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  • SOC6: How is the information regarding the use of Genetic Test for breast cancer processed and exchanged?
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How is the information regarding the use of Genetic Test for breast cancer processed and exchanged?

Authors: Pseudo85 Pseudo85, Pseudo84 Pseudo84

Internal reviewers: Eva Kernstock, Alessandra Lo Scalzo, Alexandra Sauer

The domain methodology was used for this question (analysis of selected studies extracted from the basic literature search).

Oncotype DX

A clinical roundtable monograph funded by Genomic Health, manufacturers of Oncotype DX, about incorporating the Oncotype DX breast cancer assay into routine clinical practice, reported that the discussion generally begins in the surgeon’s office, where the Oncotype DX assay is first introduced as an evaluation tool. At this time, the patient is provided with basic information, so that they are familiar with Oncotype DX when they first meet with their medical oncologist. Therefore, the Oncotype DX assay is sometimes ordered by the surgeon before the patient ever meets with a medical oncologist. In most cases, the patient would then discuss the assay result with their medical oncologist. Pathologists generally have no communication with the patient about the Oncotype DX assay, because their main role is to select the most representative tumour block to send out after receiving a request. {2}

Palmer et al. stated that, given the anxiety that patients experience following surgery and prior to making an adjuvant treatment decision, there could be value in surgeons ordering the Oncotype DX assay as this is expected to reduce the time required for patients to receive results. Moreover, having RS results at the time of the first consultation with the medical oncologist can lead to a smoother and more meaningful conversation with the patient. {8}

Tzeng JP studied how women receive and incorporate the results of Oncotype DX into decisions about adjuvant treatment for early-stage breast cancer. Most of the women surveyed (77 women with early-stage, oestrogen receptor-positive breast cancer with 0 to 3 positive lymph nodes who received Oncotype DX between 2004 and 2009) preferred having an active (38%) or shared (49%) role in medical decisions. {11}

Although genomic tests can help inform treatment decisions, a challenge is how best to communicate and incorporate test results when making complex decisions about adjuvant treatment for cancer. Informed decision making about adjuvant treatments often involves discussions about patients’ chances of recurrence. To date, there is little consensus about the most effective method of communicating risk information. Moreover, cognitive constraints such as low health literacy or low numeracy may result in reduced understanding of medical and probabilistic information. {5, 11}

A recent US study assessed retention of information about genomic tests among a proxy population of breast cancer patients who had not received Oncotype DX, but who were provided with an oral and written description of the test immediately before completing the survey. According to Lillie et al. (2008) health literacy may affect women’s capacity to learn about the new genomic tests as well as their desire for informed participation in their medical care. The retention of information about the risk of recurrence of breast cancer is sensitive to the individual’s capacity for processing information; patient-oriented educational materials about the recurrence risk test must help to reduce this effect. These data suggest that clinicians and health educators should be concerned about patients’ health literacy levels when discussing genomic recurrence risk tests. {5}

The literature contains little information on how information about the use of prognostic tests for breast cancer is processed and exchanged. There are no studies that address these questions for the MammaPrint and uPA/PAI-1 tests.

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Pseudo85 P, Pseudo84 P Result Card SOC6 In: Pseudo85 P, Pseudo84 P Social aspects In: Jefferson T, Vicari N, Raatz H [eds.]. Prognostic tests for breast cancer recurrence (uPA/PAI-1 [FEMTELLE], MammaPrint, Oncotype DX ) [Core HTA], Agenzia nationale per i servizi sanitari regionali (age.na.s), Italy ; 2013. [cited 7 February 2023]. Available from: http://corehta.info/ViewCover.aspx?id=113

References