Comprehensive Cancer Center, Berlin, Germany
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Anderson N, Delavar A, Friedman DN, Joseph V, Mubdi N, Oeffinger KC, Sklar CA, Offit K, Matasar M, Raghunathan N, Antal Z, Straus D, Walsh M, Latham A, Tonorezos ES. Utilization of clinical genetic counseling among childhood and young adult cancer survivors in a registry trial. J Community Genet 2020; 11:501-504. [PMID: 32676930 DOI: 10.1007/s12687-020-00478-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 07/10/2020] [Indexed: 10/23/2022] Open
Abstract
We describe utilization of clinical genetic services among survivors of childhood and young adult cancer after participation in a genetic registry. Clinical genetic counselors flagged 162 out of 1069 pedigrees (15.2%) as suggestive of inheritable cancer susceptibility, resulting in 126 (11.8%) referral letters. Following delivery of the referral letters, 19 (15.1%) participants completed clinical genetic counseling, 16 (12.7%) received testing, and four (3.2%) were found to have actionable results. Our results suggest a discordance between reported willingness to undergo genetic counseling and real-world utilization.
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Affiliation(s)
| | - Arash Delavar
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,School of Medicine, University of California San Diego, La Jolla, CA, USA
| | | | - Vijai Joseph
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nidha Mubdi
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Kenneth Offit
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Matthew Matasar
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Nirupa Raghunathan
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Zoltan Antal
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David Straus
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Michael Walsh
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alicia Latham
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Emily S Tonorezos
- Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Weill Cornell Medical College, New York, NY, USA. .,Adult Long-Term Follow-Up Program, Memorial Sloan Kettering, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA.
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30
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Davies G, Butow P, Napier CE, Bartley N, Juraskova I, Meiser B, Ballinger ML, Thomas DM, Schlub TE, Best MC. Advanced Cancer Patient Knowledge of and Attitudes towards Tumor Molecular Profiling. Transl Oncol 2020; 13:100799. [PMID: 32450551 PMCID: PMC7256320 DOI: 10.1016/j.tranon.2020.100799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 01/24/2023] Open
Abstract
Limited research has indicated that despite their overwhelming interest in tumor molecular profiling (MP),1 cancer patients have poor knowledge about MP. The current study aimed to investigate demographic and psychological predictors of knowledge and perceived importance of MP in an advanced cancer patient cohort. Eligible participants had advanced solid cancers of any histological type with sufficient accessible tissue for MP and were enrolled in the Molecular Screening and Therapeutics (MoST) Program. A questionnaire was completed by 1074 participants (91% response rate) after consent, prior to undergoing MP. Overall, participants had poor to moderate knowledge of MP, yet perceived MP to have high importance. Higher education, speaking English at home, and greater satisfaction with the decision to undergo MP were associated with higher knowledge scores. More negative attitudes towards uncertainty, greater self-efficacy to cope with results, and lower perceived likelihood of cancer progression were associated with greater perceived importance of MP. Less educated participants and those who do not speak English at home will need clear explanations, visual aids and ample opportunity to ask questions about MP at the time of their decision-making. Clinicians also need to consider psychological factors relevant to patients' decision to pursue MP. Given the increased awareness of and demand for cancer genomic information and the rapidly changing nature of the actionability of MP, these findings will help inform an important ongoing debate on how to facilitate ethical and informed consent and manage patient expectations about personalized treatments.
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Affiliation(s)
- Grace Davies
- The University of Sydney, Faculty of Science, School of Psychology, Psycho-Oncology Co-operative Research Group, Sydney, NSW 2006, Australia.
| | - Phyllis Butow
- The University of Sydney, Faculty of Science, School of Psychology, Psycho-Oncology Co-operative Research Group, Sydney, NSW 2006, Australia.
| | - Christine E Napier
- Cancer Division, Garvan Institute of Medical Research, Sydney, NSW 2010, Australia.
| | - Nicci Bartley
- The University of Sydney, Faculty of Science, School of Psychology, Psycho-Oncology Co-operative Research Group, Sydney, NSW 2006, Australia.
| | - Ilona Juraskova
- The University of Sydney, Faculty of Science, School of Psychology, Psycho-Oncology Co-operative Research Group, Sydney, NSW 2006, Australia.
| | - Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, University of NSW, Sydney, NSW 2032, Australia.
| | - Mandy L Ballinger
- Cancer Division, Garvan Institute of Medical Research, Sydney, NSW 2010, Australia; St Vincent's Clinical School, University of NSW, Sydney, NSW 2010, Australia.
| | - David M Thomas
- Cancer Division, Garvan Institute of Medical Research, Sydney, NSW 2010, Australia; St Vincent's Clinical School, University of NSW, Sydney, NSW 2010, Australia.
| | - Timothy E Schlub
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney, NSW 2006, Australia.
| | - Megan C Best
- The University of Sydney, Faculty of Science, School of Psychology, Psycho-Oncology Co-operative Research Group, Sydney, NSW 2006, Australia.
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31
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Solomon IB, McGraw S, Shen J, Albayrak A, Alterovitz G, Davies M, Del Vecchio Fitz C, Freedman RA, Lopez LN, Sholl LM, Van Allen E, Mortimer J, Fakih M, Pal S, Reckamp KL, Yuan Y, Gray SW. Engaging Patients in Precision Oncology: Development and Usability of a Web-Based Patient-Facing Genomic Sequencing Report. JCO Precis Oncol 2020; 4:1900195. [PMID: 32923887 DOI: 10.1200/po.19.00195] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Evidence-based somatic and germline sequencing has transformed cancer care and improves patient outcomes. However, patients' low genetic literacy and misunderstanding of their own genomic results poses a threat to the realization of precision oncology. To optimize patient genomic comprehension, we developed a Web-based, patient-directed, genomic sequencing education and return-of-results tool, HOPE-Genomics. METHODS The HOPE-Genomics prototype included somatic and germline sequencing results, embedded multimedia genomic education, and interactive features (eg, request for genetic counseling). Between January and April 2018, we elicited feedback on tool usability and comprehensiveness through participant surveys, 4 focus groups of patients with cancer and their family members, and 3 provider focus groups (comprising 8 patients, 5 family members, and 19 providers). RESULTS We identified themes in patient/family tool-related responses, including the desire to view a patient-friendly report, a desire to receive multiple types of genomic information (eg, prognostic and uncertain), high acceptability of report content, and interest in tool-enabled access to genetic counseling. Major themes from the clinician focus groups included believing the tool could help patients formulate questions and facilitate patients' communication of results to family members. However, there were diverse responses from all participants in terms of tool implementation (ie, timing and nature of report release). Some participants preferred report release before meeting with the provider, and others preferred it during the appointment. Additionally, some clinicians were concerned about providing prognostic and treatment information through the tool. CONCLUSION There was high acceptability and interest from patients, family members, and providers in a patient-directed genomics report. Future work will determine whether direct-to-patient reporting of genomic results improves patient knowledge, care engagement, and compliance with genomically guided interventions.
