Exploring motivation to pursue genomic profiling among patients with metastatic genitourinary cancers.

Abstract

663 Background: Genomic profiling (GP) is becoming more widespread in oncologic care, yet little is known regarding patients’ motivations to pursue or accept such testing. The current study examined patients’ reasons to pursue GP in the context of advanced genitourinary disease, and their potential association with demographic characteristics and psychiatric symptoms (anxiety and depression). Methods: Patients were recruited from a single institution after receiving a standardized dialogue about GP from their oncologist. Patients were included if they had received GP in the context of routine clinical care. Patients’ reasons for pursuing GP were assessed, as well as anxiety and depression via the PROMIS measures. The Kruskal-Wallis test was used. Results: A cohort of 90 patients (median 64 years old; 76% male; 71% white) with metastatic genitourinary cancers (61% renal cell carcinoma, 22% urothelial carcinoma and 17% prostate cancer) were enrolled. Demographic characteristics and psychosocial symptoms were associated with the pursuit of GP. Older and female patients tended to report that their physician’s recommendation was a primary driver of their decision (p<0.05), while younger patients sought to avoid unnecessary treatment and side-effects (p=0.04). In addition, patients experiencing anxiety and depression reported that GP adoption was driven by a desire to predict disease outcomes (p<0.05). Conclusions: The current study provides novel insight into the motivations underlying patients’ adoption of GP. The importance of a physicians’ recommendation may be indicative of the lasting influence of a paternalistic model of care, while the desire to avoid of side-effects can help guide effective discussions concerning the role of GP in care planning. The association between anxiety/depression and the hope that GP can predict disease outcomes reinforces the importance of ensuring patients possess an accurate understanding of this testing paradigm.