The value of personalizing medicine: medical oncologists' views on gene expression profiling in breast cancer treatment.
OBJECTIVE
Guidelines recommend gene-expression profiling (GEP) tests to identify early-stage breast cancer patients who may benefit from chemotherapy. However, variation exists in oncologists' use of GEP. We explored medical oncologists' views of GEP tests and factors impacting its use in clinical practice.


METHODS
We used a qualitative design, comprising telephone interviews with medical oncologists (n = 14; 10 academic, 4 in the community) recruited through oncology clinics, professional advertisements, and referrals. Interviews were analyzed for anticipated and emergent themes using the constant comparative method including searches for disconfirming evidence.


RESULTS
Some oncologists considered GEP to be a tool that enhanced confidence in their established approach to risk assessments, whereas others described it as "critical" to resolving their uncertainty about whether to recommend chemotherapy. Some community oncologists also valued the test in interpreting what they considered variable practice and accuracy across pathology reports and testing facilities. However, concerns were also raised about GEP's cost, overuse, inappropriate use, and over-reliance on the results within the medical community. In addition, although many oncologists said it was simple to explain the test to patients, paradoxically, they remained uncertain about patients' understanding of the test results and their treatment implications.


CONCLUSIONS
Oncologists valued the test as a treatment-decision support tool despite their concerns about its cost, over-reliance, overuse, and inappropriate use by other oncologists, as well as patients' limited understanding of GEP. The results identify a need for decision aids to support patients' understanding and clinical practice guidelines to facilitate standardized use of the test.
Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Insititute of Health Policy, Management and Evaluation, Department of Medicine, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Independent Qualitative Researcher; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada; DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada yvonne.bombard@utoronto.ca.
Yvonne
Y
Bombard
Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Insititute of Health Policy, Management and Evaluation, Department of Medicine, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Independent Qualitative Researcher; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada; DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Linda
L
Rozmovits
Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Insititute of Health Policy, Management and Evaluation, Department of Medicine, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Independent Qualitative Researcher; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada; DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Maureen
M
Trudeau
Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Insititute of Health Policy, Management and Evaluation, Department of Medicine, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Independent Qualitative Researcher; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada; DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Natasha B
NB
Leighl
Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Insititute of Health Policy, Management and Evaluation, Department of Medicine, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Independent Qualitative Researcher; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada; DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Ken
K
Deal
Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Insititute of Health Policy, Management and Evaluation, Department of Medicine, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Independent Qualitative Researcher; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada; DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Deborah A
DA
Marshall
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000235:genetics* / Q000628:therapy*; D005260:Female; D020869:Gene Expression Profiling / Q000706:statistics & numerical data; D006801:Humans; D008495:Medical Oncology; D008875:Middle Aged; D010817:Physician-Patient Relations; D057285:Precision Medicine
Breast cancer; Gene expression profiling; Oncologists; Oncotype DX; Perceptions; Treatment