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Affiliation(s)
- Ilana B Solomon
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | | | - Jenny Shen
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA
| | | | - Gil Alterovitz
- Harvard Medical School, Boston, MA.,Department of Biomedical Informatics, Boston Children's' Hospital, Boston; and Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA
| | - Melanie Davies
- Department of Informatics and Analytics, Dana-Farber Cancer Institute, Boston, MA
| | | | - Rachel A Freedman
- Harvard Medical School, Boston, MA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Lisa N Lopez
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Lynette M Sholl
- Harvard Medical School, Boston, MA.,Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | - Eliezer Van Allen
- Harvard Medical School, Boston, MA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.,The Broad Institute, Cambridge, MA
| | - Joanne Mortimer
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Marwan Fakih
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Sumanta Pal
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Karen L Reckamp
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Yuan Yuan
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Stacy W Gray
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA
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32
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Hillyer GC, Schmitt KM, Reyes A, Cruz A, Lizardo M, Schwartz GK, Terry MB. Community education to enhance the more equitable use of precision medicine in Northern Manhattan. J Genet Couns 2020; 29:247-258. [PMID: 32157769 DOI: 10.1002/jgc4.1244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 02/15/2020] [Accepted: 02/17/2020] [Indexed: 12/30/2022]
Abstract
Focusing screening and treatment to those most likely to benefit is the promise of precision medicine but inequitable distribution of precision medicine innovations may exacerbate health disparities. We investigated whether complex genomic concepts can be successfully communicated to diverse populations. Incorporating principles of Community-based Participatory Research, we created a precision medicine curriculum tailored to the needs of our predominantly Hispanic community. We administered the curriculum over 26 months, assessed pre- and post-test comprehension of 8 genetics-related terms, and compared comprehension differences based on demography and health literacy. In total, 438 individuals completed pre-/post-test assessments. At pre-test, 45.6% scored ≥75% across eight major constructs; 66.7% at post-test. Comprehension increased for 7/8 terms with greatest pre/post-test increases for 'mutation' (55% to 78%) and 'sporadic' (34% to 59%). Mean pre-test comprehension scores (≥75%) were lower for Spanish versus. English speakers; mean post-test scores were equivalent. No heterogeneity by demographics or health literacy was observed. We demonstrate that a brief community educational program can improve knowledge of complex genomic concepts. Interventions to increase understanding of genomic concepts underlying precision medicine are key to patients making informed treatment and prevention decisions and may lead to more equitable uptake of precision medicine initiatives.
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Affiliation(s)
- Grace C Hillyer
- Department of Epidemiology, Mailman School of Public Health, New York, NY, USA.,Herbert Irving Comprehensive Cancer Center of Columbia University, New York, NY, USA
| | - Karen M Schmitt
- Herbert Irving Comprehensive Cancer Center of Columbia University, New York, NY, USA.,New York Presbyterian Hospital, New York, NY, USA
| | - Andria Reyes
- Herbert Irving Comprehensive Cancer Center of Columbia University, New York, NY, USA
| | - Alejandro Cruz
- Herbert Irving Comprehensive Cancer Center of Columbia University, New York, NY, USA
| | - Maria Lizardo
- Northern Manhattan Improvement Corporation, New York, NY, USA
| | - Gary K Schwartz
- Herbert Irving Comprehensive Cancer Center of Columbia University, New York, NY, USA.,Columbia University Irving Medical Center, New York, NY, USA
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, New York, NY, USA.,Herbert Irving Comprehensive Cancer Center of Columbia University, New York, NY, USA
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33
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Wolyniec K, Sharp J, Lazarakis S, Mileshkin L, Schofield P. Understanding and information needs of cancer patients regarding treatment‐focused genomic testing: A systematic review. Psychooncology 2020; 29:632-638. [DOI: 10.1002/pon.5351] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/28/2020] [Accepted: 02/02/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Kamil Wolyniec
- Department of Psychological SciencesSwinburne University of Technology Hawthorn Victoria Australia
- Department of Cancer Experiences ResearchPeter MacCallum Cancer Centre Melbourne Victoria Australia
| | - Jessica Sharp
- Department of Statistics Data Science and EpidemiologySwinburne University of Technology Hawthorn Victoria Australia
| | - Smaro Lazarakis
- Health Sciences LibraryRoyal Melbourne Hospital Melbourne Victoria Australia
| | - Linda Mileshkin
- Sir Peter MacCallum Department of OncologyUniversity of Melbourne Melbourne Victoria Australia
| | - Penelope Schofield
- Department of Psychological SciencesSwinburne University of Technology Hawthorn Victoria Australia
- Department of Cancer Experiences ResearchPeter MacCallum Cancer Centre Melbourne Victoria Australia
- Sir Peter MacCallum Department of OncologyUniversity of Melbourne Melbourne Victoria Australia
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34
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Lee MJ, Hueniken K, Kuehne N, Lu L, Jiang SX, Id Said B, McCartney A, Gao Y, Liang M, Obuobi T, Sorotsky H, Eng L, Brown MC, Xu W, Liu G. Cancer Patient-Reported Preferences and Knowledge for Liquid Biopsies and Blood Biomarkers at a Comprehensive Cancer Center. Cancer Manag Res 2020; 12:1163-1173. [PMID: 32104096 PMCID: PMC7025660 DOI: 10.2147/cmar.s235777] [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: 10/27/2019] [Accepted: 01/29/2020] [Indexed: 01/11/2023] Open
Abstract
Background Blood-based biomarkers (liquid biopsy) are increasingly used in precision oncology. Yet, little is known about cancer patients' perspectives in clinical practice. We explored patients' depth of preferences for liquid vs tissue biopsies and knowledge regarding the role of blood biomarkers on their cancer. Methods Three interviewer-administered trade-off scenarios and a 54-item self-administered questionnaire were completed by cancer outpatients across all disease sites at the Princess Margaret Cancer Centre. Results Of 413 patients, 54% were female; median age was 61 (range 18-101) years. In trade-off scenario preference testing, 90% (n=372) preferred liquid over tissue biopsy at baseline; when wait times for their preferred test were increased from 2 weeks, patients tolerated an additional mean of 1.8 weeks (SD 2.1) for liquid biopsy before switching to tissue biopsy (with wait time 2 weeks). Patients also tolerated a 6.2% decrease (SD 8.8) in the chance that their preferred test would conclusively determine optimal treatment before switching from the baseline of 80%. 216 patients (58%) preferred liquid biopsy even with no chance of adverse events from tissue biopsy. Patients' knowledge of blood-based biomarkers related to their cancer was low (mean 23%); however, the majority viewed development of blood biomarkers as important. Conclusion Patients had limited understanding of cancer-specific blood-based biomarkers, but 90% preferred liquid over tissue biopsies to assess biomarkers. There was little tolerance to wait longer for results, or for decreased test-conclusiveness. Developing accurate, low-risk tests for cancer diagnosis and management for blood biomarkers is therefore desirable to patients.
