title: Impact of genomic testing and patient-reported outcomes on receipt of adjuvant chemotherapy.
abstract: Practice guidelines incorporate genomic tumor profiling, using results such as the Oncotype DX Recurrence Score (RS), to refine recurrence risk estimates for the large proportion of breast cancer patients with early-stage, estrogen receptor-positive disease. We sought to understand the impact of receiving genomic recurrence risk estimates on breast cancer patients' well-being and the impact of these patient-reported outcomes on receipt of adjuvant chemotherapy. Participants were 193 women (mean age 57) newly diagnosed with early-stage breast cancer. Women were interviewed before and 2-3 weeks after receiving the RS result between 2011 and 2015. We assessed subsequent receipt of chemotherapy from chart review. After receiving their RS, perceived pros (t = 4.27, P < .001) and cons (t = 8.54, P < .001) of chemotherapy increased from pre-test to post-test, while perceived risk of breast cancer recurrence decreased (t = 2.90, P = .004). Women with high RS tumors were more likely to receive chemotherapy than women with low RS tumors (88 vs. 5 %, OR 0.01, 0.00-0.02, P < .001). Higher distress (OR 2.19, 95 % CI 1.05-4.57, P < .05) and lower perceived cons of chemotherapy (OR 0.50, 95 % CI 0.26-0.97, P < .05) also predicted receipt of chemotherapy. Distressed patients who saw few downsides of chemotherapy received this treatment. Clinicians should consider these factors when discussing chemotherapy with breast cancer patients.
authors.affiliation: Department of Oncology, Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.
authors.forename: Chalanda N
authors.initials: CN
authors.lastname: Evans
authors.affiliation: Gillings School of Global Public Health, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Noel T
authors.initials: NT
authors.lastname: Brewer
authors.affiliation: Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Susan T
authors.initials: ST
authors.lastname: Vadaparampil
authors.affiliation: MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Boisvert
authors.affiliation: Franklin Square Medical Center, Baltimore, MD, USA.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Ottaviano
authors.affiliation: Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: M Catherine
authors.initials: MC
authors.lastname: Lee
authors.affiliation: Department of Oncology, Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.
authors.forename: Claudine
authors.initials: C
authors.lastname: Isaacs
authors.affiliation: Department of Oncology, Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.
authors.forename: Marc D
authors.initials: MD
authors.lastname: Schwartz
authors.affiliation: Department of Oncology, Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA. sco4@georgetown.edu.
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: O'Neill
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000523:psychology*; D017024:Chemotherapy, Adjuvant; D005260:Female; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing / Q000379:methods*; D019983:Guideline Adherence; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000523:psychology; D000071066:Patient Reported Outcome Measures; D017410:Practice Guidelines as Topic; D018570:Risk Assessment
keywords: 21-Gene; Breast cancer; Chemotherapy; Treatment decisions