Evans Chalanda N, Brewer Noel T, Vadaparampil Susan T, Boisvert Marc, Ottaviano Yvonne, Lee M Catherine, Isaacs Claudine, Schwartz Marc D, O'Neill Suzanne C
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.
Gillings School of Global Public Health, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
Breast Cancer Res Treat. 2016 Apr;156(3):549-555. doi: 10.1007/s10549-016-3780-5. Epub 2016 Apr 8.
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.
实践指南纳入了基因组肿瘤分析，利用诸如Oncotype DX复发评分（RS）等结果，来优化对大部分早期雌激素受体阳性乳腺癌患者的复发风险评估。我们试图了解获得基因组复发风险评估对乳腺癌患者幸福感的影响，以及这些患者报告的结果对辅助化疗接受情况的影响。研究参与者为193名新诊断为早期乳腺癌的女性（平均年龄57岁）。在2011年至2015年期间，这些女性在收到RS结果之前以及之后2至3周接受了访谈。我们通过病历审查评估后续化疗的接受情况。在收到RS结果后，化疗的感知益处（t = 4.27，P <.001）和弊端（t = 8.54，P <.001）从测试前到测试后均有所增加，而乳腺癌复发的感知风险则降低（t = 2.90，P =.004）。RS高的肿瘤患者比RS低的肿瘤患者更有可能接受化疗（88%对5%，OR 0.01，0.00 - 0.02，P <.001）。更高的痛苦程度（OR 2.19，95%CI 1.05 - 4.57，P <.05）和更低的化疗感知弊端（OR 0.50，95%CI 0.26 - 0.97，P <.05）也预示着会接受化疗。认为化疗弊端少的痛苦患者接受了这种治疗。临床医生在与乳腺癌患者讨论化疗时应考虑这些因素。