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Affiliation(s)
- Min Joon Lee
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Katrina Hueniken
- Department of Medical Biophysics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Nathan Kuehne
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Lin Lu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Shirley Xue Jiang
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Badr Id Said
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Alex McCartney
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Yizhuo Gao
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Mindy Liang
- Department of Medical Biophysics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Tamara Obuobi
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Hadas Sorotsky
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Lawson Eng
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - M Catherine Brown
- Department of Medical Biophysics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Geoffrey Liu
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Medical Biophysics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Epidemiology, Dalla Lana School of Public Health, Toronto, ON, Canada
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35
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Rohrmoser A, Pichler T, Letsch A, Westphalen CB, Keilholz U, Heinemann V, Goerling U, Herschbach P. Cancer patients' expectations when undergoing extensive molecular diagnostics—A qualitative study. Psychooncology 2019; 29:423-429. [DOI: 10.1002/pon.5282] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/02/2019] [Accepted: 10/27/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Amy Rohrmoser
- Charité Comprehensive Cancer Center Charité—Universitätsmedizin Berlin Berlin Germany
| | - Theresia Pichler
- Comprehensive Cancer Center München Munich Germany
- Klinikum rechts der Isar Technische Universität München Munich Germany
| | - Anne Letsch
- Charité Comprehensive Cancer Center Charité—Universitätsmedizin Berlin Berlin Germany
- Medizinische Klinik für Hämatologie und Onkologie Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin Berlin Germany
| | - C. Benedikt Westphalen
- Comprehensive Cancer Center München Munich Germany
- Medizinische Klinik und Poliklinik III Klinikum der Universität München Munich Germany
| | - Ulrich Keilholz
- Charité Comprehensive Cancer Center Charité—Universitätsmedizin Berlin Berlin Germany
| | - Volker Heinemann
- Comprehensive Cancer Center München Munich Germany
- Medizinische Klinik und Poliklinik III Klinikum der Universität München Munich Germany
| | - Ute Goerling
- Charité Comprehensive Cancer Center Charité—Universitätsmedizin Berlin Berlin Germany
| | - Peter Herschbach
- Comprehensive Cancer Center München Munich Germany
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Klinikum rechts der Isar Technische Universität München Munich Germany
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36
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Pentz RD, Lohani M, Hayban M, Switchenko JM, Dixon MD, DeFeo RJ, Orloff GM, Jani AB, Master VA. Videos improve patient understanding of misunderstood chemotherapy terminology. Cancer 2019; 125:4011-4018. [PMID: 31418849 DOI: 10.1002/cncr.32421] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 04/10/2019] [Accepted: 04/17/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Chemotherapy is the backbone of many cancer therapies; however, the terminology used to describe chemotherapy may be difficult for patients to understand, particularly in underserved populations. Studies have shown that educational videos can improve patient understanding of cancer-related terms. The goal of this study was to identify chemotherapy terms that were difficult for an underserved population to understand and then develop and test educational videos describing these terms. METHODS A word bank of 50 difficult-to-understand chemotherapy terms was developed by querying 15 providers and 50 patients at an underserved hospital. Twenty of these terms were then tested with 50 additional patients to determine rates of misunderstanding. Six pilot educational videos describing 6 important terms were created using VideoScribe and then assessed with 50 patients to see if they improved understanding. RESULTS Fifteen of the 20 terms tested to establish rates of misunderstanding were misunderstood by more than one third of patients, with 98% unable to define maintenance, 74% unable to define cancer, and 58% unable to define chemotherapy. Patient understanding of all 6 terms improved by at least 20% after watching the videos. Notable improvement was reported for palliative chemotherapy, where before-and-after video understanding increased from 0% to 72%. CONCLUSION Chemotherapy, a backbone of cancer treatment, is described with terms that are difficult to understand. Short, animated educational videos can significantly increase patient understanding of chemotherapy terminology.
