The impact of gene expression profile testing on confidence in chemotherapy decisions and prognostic expectations
Little is known about whether gene expression profile (GEP) testing and specific recurrence scores (e.g., medium risk) improve women’s confidence in their chemotherapy decision or perceived recurrence risk. We evaluate the relationship between these outcomes and GEP testing.
We surveyed women eligible for GEP testing (stage I or II, Gr1-2, ER+, HER2−) identified through the Surveillance, Epidemiology, and End Results (SEER) Registry of Washington or Kaiser Permanente Northern California from 2012 to 2016, approximately 0–4 years from diagnosis (N = 904, RR = 45.4%). Confidence in chemotherapy was measured as confident (Very, completely) versus Not Confident (Somewhat, A little, Not At All); perceived risk recurrence was recorded numerically (0–100%). Women reported their GEP test receipt (Yes, No, Unknown) and risk recurrence score (High, Intermediate, Low, Unknown). In our analytic sample (N = 833), we propensity score weighted the three test receipt cohorts and used propensity weighted multivariable regressions to examine associations between the outcomes and the three test receipt cohorts, with receipt stratified by score.
29.5% reported an unknown GEP test receipt; 86% being confident. Compared to no test receipt, an intermediate score (aOR 0.34; 95% CI 0.20–0.58), unknown score (aOR 0.09; 95% CI 0.05–0.18), and unknown test receipt (aOR 0.37; 95% CI 0.24–0.57) were less likely to report confidence. Most women greatly overestimated their recurrence risk regardless of their test receipt or score.
GEP testing was not associated with greater confidence in chemotherapy decisions. Better communication about GEP testing and the implications for recurrence risk may improve women’s decisional confidence.
KeywordsGene expression profile testing Breast cancer Chemotherapy
We appreciate the contributions of the KPNC Research Team, including Yan Li, MD, Laurel Habel, PhD, Stephanie Prausnitz, MS, Tom Ray, MBA, and Alice Ansfield, Pete Bogdanos, and Lillian Pacheco.
This research was supported by National Cancer Institute Grant #UO1 CA183081 (to JM, TL, and SR). This work was also supported, in part, by Grant #U01 CA152958 from the National Cancer Institute as part of the Cancer Intervention and Surveillance Modeling Network (CISNET), Grant #R35CA197289 (to JM) from the National Cancer Institute, Grant #UC2 CA148471 (to Katrina Goddard, Lawrence Kushi, and Evelyn Whitlock) from the National Cancer Institute, R01 CA105274 (to Lawrence Kushi) from the National Cancer Institute, and a supplement to Grant # UO1 CA183081 from the National Cancer Institute (SCO), Georgetown-Lombardi American Cancer Society Young Investigator Award (ACS IRG 92-152-20) and the Cancer Prevention Research Fellowship sponsored by the American Society of Preventive Oncology and Breast Cancer Research Foundation (ASPO-17-001) (to Jinani Jayasekera). The content is solely the responsibility of the authors and does not represent the official views of the National Cancer Institute at the National Institutes of Health.
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
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.
Informed consent was obtained from all individual participants included in the study.
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