O'Brien M A, Dhesy-Thind S, Charles C, Hammond Mobilio M, Leighl N B, Grunfeld E
Department of Family and Community Medicine, University of Toronto, Toronto.
Department of Oncology and.
Curr Oncol. 2017 Apr;24(2):e138-e145. doi: 10.3747/co.24.3395. Epub 2017 Apr 27.
Advances in personalized medicine have produced novel tests and treatment options for women with breast cancer. Relatively little is known about the process by which such tests are adopted into oncology practice. The objectives of the present study were to understand the experiences of medical oncologists with multigene expression profile (gep) tests, including their adoption into practice in early-stage breast cancer, and the perceptions of the oncologists about the influence of test results on treatment decision-making.
We conducted a qualitative descriptive study involving interviews with medical oncologists from academic and community cancer centres or hospitals in 8 communities in Ontario. A 21-gene breast cancer assay was used as the example of gep testing. Qualitative analytic techniques were used to identify the main themes.
Of 28 oncologists who were approached, 21 (75%) participated in the study [median age: 43 years; 12 women (57%)]. Awareness and knowledge of gep testing were derived from several sources: international scientific meetings, participation in clinical studies, discussions with respected colleagues, and manufacturer-sponsored meetings. Oncologists observed that incorporating gep testing into their clinical practice resulted in several changes, including longer consultation times, second visits, and taking steps to minimize treatment delays. Oncologists expressed divergent opinions about the strength of evidence and added value of gep testing in guiding treatment decisions.
Incorporation of gep testing into clinical practice in early-stage breast cancer required oncologists to make changes to their usual routines. The opinions of oncologists about the quality of evidence underpinning the test affected how much weight they gave to test results in treatment decision-making.
个性化医疗的进展为乳腺癌女性患者带来了新的检测方法和治疗选择。对于此类检测方法如何应用于肿瘤学实践，人们了解相对较少。本研究的目的是了解医学肿瘤学家在多基因表达谱（GEP）检测方面的经验，包括其在早期乳腺癌实践中的应用，以及肿瘤学家对检测结果对治疗决策影响的看法。
我们进行了一项定性描述性研究，对安大略省8个社区的学术和社区癌症中心或医院的医学肿瘤学家进行访谈。以21基因乳腺癌检测作为GEP检测的示例。采用定性分析技术来确定主要主题。
在接触的28名肿瘤学家中，21名（75%）参与了研究[中位年龄：43岁；12名女性（57%）]。对GEP检测的认识和了解来源于多个渠道：国际科学会议、参与临床研究、与受尊敬的同事讨论以及制造商赞助的会议。肿瘤学家观察到，将GEP检测纳入临床实践带来了一些变化，包括会诊时间延长、二次就诊以及采取措施尽量减少治疗延误。肿瘤学家对GEP检测在指导治疗决策方面的证据强度和附加价值表达了不同意见。
将GEP检测纳入早期乳腺癌的临床实践要求肿瘤学家改变其常规做法。肿瘤学家对该检测所依据证据质量的看法影响了他们在治疗决策中对检测结果的重视程度。