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Affiliation(s)
- Rebecca D Pentz
- Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, Georgia.,Winship Cancer Institute, Atlanta, Georgia
| | - Minisha Lohani
- Medical School, Philadelphia College of Osteopathic Medicine-Georgia, Suwanee, Georgia
| | - Melissa Hayban
- Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Jeffrey M Switchenko
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Margie D Dixon
- Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Richard J DeFeo
- Care and Counseling Center of Georgia, Inc, Decatur, Georgia
| | - Gregg M Orloff
- Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Ashesh B Jani
- Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, Georgia.,Winship Cancer Institute, Atlanta, Georgia
| | - Viraj A Master
- Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, Georgia.,Winship Cancer Institute, Atlanta, Georgia
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37
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Underhill-Blazey M, Stopfer J, Chittenden A, Nayak MM, Lansang K, Lederman R, Garber J, Gundersen DA. Development and testing of the KnowGene scale to assess general cancer genetic knowledge related to multigene panel testing. PATIENT EDUCATION AND COUNSELING 2019; 102:1558-1564. [PMID: 31010603 DOI: 10.1016/j.pec.2019.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/13/2019] [Accepted: 04/12/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE To develop and evaluate a measure of cancer genetics knowledge relevant to multigene panel testing. METHODS The instrument was developed using systematic input from a national panel of genetics experts, acceptability evaluation by patient advocates, and cognitive testing. Twenty-four candidate items were completed by 591 breast or gynecological patients who had undergone genetic counseling and multigene panel testing in the past 18 months. A unidimensional item response theory model was fit with a mix of 2-parameter logistic nested response (2 plnrm) and 2-parameter logistic (2 pl) items. RESULTS Key domains addressing cancer genetics knowledge were found to be overlapping. Of the 24 candidate items, 8 items were removed due to poor discrimination or local dependence. The remaining 16 items had good fit (RMSEA = 0.045, CFI = 0.946) and discrimination parameters ranging from 0.49 to 1.60. The items specified as 2 plnrm distinguish between those answering incorrect versus don't know, with discrimination ranging from 0.51 to 1.02. Information curves were highest among those with lower knowledge. CONCLUSION KnowGene is a rigorously developed and effective measure of knowledge after cancer genetic counseling and multigene panel testing. PRACTICE IMPLICATIONS Measuring knowledge in a systematic way will inform practice and research initiatives in cancer genetics.
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Affiliation(s)
| | - Jill Stopfer
- Dana-Farber Cancer Institute, Brigham and Womens Hospital, Simmons College, United States
| | - Anu Chittenden
- Dana-Farber Cancer Institute, Brigham and Womens Hospital, Simmons College, United States
| | - Manan M Nayak
- Dana-Farber Cancer Institute, Brigham and Womens Hospital, Simmons College, United States
| | - Kristina Lansang
- Dana-Farber Cancer Institute, Brigham and Womens Hospital, Simmons College, United States
| | - Ruth Lederman
- Dana-Farber Cancer Institute, Brigham and Womens Hospital, Simmons College, United States
| | - Judy Garber
- Dana-Farber Cancer Institute, Brigham and Womens Hospital, Simmons College, United States
| | - Daniel A Gundersen
- Dana-Farber Cancer Institute, Brigham and Womens Hospital, Simmons College, United States
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38
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Best MC, Bartley N, Jacobs C, Juraskova I, Goldstein D, Newson AJ, Savard J, Meiser B, Ballinger M, Napier C, Thomas D, Biesecker B, Butow P. Patient perspectives on molecular tumor profiling: "Why wouldn't you?". BMC Cancer 2019; 19:753. [PMID: 31366375 PMCID: PMC6670204 DOI: 10.1186/s12885-019-5920-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 07/10/2019] [Indexed: 12/28/2022] Open
Abstract
Aim This study explored the attitudes of patients with advanced cancer towards MTP and return of results, prior to undergoing genomic testing within a research program. Methods Participants were recruited as part of the longitudinal PiGeOn (Psychosocial Issues in Genomics in Oncology) study involving patients with advanced/metastatic solid cancer who had exhausted therapeutic options and who were offered MTP in order to identify cognate therapies. Twenty patients, selected by purposive sampling, were interviewed around the time they gave consent to MTP. Interviews were audio recorded, transcribed and analysed using thematic analysis. Themes identified in the transcripts were cross-validated via qualitative responses to the PiGeOn study survey (n = 569; 63%). Results All interviewed participants gave consent to MTP without reservation. Three themes were identified and further supported via the survey responses: (1) Obvious agreement to participate, primarily because of desire for new treatments and altruism. (2) The black box – while participant knowledge of genomics was generally poor, faith in their oncologists and the scientific process encouraged them to proceed with testing; and (3) Survival is the priority – receiving treatment to prolong life was the priority for all participants, and other issues such as identification of a germline variant were generally seen as ancillary. Conclusion Having advanced cancer seemed to abrogate any potential concerns about MTP. Participants valued the research for varied reasons, but this was secondary to their priority to survive. While no negative attitudes toward MTP emerged, limitations in understanding of genomics were evident. Electronic supplementary material The online version of this article (10.1186/s12885-019-5920-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Megan C Best
- University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Level 6 North, Lifehouse C39Z, Sydney NSW, Sydney, 2006, Australia.
