Advanced Cancer Patient Knowledge of and Attitudes towards Tumor Molecular Profiling

Abstract

Limited research has indicated that despite their overwhelming interest in tumor molecular profiling (MP),11Abbreviations: Accessibility and Remoteness Index of Australia (ARIA): an indication of the proximity of service centers relative to where the participant lives. Eastern Cooperative Oncology Group (ECOG): A performance status measure to quantify cancer patients' general well-being and activities of daily life. Molecular Therapeutics (MoST) Program: A research program which forms a component of the Australian Genomic Cancer Medicine Program. The Psychosocial Issues in Genomic Oncology (PiGeOn) Project: a longitudinal, mixed methods psychosocial sub-study of the MoST Program which aims to examine the psychosocial, behavioral and ethical impact of MP. Tumor molecular profiling (MP): a form of genomic testing, that involves characterization of tumor-derived DNA and RNA. cancer patients have poor knowledge about MP. The current study aimed to investigate demographic and psychological predictors of knowledge and perceived importance of MP in an advanced cancer patient cohort. Eligible participants had advanced solid cancers of any histological type with sufficient accessible tissue for MP and were enrolled in the Molecular Screening and Therapeutics (MoST) Program. A questionnaire was completed by 1074 participants (91% response rate) after consent, prior to undergoing MP. Overall, participants had poor to moderate knowledge of MP, yet perceived MP to have high importance. Higher education, speaking English at home, and greater satisfaction with the decision to undergo MP were associated with higher knowledge scores. More negative attitudes towards uncertainty, greater self-efficacy to cope with results, and lower perceived likelihood of cancer progression were associated with greater perceived importance of MP. Less educated participants and those who do not speak English at home will need clear explanations, visual aids and ample opportunity to ask questions about MP at the time of their decision-making. Clinicians also need to consider psychological factors relevant to patients' decision to pursue MP. Given the increased awareness of and demand for cancer genomic information and the rapidly changing nature of the actionability of MP, these findings will help inform an important ongoing debate on how to facilitate ethical and informed consent and manage patient expectations about personalized treatments.