Breast Cancer Patients' Views on the Use of Genomic Testing to Guide Decisions about Their Postoperative Chemotherapy

Abstract

Background/Aims: Incorporating gene expression profiling into routine clinical practices is beginning to be recommended as part of breast cancer treatment. The aim of the present study was to investigate the decision-making involved in genomic testing from the perspective of patients enrolled in a genomics-based clinical trial of adjuvant chemotherapy. Methods: The prospective SA02 clinical trial was designed to assess the clinical benefits of a genomic test on axillary lymph node-positive (N+) early breast cancer patients. The patients enrolled in the SA02 trial were defined by ‘good prognosis' genomic test results consistent with the delivery of postoperative anthracycline-based chemotherapy without taxane. The present companion study was presented by oncologists to 64 out of the 88 patients enrolled. Data were collected using self-administered questionnaires. Results: The response rate was 67% (questionnaires were returned 35 days on average after enrolment in the trial). Only 33% of the respondents accurately recalled or described their genomic test results. Although most N+ patients classically undergo anthracycline/taxane adjuvant chemotherapy, 23% of the present respondents did not recall participating in the clinical study involving chemotherapy without taxanes. Recall was mainly associated with higher risk perception of chemotherapy-related side effects and better understanding of test results. Among the respondents who recalled participating in the trial, 39% experienced decisional conflicts. Conclusions: Devoting greater efforts to explaining genomic test results to patients could be highly relevant in terms of the trade-off between the risk of unnecessary chemotherapy-related side effects and the loss of survival time possibly resulting from less aggressive treatment.