| | - Nicole Bartley
- University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Level 6 North, Lifehouse C39Z, Sydney NSW, Sydney, 2006, Australia
| | - Chris Jacobs
- University of Technology Sydney, Graduate School of Health, Broadway NSW, Sydney, 2007, Australia
| | - Ilona Juraskova
- University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Level 6 North, Lifehouse C39Z, Sydney NSW, Sydney, 2006, Australia
| | - David Goldstein
- Prince of Wales Clinical School, University of NSW, High Street, Kensington, NSW, 2032, Australia
| | - Ainsley J Newson
- Faculty of Medicine and Health, Sydney Health Ethics, University of Sydney, 92/94 Parramatta Road, Camperdown, NSW, 2050, Australia
| | - Jacqueline Savard
- School of Medicine, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
| | - Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, University of NSW, HighStreet, Kensington, NSW, 2032, Australia
| | - Mandy Ballinger
- Cancer Division, Garvan Institute of Medical Research, 384 Victoria street, Darlinghurst, NSW, 2010, Australia
| | - Christine Napier
- Cancer Division, Garvan Institute of Medical Research, 384 Victoria street, Darlinghurst, NSW, 2010, Australia
| | - David Thomas
- Cancer Division, Garvan Institute of Medical Research, 384 Victoria street, Darlinghurst, NSW, 2010, Australia
| | | | - Phyllis Butow
- University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Level 6 North, Lifehouse C39Z, Sydney NSW, Sydney, 2006, Australia
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Yanez B, Bouchard LC, Cella D, Sosman JA, Kircher SM, Mohindra NA, Cristofanilli M, Penedo FJ. Patient-centered engagement and symptom/toxicity monitoring in the new era of tumor next-generation sequencing and immunotherapy: The OncoTool and OncoPRO platforms. Cancer 2019; 125:2338-2344. [PMID: 31034599 DOI: 10.1002/cncr.32030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Laura C Bouchard
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jeffrey A Sosman
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sheetal M Kircher
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nisha A Mohindra
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Massimo Cristofanilli
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Frank J Penedo
- Departments of Psychology and Medicine, University of Miami, Miami, Florida
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Mihaela Micheu M, Udrea OM, Octavia Popa M, Rusu I, Gheorghe-Fronea O, Scafa-Udriste A, Dorobantu M. The Attitude of Patients from a Romanian Tertiary Cardiology Center as Regards Participation in Biomarker-Based Clinical Trials - Survey Methodology. J Med Life 2019; 11:320-327. [PMID: 30894889 PMCID: PMC6418342 DOI: 10.25122/jml-2018-0072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
One of the challenges faced when conducting a clinical trial is the recruitment of the proposed number of participants. Accordingly, identifying barriers to patients’ enrollment and developing effective strategies to overcome them is mandatory. One of the main strategies employed to improve participation rate consists of designing the informed consent forms based on patients’ feedback. This survey aims to explore the attitude of patients admitted in a Romanian tertiary cardiology center to take part in biomarker-based clinical trials. This is a descriptive, prospective and longitudinal single-center study. Participants will be recruited until the planned sample size will be reached (n=333). The patients will be interviewed based on a semi-structured questionnaire which includes four sections: demographics (7 items), personal medical history (7 items), attitudes (9 items) and trust (4 items). Descriptive statistics will be used to illustrate patients’ demographics, medical history, attitudes toward biomarker-based clinical trials and trust in medical researchers. Logistic regression models will be employed to assess relations between patients’ attitudes, trust, and different socio-demographic variables. Data analysis will offer answers to key questions addressed by this survey: What amount of and in what form should information be disclosed? Who should make the invitation to participate? The information gained will facilitate tailoring informed consent forms to suit the needs of patients with various demographic, social and educational backgrounds.
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Affiliation(s)
- Miruna Mihaela Micheu
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Bucharest, Romania
| | - Oana-Maria Udrea
- Department of Psychology, "Grigore Alexandrescu" Clinical Hospital of Bucharest, Bucharest, Romania
| | | | - Iulia Rusu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Oana Gheorghe-Fronea
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Bucharest, Romania.,University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Alexandru Scafa-Udriste
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Bucharest, Romania.,University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Maria Dorobantu
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Bucharest, Romania.,University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
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González-Gomariz J, Guruceaga E, López-Sánchez M, Segura V. Proteogenomics in the context of the Human Proteome Project (HPP). Expert Rev Proteomics 2019; 16:267-275. [PMID: 30654666 DOI: 10.1080/14789450.2019.1571916] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The technological and scientific progress performed in the Human Proteome Project (HPP) has provided to the scientific community a new set of experimental and bioinformatic methods in the challenging field of shotgun and SRM/MRM-based Proteomics. The requirements for a protein to be considered experimentally validated are now well-established, and the information about the human proteome is available in the neXtProt database, while targeted proteomic assays are stored in SRMAtlas. However, the study of the missing proteins continues being an outstanding issue. Areas covered: This review is focused on the implementation of proteogenomic methods designed to improve the detection and validation of the missing proteins. The evolution of the methodological strategies based on the combination of different omic technologies and the use of huge publicly available datasets is shown taking the Chromosome 16 Consortium as reference. Expert commentary: Proteogenomics and other strategies of data analysis implemented within the C-HPP initiative could be used as guidance to complete in a near future the catalog of the human proteins. Besides, in the next years, we will probably witness their use in the B/D-HPP initiative to go a step forward on the implications of the proteins in the human biology and disease.
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Affiliation(s)
- José González-Gomariz
- a Bioinformatics Platform, Center for Applied Medical Research , University of Navarra , Pamplona , Spain.,b IdiSNA , Navarra Institute for Health Research , Pamplona , Spain
| | - Elizabeth Guruceaga
- a Bioinformatics Platform, Center for Applied Medical Research , University of Navarra , Pamplona , Spain.,b IdiSNA , Navarra Institute for Health Research , Pamplona , Spain
| | - Macarena López-Sánchez
- a Bioinformatics Platform, Center for Applied Medical Research , University of Navarra , Pamplona , Spain
| | - Victor Segura
- a Bioinformatics Platform, Center for Applied Medical Research , University of Navarra , Pamplona , Spain.,b IdiSNA , Navarra Institute for Health Research , Pamplona , Spain
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Marron JM, Cronin AM, DuBois SG, Glade-Bender J, Kim A, Crompton BD, Meyer SC, Janeway KA, Mack JW. Duality of purpose: Participant and parent understanding of the purpose of genomic tumor profiling research among children and young adults with solid tumors. JCO Precis Oncol 2019; 3. [PMID: 31240271 DOI: 10.1200/po.18.00176] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Increasing use of genomic tumor profiling may blur the line between research and clinical care. We aimed to describe research participants' perspectives on the purpose of genomic tumor profiling research in pediatric oncology. METHODS We surveyed 45 participants (response rate 85%) in a pilot study of genomic profiling in pediatric solid tumors at four academic cancer centers following return of sequencing results. We defined understanding according to a one-item ("basic") definition (recognizing that the primary purpose was not to improve the patient's treatment) and a four-item ("comprehensive") definition (primary purpose was not to improve patient's treatment; primary purpose was to improve treatment of future patients; there may not be direct medical benefit; most likely result of participation was not increased likelihood of cure). RESULTS Sixty-eight percent of respondents (30/44) demonstrated basic understanding of the study purpose; 55% (24/44) demonstrated comprehensive understanding. Understanding was more frequently seen in those with higher education and greater genetic knowledge according to basic (81% vs 50%, p=0.05; and 82% vs 46%, p=0.03, respectively) and comprehensive definitions (73% vs 28%, p=0.01; 71% vs 23%, p=0.01). Ninety-three percent of respondents who believed the primary purpose was to improve the patient's care simultaneously stated that the research also aimed to benefit future patients. CONCLUSIONS Most participants in pediatric tumor profiling research understand that the primary goal of this research is to improve care for future patients, but many express dual goals when participating in sequencing research. Some populations demonstrate increased rates of misunderstanding. Nuanced participant views suggest further work is needed to assess and improve participant understanding, particularly as tumor sequencing moves beyond research into clinical practice.
