Breast Cancer Patients' Views on the Use of Genomic Testing to Guide Decisions about Their Postoperative Chemotherapy.

Seror V, Marino P, Bertucci F, Mancini J, Extra JM, Ferrero JM, Bachelot T, Viens P, Julian-Reynier C.

Source

INSERM, UMR 912 'Economics and Social Sciences Applied to Health and Analysis of Medical Information', Marseille, France.

Abstract

Background/Aims: Incorporating gene expression profiling into routine clinical practices is beginning to be recommended as part of breast cancer treatment. The aim of the present study was to investigate the decision-making involved in genomic testing from the perspective of patients enrolled in a genomics-based clinical trial of adjuvant chemotherapy. Methods: The prospective SA02 clinical trial was designed to assess the clinical benefits of a genomic test on axillary lymph node-positive (N+) early breast cancer patients. The patients enrolled in the SA02 trial were defined by 'good prognosis' genomic test results consistent with the delivery of postoperative anthracycline-based chemotherapy without taxane. The present companion study was presented by oncologists to 64 out of the 88 patients enrolled. Data were collected using self-administered questionnaires. Results: The response rate was 67% (questionnaires were returned 35 days on average after enrolment in the trial). Only 33% of the respondents accurately recalled or described their genomic test results. Although most N+ patients classically undergo anthracycline/taxane adjuvant chemotherapy, 23% of the present respondents did not recall participating in the clinical study involving chemotherapy without taxanes. Recall was mainly associated with higher risk perception of chemotherapy-related side effects and better understanding of test results. Among the respondents who recalled participating in the trial, 39% experienced decisional conflicts. Conclusions: Devoting greater efforts to explaining genomic test results to patients could be highly relevant in terms of the trade-off between the risk of unnecessary chemotherapy-related side effects and the loss of survival time possibly resulting from less aggressive treatment.
Copyright © 2013 S. Karger AG, Basel.