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Pichler T, Mumm F, Dehar N, Dickman E, Díez de Los Ríos de la Serna C, Dinkel A, Heinrich K, Hennink M, Parviainen AD, Raske V, Wicki N, Moore AC. Understanding communication between patients and healthcare professionals regarding comprehensive biomarker testing in precision oncology: A scoping review. Cancer Med 2024; 13:e6913. [PMID: 38298115 PMCID: PMC10905543 DOI: 10.1002/cam4.6913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/15/2023] [Accepted: 12/23/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Precision oncology, using comprehensive biomarker testing (cBT) to inform individual cancer diagnosis, prognosis and treatment, includes increasingly complex technology and clinical data sets. People impacted by cancer (patients and caregivers) and healthcare professionals (HCPs) face distinct challenges in navigating the cBT and personalized treatment landscape. This review summarizes evidence regarding cBT-related communication between people impacted by cancer and HCPs and identifies important avenues for future research in precision oncology. METHODS A scoping review was conducted using records published in PubMed during January 2017-August 2022, focusing on the breadth of topics on patient-HCP communication and knowledge resources used by HCPs as guidance in cBT-related communication. Data were extracted from records meeting inclusion criteria, and findings were summarized according to main topics. RESULTS The search identified 287 unique records and data were extracted from 42 records, including nine from expert input. Most records originated from the United States included patients with different types of cancer, and oncologists were the main HCPs. Patients' motivation for undergoing cBT and receiving results was generally high in different settings. However, patients' understanding of cBT-related concepts was limited, and their knowledge and information preferences changed based on cBT implications and significance to family members. HCPs were valued by patients as a trusted source of information. Limited evidence was available on HCPs' information-seeking behavior and factors influencing cBT-related knowledge and confidence, often self-reported as insufficient. CONCLUSIONS Patient education by knowledgeable and confident HCPs, information management and a caring patient-HCP relationship communicating continuity of care regardless of cBT results are crucial to empower patients and shared decision-making in precision oncology. More data on the process and structure of cBT-related communication, distinction between and characterization of different timepoints of patient-HCP interactions are needed.
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Affiliation(s)
- Theresia Pichler
- Department of Internal Medicine III, University HospitalLMU MunichMunichGermany
- Comprehensive Cancer Center Munich LMU (CCC Munich)MunichGermany
| | - Friederike Mumm
- Department of Internal Medicine III, University HospitalLMU MunichMunichGermany
- Comprehensive Cancer Center Munich LMU (CCC Munich)MunichGermany
| | - Navdeep Dehar
- Department of Medical OncologyQueen's UniversityKingstonOntarioCanada
| | - Erin Dickman
- Oncology Nursing SocietyPittsburghPennsylvaniaUSA
| | - Celia Díez de Los Ríos de la Serna
- European Oncology Nursing SocietyBrusselsBelgium
- Faculty of Medicine and Health Sciences, School of NursingBarcelona UniversityBarcelonaCataloniaSpain
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine and HealthTechnical University of MunichMunichGermany
- Comprehensive Cancer Center Munich TUM (CCC Munich)MunichGermany
| | - Kathrin Heinrich
- Comprehensive Cancer Center Munich LMU (CCC Munich)MunichGermany
| | | | - Anndra D. Parviainen
- Department of Nursing Science, Faculty of Health SciencesUniversity of Eastern FinlandKuopioFinland
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Kawamura M, Shirota H, Niihori T, Komine K, Takahashi M, Takahashi S, Miyauchi E, Niizuma H, Kikuchi A, Tada H, Shimada M, Kawamorita N, Kanamori M, Sugiyama I, Tsubata M, Ichikawa H, Yasuda J, Furukawa T, Aoki Y, Ishioka C. Management of patients with presumed germline pathogenic variant from tumor-only genomic sequencing: A retrospective analysis at a single facility. J Hum Genet 2023; 68:399-408. [PMID: 36804482 DOI: 10.1038/s10038-023-01133-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/19/2023] [Accepted: 02/12/2023] [Indexed: 02/22/2023]
Abstract
Cancer treatment is increasingly evolving toward personalized medicine, which sequences numerous cancer-related genes and identifies therapeutic targets. On the other hand, patients with germline pathogenic variants (GPV) have been identified as secondary findings (SF) and oncologists have been urged to handle them. All SF disclosure considerations for patients are addressed and decided at the molecular tumor boards (MTB) in the facility. In this study, we retrospectively summarized the results of all cases in which comprehensive genomic profiling (CGP) test was conducted at our hospital, and discussed the possibility of presumed germline pathogenic variants (PGPV) at MTB. MTB recommended confirmatory testing for 64 patients. Informed consent was obtained from attending physicians for 53 of them, 30 patients requested testing, and 17 patients tested positive for a confirmatory test. Together with already known variants, 4.5 % of the total confirmed in this cohort. Variants verified in this study were BRCA1 (n = 12), BRCA2 (n = 6), MSH2 (n = 2), MSH6 (n = 2), WT1 (n = 2), TP53, MEN1, CHEK2, MLH1, TSC2, PTEN, RB1, and SMARCB1. There was no difference in the tumor's VAF between confirmed positive and negative cases for variants determined as PGPV by MTB. Current results demonstrate the actual number of cases until confirmatory germline test for patients with PGPV from tumor-only CGP test through the discussion at the MTB. The practical results at this single facility will serve as a guide for the management of the selection and distribution of SF in the genome analysis.