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Affiliation(s)
- Jonathan M Marron
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts.,Office of Ethics, Boston Children's Hospital, Boston, Massachusetts.,Center for Bioethics, Harvard Medical School, Boston, Massachusetts
| | - Angel M Cronin
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Steven G DuBois
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Julia Glade-Bender
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Columbia University Medical Center, New York, New York
| | - AeRang Kim
- Department of Pediatric Oncology, Children's National Medical Center, Washington, District of Columbia
| | - Brian D Crompton
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Stephanie C Meyer
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Katherine A Janeway
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Jennifer W Mack
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
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Reed EK, Steinmark L, Seibert DC, Edelman E. Somatic Testing: Implications for Targeted Treatment. Semin Oncol Nurs 2019; 35:22-33. [PMID: 30660356 DOI: 10.1016/j.soncn.2018.12.009] [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: 10/27/2022]
Abstract
OBJECTIVE To provide an overview of key considerations for somatic testing for the purpose of targeting cancer treatment. DATA SOURCES Literature; research reports. CONCLUSION Genomic testing of cancer cells to identify variants that drive the carcinogenic process is becoming common in clinical settings. Providers and patients need to weigh the potential benefits of testing with technologic and logistic issues. IMPLICATIONS FOR NURSING PRACTICE Testing is available for thousands of genomic variants to identify one or more to guide targeted treatment. Oncology nurses need to understand the benefits and limitations of participating in patient-centered implementation of this testing.
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Kaphingst KA, Ivanovich J, Lyons S, Biesecker B, Dresser R, Elrick A, Matsen C, Goodman M. Preferences for learning different types of genome sequencing results among young breast cancer patients: Role of psychological and clinical factors. Transl Behav Med 2018; 8:71-79. [PMID: 29385583 DOI: 10.1093/tbm/ibx042] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The growing importance of genome sequencing means that patients will increasingly face decisions regarding what results they would like to learn. The present study examined psychological and clinical factors that might affect these preferences. 1,080 women diagnosed with breast cancer at age 40 or younger completed an online survey. We assessed their interest in learning various types of genome sequencing results: risk of preventable disease or unpreventable disease, cancer treatment response, uncertain meaning, risk to relatives' health, and ancestry/physical traits. Multivariable logistic regression was used to examine whether being "very" interested in each result type was associated with clinical factors: BRCA1/2 mutation status, prior genetic testing, family history of breast cancer, and psychological factors: cancer recurrence worry, genetic risk worry, future orientation, health information orientation, and genome sequencing knowledge. The proportion of respondents who were very interested in learning each type of result ranged from 16% to 77%. In all multivariable models, those who were very interested in learning a result type had significantly higher knowledge about sequencing benefits, greater genetic risks worry, and stronger health information orientation compared to those with less interest (p-values < .05). Our findings indicate that high interest in return of various types of genome sequencing results was more closely related to psychological factors. Shared decision-making approaches that increase knowledge about genome sequencing and incorporate patient preferences for health information and learning about genetic risks may help support patients' informed choices about learning different types of sequencing results.
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Affiliation(s)
| | - Jennifer Ivanovich
- Division of Public Health Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Sarah Lyons
- Division of Public Health Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Barbara Biesecker
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD, USA
| | - Rebecca Dresser
- School of Law, Washington University in St. Louis, St. Louis, MO, USA
| | - Ashley Elrick
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Cindy Matsen
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Melody Goodman
- College of Global Public Health, New York University, New York, NY, USA
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Sanderson SC, Loe BS, Freeman M, Gabriel C, Stevenson DC, Gibbons C, Chitty L, Lewis C. Development of the Knowledge of Genome Sequencing (KOGS) questionnaire. PATIENT EDUCATION AND COUNSELING 2018; 101:1966-1972. [PMID: 30031711 DOI: 10.1016/j.pec.2018.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/07/2018] [Accepted: 07/11/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Whole-genome sequencing is being implemented in research and clinical care, yet tools to assess patients' knowledge are lacking. Our aim was to develop a robust measure of whole-genome sequencing knowledge suitable for patients and other stakeholders including research participants, public, students, and healthcare professionals. METHODS An initial set of 17 items was developed via an iterative process including literature review, expert consultation, focus groups, and cognitive interviews with patients, and then administered to 243 individuals. We used exploratory factor analysis and item-response theory to confirm the psychometric suitability of the candidate items for assessing whole-genome sequencing knowledge. RESULTS There was a strong main component after removing 5 items with low factor loadings. Item and scale homogeneity was achieved using Mokken scale analysis. Three further items were removed because they were misfits, inverse duplicates or resulted in local dependency. The remaining nine items fitted the two-parameter logistic IRT model which achieved excellent fit to the observed data. Cronbach's alpha was 0.79 indicating acceptable reliability. CONCLUSION The KOGS, developed using a rigorous psychometric approach, is a brief and reliable tool. PRACTICE IMPLICATIONS The KOGS may prove useful for researchers and healthcare professionals using whole-genome sequencing with patients and other stakeholders.
