Department of Community Health Sciences, University of Calgary, Room 3C62, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada.
Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Room 312, Toronto, Ontario M5B 1T8, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 209 Victoria Street, Room 312, Toronto, Ontario M5B 1T8, Canada.
Eur J Cancer. 2016 Jul;61:85-93. doi: 10.1016/j.ejca.2016.03.077. Epub 2016 May 4.
Women with early-stage breast cancer, of whom only 15% will experience a recurrence, are often conflicted or uncertain about taking chemotherapy. Gene expression profiling (GEP) of tumours informs risk prediction, potentially affecting treatment decisions. We examined whether receiving a GEP test score reduces decisional conflict in chemotherapy treatment decision making.
A general population sample of 200 women completed the decisional conflict scale (DCS) at baseline (no GEP test score scenario) and after (scenario with GEP test score added) completing a discrete choice experiment survey for early-stage breast cancer chemotherapy. We scaled the 16-item DCS total scores and subscores from 0 to 100 and calculated means, standard deviations and change in scores, with significance (p < 0.05) based on matched pairs t-tests.
We identified five respondent subgroups based on preferred treatment option; almost 40% did not change their chemotherapy decision after receiving GEP testing information. Total score and all subscores (uncertainty, informed, values clarity, support, and effective decision) decreased significantly in the respondent subgroup who were unsure about taking chemotherapy initially but changed to no chemotherapy (n =33). In the subgroup of respondents (n = 25) who chose chemotherapy initially but changed to unsure, effective decision subscore increased significantly. In the overall sample, changes in total and all subscores were non-significant.
GEP testing adds value for women initially unsure about chemotherapy treatment with a decrease in decisional conflict. However, for women who are confident about their treatment decisions, GEP testing may not add value. Decisions to request GEP testing should be personalised based on patient preferences.
仅有 15%的早期乳腺癌女性会复发，她们常常在是否接受化疗方面存在冲突或不确定。肿瘤的基因表达谱（GEP）可提供风险预测，从而可能影响治疗决策。我们研究了接受 GEP 检测结果是否会降低化疗治疗决策中的决策冲突。
在完成针对早期乳腺癌化疗的离散选择实验调查之前（无 GEP 测试分数情景）和之后（添加 GEP 测试分数情景），我们对 200 名女性进行了决策冲突量表（DCS）测试，该量表来自一般人群样本。我们将 16 项 DCS 总分和子量表从 0 到 100 进行了评分，并计算了平均值、标准差和得分变化，采用基于匹配对 t 检验的统计学显著性（p < 0.05）。
我们根据首选治疗方案将受访者分为五个亚组；近 40%的人在收到 GEP 检测信息后并未改变化疗决定。在最初对接受化疗犹豫不决但最终选择不化疗的受访者亚组（n = 33）中，总分和所有子量表（不确定性、知情、价值观明确、支持和有效决策）均显著下降。在最初选择化疗但最终选择不确定的受访者亚组（n = 25）中，有效决策子量表显著增加。在总体样本中，总分和所有子量表的变化均不显著。
GEP 检测为最初对化疗治疗犹豫不决的女性提供了价值，降低了决策冲突。然而，对于那些对治疗决策有信心的女性，GEP 检测可能没有价值。是否要求进行 GEP 检测应根据患者的个人偏好进行个性化决策。
