Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA.
Center for Bioethics & Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
Oncologist. 2020 Jul;25(7):620-626. doi: 10.1634/theoncologist.2019-0863. Epub 2020 Mar 13.
Genetic sequencing and precision oncology have supported clinical breakthroughs but depend upon access to vast arrays of research specimens and data. One way for academic medical centers to fund such infrastructure and research is "commercialization" of access to specimens and data to industry. Here we explore patient and clinician perspectives regarding cancer specimen and data commercialization with the goal of improving such processes in the future.
This qualitative analysis was embedded within a prospective precision oncology sequencing study of adults with head and neck cancer. Via semistructured dyadic interviews with patients with cancer and their doctors, we assessed understanding and concerns regarding potential commercialization, opinions regarding investment of profits, and perspectives regarding the return of information directly to participants from industry.
Several patient- and clinician-participants did not understand that the consent form already permitted commercialization of patient genetic data and expressed concerns regarding who would profit from the data, how profits would be used, and privacy and access. Patients were generally more comfortable with commercialization than clinicians. Many patients and clinicians were comfortable with investing profits back into research, but clinicians were more interested in investment in head and neck cancer research specifically. Patients generally supported potential return-of-results from a private entity, but their clinicians were more skeptical.
Our results illustrate the limitations of mandatory disclosures in the informed consent process. The voices of both patients and their doctors are critical to mitigate violations of privacy and a degradation of trust as stakeholders negotiate the terms of academic and commercial engagement.
Further education is needed regarding how and why specimens and data in precision oncology research may be commercialized for both patients and providers alike. This process will require increased transparency, comprehension, and engagement of involved stakeholders.
基因测序和精准肿瘤学为临床突破提供了支持,但这需要获得大量的研究标本和数据。学术医疗中心为这种基础设施和研究提供资金的一种方式是将标本和数据“商业化”,以供行业使用。在这里,我们探讨了患者和临床医生对癌症标本和数据商业化的看法,旨在改善未来的此类流程。
这项定性分析嵌入在一项针对头颈部癌症成人的前瞻性精准肿瘤测序研究中。通过对癌症患者及其医生进行半结构化的对偶访谈,我们评估了他们对潜在商业化的理解和关注、对利润投资的看法,以及对行业直接向参与者返还信息的看法。
一些患者和临床医生不理解同意书已经允许商业化患者的遗传数据,并对谁将从数据中获利、利润将如何使用以及隐私和访问权限表示担忧。患者比临床医生更能接受商业化。许多患者和临床医生都愿意将利润投资于研究,但临床医生更感兴趣的是专门投资于头颈部癌症研究。患者通常支持从私营实体获得潜在的研究结果,但他们的临床医生更持怀疑态度。
我们的研究结果说明了知情同意过程中强制性披露的局限性。患者及其医生的意见对于减轻隐私侵犯和信任度下降至关重要,因为利益相关者正在协商学术和商业参与的条款。
需要对精准肿瘤学研究中的标本和数据如何以及为何可能商业化进行进一步的教育,这不仅是对患者,也对医疗服务提供者。这一过程将需要增加透明度、理解度和利益相关者的参与度。