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Affiliation(s)
- Saskia C Sanderson
- North East Thames Regional Genetics Services, Great Ormond Street Hospital, London, UK; UCL Great Ormond Street Institute of Child Health, UK; Department of Behavioural Science and Health, University College London, London, UK.
| | - Bao Sheng Loe
- The Psychometrics Centre, University of Cambridge, Cambridge, UK
| | - Maddie Freeman
- Department of Behavioural Science and Health, University College London, London, UK
| | - Camila Gabriel
- Center for Bioethics, Harvard Medical School, Boston, USA
| | - Danielle C Stevenson
- North East Thames Regional Genetics Services, Great Ormond Street Hospital, London, UK
| | - Chris Gibbons
- Patient Reported Outcomes, Value and Experience (PROVE) Center, Brigham and Women's Hospital, Boston, USA; Department of Surgery, Harvard Medical School, Boston, USA
| | - Lyn Chitty
- North East Thames Regional Genetics Services, Great Ormond Street Hospital, London, UK; UCL Great Ormond Street Institute of Child Health, UK
| | - Celine Lewis
- North East Thames Regional Genetics Services, Great Ormond Street Hospital, London, UK; UCL Great Ormond Street Institute of Child Health, UK
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The Patient in Precision Medicine: A Systematic Review Examining Evaluations of Patient-Facing Materials. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:9541621. [PMID: 30250657 PMCID: PMC6140003 DOI: 10.1155/2018/9541621] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 08/01/2018] [Indexed: 12/16/2022]
Abstract
Precision medicine (PM) has the potential to tailor healthcare to the individual patient by using their genetic information to guide treatment choices. However, this process is complex and difficult to understand for patients and providers alike. With a recent push in the healthcare community to understand the patient experience and engage patients in their care, it is important to give patients the opportunity to learn about PM. We performed a systematic review to identify previous work assessing the quality of patient-facing PM materials from 2008 to July 2018. Ten studies were identified, which used varying methods and measures. A qualitative assessment was conducted to compare key elements of the studies, including study design, characteristics of the participant population, what measurements were used to assess the PM materials, understandability, preference, psychological reactions, and the type of PM materials being assessed. The studies identified provide important groundwork by highlighting consistent aspects of design that aid in comprehension. Eight of the ten studies focused on the content and organization of genomic test results, while the remaining two assessed educational tools. Two main design elements that appeared across the studies were appropriately designed visual aids and simplified language. The studies identified were limited by the participant populations that were used, which were primarily white and well educated. Only one study attempted to oversample patient populations typically underrepresented in this type of research. Through our systematic review, it is evident that the breadth of knowledge in this field is limited in scope and that more work must be done to ensure that patients can engage in their care when faced with PM.
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Differences in attitudes toward genetic testing among the public, patients, and health-care professionals in Korea. Eur J Hum Genet 2018; 26:1432-1440. [PMID: 29915183 DOI: 10.1038/s41431-018-0191-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/26/2018] [Accepted: 04/26/2018] [Indexed: 11/08/2022] Open
Abstract
With further advances in medical genetics, genetic tests to determine predisposition to disease are becoming viable for a growing number of diseases. Accordingly, it has also become important to identify various viewpoints on genetic testing. The aims of this study were to examine awareness of and attitudes toward genetic testing among the general public (public), cancer patients (patients), and health-care professionals (clinicians and researchers) in Korea. The present survey was conducted from November 2016 to February 2017. The public and patients were surveyed via face-to-face interviews conducted by trained interviewers. Health-care professionals were surveyed via self-administered questionnaires. In total, 1500 individuals from the general public, 1500 cancer patients, 113 clinicians, and 413 researchers were surveyed. Most respondents from the public and patients had previously heard about genetic testing (public, 89.4%; patients, 92.7%, p < 0.01). Differences in attitudes toward genetic testing among the public, patients, and professionals were noted, although most respondents in the present study were aware of genetic testing. Most of the cancer patients tended to overestimate the potential benefit of genetic testing, whereas clinicians expressed concerns for genetic testing. Providing correct information to people who are scheduled to undergo or order genetic testing could help in making an informed decision thereon.
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Best M, Newson AJ, Meiser B, Juraskova I, Goldstein D, Tucker K, Ballinger ML, Hess D, Schlub TE, Biesecker B, Vines R, Vines K, Thomas D, Young MA, Savard J, Jacobs C, Butow P. The PiGeOn project: protocol for a longitudinal study examining psychosocial, behavioural and ethical issues and outcomes in cancer tumour genomic profiling. BMC Cancer 2018; 18:389. [PMID: 29621994 PMCID: PMC5887192 DOI: 10.1186/s12885-018-4310-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 03/26/2018] [Indexed: 12/25/2022] Open
Abstract
Background Genomic sequencing in cancer (both tumour and germline), and development of therapies targeted to tumour genetic status, hold great promise for improvement of patient outcomes. However, the imminent introduction of genomics into clinical practice calls for better understanding of how patients value, experience, and cope with this novel technology and its often complex results. Here we describe a protocol for a novel mixed-methods, prospective study (PiGeOn) that aims to examine patients’ psychosocial, cognitive, affective and behavioural responses to tumour genomic profiling and to integrate a parallel critical ethical analysis of returning results. Methods This is a cohort sub-study of a parent tumour genomic profiling programme enrolling patients with advanced cancer. One thousand patients will be recruited for the parent study in Sydney, Australia from 2016 to 2019. They will be asked to complete surveys at baseline, three, and five months. Primary outcomes are: knowledge, preferences, attitudes and values. A purposively sampled subset of patients will be asked to participate in three semi-structured interviews (at each time point) to provide deeper data interpretation. Relevant ethical themes will be critically analysed to iteratively develop or refine normative ethical concepts or frameworks currently used in the return of genetic information. Discussion This will be the first Australian study to collect longitudinal data on cancer patients’ experience of tumour genomic profiling. Findings will be used to inform ongoing ethical debates on issues such as how to effectively obtain informed consent for genomic profiling return results, distinguish between research and clinical practice and manage patient expectations. The combination of quantitative and qualitative methods will provide comprehensive and critical data on how patients cope with ‘actionable’ and ‘non-actionable’ results. This information is needed to ensure that when tumour genomic profiling becomes part of routine clinical care, ethical considerations are embedded, and patients are adequately prepared and supported during and after receiving results. Trial registration Not required for this sub-study, parent trial registration ACTRN12616000908437.
