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Impact of genomic testing and patient-reported outcomes on receipt of adjuvant chemotherapy

  • Epidemiology
  • Published:
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Abstract

Practice guidelines incorporate genomic tumor profiling, using results such as the Oncotype DX Recurrence Score (RS), to refine recurrence risk estimates for the large proportion of breast cancer patients with early-stage, estrogen receptor-positive disease. We sought to understand the impact of receiving genomic recurrence risk estimates on breast cancer patients’ well-being and the impact of these patient-reported outcomes on receipt of adjuvant chemotherapy. Participants were 193 women (mean age 57) newly diagnosed with early-stage breast cancer. Women were interviewed before and 2–3 weeks after receiving the RS result between 2011 and 2015. We assessed subsequent receipt of chemotherapy from chart review. After receiving their RS, perceived pros (t = 4.27, P < .001) and cons (t = 8.54, P < .001) of chemotherapy increased from pre-test to post-test, while perceived risk of breast cancer recurrence decreased (t = 2.90, P = .004). Women with high RS tumors were more likely to receive chemotherapy than women with low RS tumors (88 vs. 5 %, OR 0.01, 0.00–0.02, P < .001). Higher distress (OR 2.19, 95 % CI 1.05–4.57, P < .05) and lower perceived cons of chemotherapy (OR 0.50, 95 % CI 0.26–0.97, P < .05) also predicted receipt of chemotherapy. Distressed patients who saw few downsides of chemotherapy received this treatment. Clinicians should consider these factors when discussing chemotherapy with breast cancer patients.

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Acknowledgments

This study and manuscript preparation were supported by grants from the American Cancer Society (MRSG-10-110-01) and National Cancer Institute (P30CA05100). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health. We thank the physicians and staff of the MedStar Cancer Network and the H. Lee Moffitt Cancer Center for their assistance during the study. Most importantly, we thank the women who participated in this study.

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Authors and Affiliations

  1. Department of Oncology, Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA

    Chalanda N. Evans, Claudine Isaacs, Marc D. Schwartz & Suzanne C. O’Neill

  2. Gillings School of Global Public Health, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA

    Noel T. Brewer

  3. Moffitt Cancer Center, Tampa, FL, USA

    Susan T. Vadaparampil & M. Catherine Lee

  4. MedStar Washington Hospital Center, Washington, DC, USA

    Marc Boisvert

  5. Franklin Square Medical Center, Baltimore, MD, USA

    Yvonne Ottaviano

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  1. Chalanda N. Evans
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  7. Claudine Isaacs
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  9. Suzanne C. O’Neill
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Correspondence to Suzanne C. O’Neill.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Evans, C.N., Brewer, N.T., Vadaparampil, S.T. et al. Impact of genomic testing and patient-reported outcomes on receipt of adjuvant chemotherapy. Breast Cancer Res Treat 156, 549–555 (2016). https://doi.org/10.1007/s10549-016-3780-5

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  • DOI: https://doi.org/10.1007/s10549-016-3780-5

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