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Affiliation(s)
- Maako Kawamura
- Personalized Medicine Center, Tohoku University Hospital, Sendai, Japan
| | - Hidekazu Shirota
- Department of Clinical Oncology, Tohoku University Hospital, Sendai, Japan.
| | - Tetsuya Niihori
- Department of Medical Genetics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Keigo Komine
- Department of Clinical Oncology, Tohoku University Hospital, Sendai, Japan
| | - Masanobu Takahashi
- Department of Clinical Oncology, Tohoku University Hospital, Sendai, Japan
| | - Shin Takahashi
- Department of Clinical Oncology, Tohoku University Hospital, Sendai, Japan
| | - Eisaku Miyauchi
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hidetaka Niizuma
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Atsuo Kikuchi
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Hiroshi Tada
- Department of Breast and Endocrine Surgical Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Muneaki Shimada
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Japan
| | - Naoki Kawamorita
- Department of Urology, Tohoku University School of Medicine, Sendai, Japan
| | - Masayuki Kanamori
- Department of Neurosurgery, Tohoku University School of Medicine, Sendai, Japan
| | - Ikuko Sugiyama
- Personalized Medicine Center, Tohoku University Hospital, Sendai, Japan
| | - Mari Tsubata
- Department of Medical Genetics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hitotshi Ichikawa
- Department of Clinical Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Jun Yasuda
- Division of Molecular Cellular Oncology, Miyagi Cancer Center Research Institute, Natori, Japan
| | - Toru Furukawa
- Department of Investigative Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoko Aoki
- Department of Medical Genetics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Chikashi Ishioka
- Department of Clinical Oncology, Tohoku University Hospital, Sendai, Japan.
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Current status and issues related to secondary findings in the first public insurance covered tumor genomic profiling in Japan: multi-site questionnaire survey. J Hum Genet 2022; 67:557-563. [PMID: 35322199 DOI: 10.1038/s10038-022-01028-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/23/2022] [Indexed: 11/08/2022]
Abstract
In June 2019, the Japanese National Health Insurance (NHI) system introduced coverage for two types of tumor genomic profiling (TGP): FoundationOneⓇ CDx (F1) and OncoGuide™ NCC OncoPanel System (NCCOP). TGP sometimes reveals germline variants that are potentially pathogenic as secondary findings (SFs). We conducted a questionnaire-based survey to find out the operational statuses of F1 and NCCOP at institutions where TGP was performed to elucidate issues related to SFs. Responses were received from 97 of 112 institutions (86.6%). As of May 31, 2020, 88 (90.7%) and 78 (80.4%) institutions started performing F1 and NCCOP, respectively. Since F1 only examines tumor samples, germline confirmatory testing is necessary to determine whether they are actually germline pathogenic variants (GPVs). When physicians are obtaining informed consent all but 2.3% of the patients requested SF disclosure. Conversely, when presumed germline pathogenic variants (PGPVs) were detected, 46.2% were not willing to receive confirmatory tests as they wanted to prioritize cancer treatment over SFs investigation, while only 23.3% underwent confirmatory tests. Problems in cancer genomic medicine reported by clinical genetics departments included short-staffing (n = 10), insufficient interdepartmental cooperation (n = 9), inconsistent understanding of genetics among healthcare professionals (n = 8), and low utilization rate of SFs due to lack of insurance coverage for confirmatory tests and post-test health checkups (n = 8). Solutions include; determining the appropriate timing to confirm patient intent on SF disclosure, covering confirmatory tests for PGPVs by the NHI, and establishing cooperation between the oncology and clinical genetics departments.
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