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Affiliation(s)
- Megan Best
- Psycho-oncology Co-operative Research Group (PoCoG), University of Sydney, Level 6 North, Lifehouse (C39Z), Sydney, NSW, 2006, Australia. .,Sydney Health Ethics, Sydney School of Public Health, University of Sydney, Camperdown, NSW, 2006, Australia.
| | - Ainsley J Newson
- Sydney Health Ethics, Sydney School of Public Health, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Bettina Meiser
- Prince of Wales Clinical School, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Ilona Juraskova
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED - Psychology), University of Sydney, Camperdown, NSW, 2006, Australia
| | - David Goldstein
- Prince of Wales Clinical School, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Kathy Tucker
- Prince of Wales Clinical School, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Mandy L Ballinger
- Cancer Division, Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, NSW, 2021, Australia
| | - Dominique Hess
- Cancer Division, Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, NSW, 2021, Australia
| | - Timothy E Schlub
- Sydney School of Public Health, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Barbara Biesecker
- The National Human Genome Research Institute, National Institutes of Health, 31 Center Drive, MSC 2073, Bethesda, MD, 20892, USA
| | - Richard Vines
- Rare Cancers, PO Box 440, Bowral, NSW, 2576, Australia
| | - Kate Vines
- Rare Cancers, PO Box 440, Bowral, NSW, 2576, Australia
| | - David Thomas
- Cancer Division, Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, NSW, 2021, Australia
| | - Mary-Anne Young
- Genome One, Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, NSW, 2021, Australia
| | - Jacqueline Savard
- Sydney Health Ethics, Sydney School of Public Health, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Chris Jacobs
- Prince of Wales Clinical School, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Phyllis Butow
- Psycho-oncology Co-operative Research Group (PoCoG), University of Sydney, Level 6 North, Lifehouse (C39Z), Sydney, NSW, 2006, Australia.,Centre for Medical Psychology and Evidence-based Decision-making (CeMPED - Psychology), University of Sydney, Camperdown, NSW, 2006, Australia
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Oberg JA, Ruiz J, Ali-Shaw T, Schlechtweg KA, Ricci A, Kung AL, Chung WK, Appelbaum PS, Glade Bender JL, Levine JM. Whole-Genome and Whole-Exome Sequencing in Pediatric Oncology: An Assessment of Parent and Young Adult Patient Knowledge, Attitudes, and Expectations. JCO Precis Oncol 2018; 2:1700104. [PMID: 32913997 DOI: 10.1200/po.17.00104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose The complexity of results generated from whole-genome sequencing (WGS) and whole-exome sequencing (WES) adds challenges to obtaining informed consent in pediatric oncology. Little is known about knowledge of WGS and WES in this population, and no validated tools exist in pediatric oncology. Methods We developed and psychometrically evaluated a novel WGS and WES knowledge questionnaire, the Precision in Pediatric Sequencing Knowledge Questionnaire (PIPseqKQ), to identify levels of understanding among parents and young adult cancer survivors (≥ 18 years old), off therapy for at least 1 year from a single-institution pediatric oncology outpatient clinic. Participants also completed health literacy and numeracy questionnaires. All participants provided written informed consent. Results One hundred eleven participants were enrolled: 76 were parents, and 35 were young adults. Of the total cohort, 77 (69%) were female, 63 (57%) self-identified as white, and 74 (67%) self-identified as non-Hispanic. Sixty-six (59%) had less than a college degree. Adequate health literacy (n = 87; 80%) and numeracy (n = 89; 80%) were demonstrated. Internal consistency was high (Cronbach's α = .88), and test-retest reliability was greater than the 0.7 minimum requirement. Scores were highest for genetic concepts related to health and cancer and lowest for WGS and WES concepts. Health literacy and educational attainment were significantly associated with PIPseqKQ scores. Overall, participants felt the benefits of WGS and WES outweighed the potential risks. Conclusion Parents and young adult cancer survivors have some genetics knowledge, but they lack knowledge about WGS and WES. The PIPseqKQ is a reliable tool that can identify deficits in knowledge, identify perceptions of risks and benefits of WGS and WES, and help clinicians tailor their consent discussions to best fit families. The PIPseqKQ also may inform the development of educational tools to better facilitate the informed consent process in pediatric oncology.
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Affiliation(s)
- Jennifer A Oberg
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
| | - Jenny Ruiz
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
| | - Trisha Ali-Shaw
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
| | - Kathryn A Schlechtweg
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
| | - Angela Ricci
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
| | - Andrew L Kung
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
| | - Wendy K Chung
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
| | - Paul S Appelbaum
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
| | - Julia L Glade Bender
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
| | - Jennifer M Levine
- , , , , , , and , Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center; and , NewYork-Presbyterian Hospital; and , Columbia University College of Physicians and Surgeons, New York, NY
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Raghunathan NJ, Benedict C, Thom B, Friedman DN, Kelvin JF. Young Adult Female Cancer Survivors' Concerns About Future Children's Health and Genetic Risk. J Adolesc Young Adult Oncol 2018; 7:125-129. [PMID: 29364765 PMCID: PMC5813728 DOI: 10.1089/jayao.2017.0050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
As young adult female cancer survivors (aged 18-35) make family-building decisions, understanding the specific nature of their concerns is important. We evaluated survivors' concerns about potential health risks to future children including genetic susceptibility for cancer with an internet-based survey study (N = 187). Sixty-five percent reported concern about passing on a genetic cancer risk to their children, and scores did not vary regardless of association with cancer at high risk for genetic transmission. Genetic counseling and education about family-building options may be important to survivors concerned about health risks to offspring to support family-building decisions based on personalized medical information.
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Affiliation(s)
- Nirupa Jaya Raghunathan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Survivorship Center, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Catherine Benedict
- Department of Medicine, Hofstra Northwell School of Medicine, Manhasset, New York
| | - Bridgette Thom
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Survivorship Center, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Danielle Novetsky Friedman
- Survivorship Center, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joanne Frankel Kelvin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Survivorship Center, Memorial Sloan Kettering Cancer Center, New York, New York
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