O'Brien M A, Carroll J C, Manca D P, Miedema B, Groome P A, Makuwaza T, Easley J, Sopcak N, Jiang L, Decker K, McBride M L, Moineddin R, Permaul J A, Heisey R, Eisenhauer E A, Krzyzanowska M K, Pruthi S, Sawka C, Schneider N, Sussman J, Urquhart R, Versaevel C, Grunfeld E
Ontario: Department of Family and Community Medicine, University of Toronto, Toronto (Carroll, Grunfeld, Heisey, Makuwaza, Moineddin, O'Brien); Ray D. Wolfe Department of Family Medicine, Sinai Health System, Toronto (Carroll, Makuwaza, Permaul); Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston (Groome, Jiang); Department of Family and Community Medicine, Women's College Hospital, Toronto (Heisey); Department of Oncology, Kingston General Hospital, Kingston (Eisenhauer); Department of Oncology, Queen's University, Kingston (Eisenhauer); Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (Krzyzanowska); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Krzyzanowska, Sawka); Cancer Care Ontario, Toronto (Krzyzanowska); Department of Oncology, McMaster University, Hamilton (Sussman); Ontario Institute for Cancer Research, Toronto (Grunfeld).
Alberta: Department of Family Medicine, University of Alberta, Edmonton (Manca, Sopcak).
Curr Oncol. 2017 Apr;24(2):95-102. doi: 10.3747/co.24.3457. Epub 2017 Apr 27.
Family physicians (fps) play a role in aspects of personalized medicine in cancer, including assessment of increased risk because of family history. Little is known about the potential role of fps in supporting cancer patients who undergo tumour gene expression profile (gep) testing.
We conducted a mixed-methods study with qualitative and quantitative components. Qualitative data from focus groups and interviews with fps and cancer specialists about the role of fps in breast cancer gep testing were obtained during studies conducted within the pan-Canadian canimpact research program. We determined the number of visits by breast cancer patients to a fp between the first medical oncology visit and the start of chemotherapy, a period when patients might be considering results of gep testing.
The fps and cancer specialists felt that ordering gep tests and explaining the results was the role of the oncologist. A new fp role was identified relating to the fp-patient relationship: supporting patients in making adjuvant therapy decisions informed by gep tests by considering the patient's comorbid conditions, social situation, and preferences. Lack of fp knowledge and resources, and challenges in fp-oncologist communication were seen as significant barriers to that role. Between 28% and 38% of patients visited a fp between the first oncology visit and the start of chemotherapy.
Our findings suggest an emerging role for fps in supporting patients who are making adjuvant treatment decisions after receiving the results of gep testing. For success in this new role, education and point-of-care tools, together with more effective communication strategies between fps and oncologists, are needed.
家庭医生在癌症个性化医疗的多个方面发挥作用，包括评估因家族病史导致的风险增加。关于家庭医生在支持接受肿瘤基因表达谱（GEP）检测的癌症患者方面的潜在作用，人们了解甚少。
我们开展了一项包含定性和定量成分的混合方法研究。在泛加拿大癌症影响研究项目开展的研究中，通过焦点小组以及对家庭医生和癌症专家进行访谈，获取了关于家庭医生在乳腺癌GEP检测中作用的定性数据。我们确定了乳腺癌患者在首次肿瘤内科就诊至化疗开始期间（这段时间患者可能正在考虑GEP检测结果）拜访家庭医生的次数。
家庭医生和癌症专家认为，开具GEP检测并解释检测结果是肿瘤内科医生的职责。确定了一个与家庭医生 - 患者关系相关的新角色：通过考虑患者的合并症、社会状况和偏好，支持患者在GEP检测结果的指导下做出辅助治疗决策。家庭医生缺乏知识和资源，以及家庭医生与肿瘤内科医生沟通方面的挑战被视为该角色的重大障碍。在首次肿瘤内科就诊至化疗开始期间，28%至38%的患者拜访了家庭医生。
我们的研究结果表明，家庭医生在支持患者在接受GEP检测结果后做出辅助治疗决策方面正发挥着新的作用。要在这一新角色中取得成功，需要开展教育并提供即时医疗工具，同时家庭医生与肿瘤内科医生之间要有更有效的沟通策略。
