Abstract
PurposeLittle is known about the impact of 70-gene signature (70-GS) use on patients’ chemotherapy decision-making. The primary aim of this study was to evaluate the impact of 70-GS use on patients’ decisions to undergo chemotherapy. The perceived decision conflict during decision-making was a secondary objective of the study.MethodsPatients operated for estrogen receptor positive early breast cancer were asked to fill out a questionnaire probing their inclination to undergo chemotherapy before deployment of the 70-GS test. After disclosure of the 70-GS result patients were asked about their decision regarding chemotherapy. Patients’ decisional conflict was measured using the 16-item decisional conflict scale (DCS); scores < 25 are associated with a persuaded decision while a score > 37.5 implies that one feels unsure about a choice.ResultsBetween January 1th 2017 and December 31th 2018, 106 patients completed both questionnaires. Before deployment of the 70-GS, 58% of patients (n = 62) formulated a clear treatment preference, of whom 21 patients (34%) changed their opinion on treatment with chemotherapy following the 70-GS. The final decision regarding chemotherapy was in line with the 70-GS result in 90% of patients. The percentage of patients who felt unsure about their preference to be treated with chemotherapy decreased from 42 to 5% after disclosure of the 70-GS. The mean total DCS significantly decreased from pre-test to post-test from 35 to 23, irrespective of the risk estimate (p < 0.001).ConclusionDeployment of the 70-GS changed patients’ inclination to undergo adjuvant chemotherapy in one third of patients and decreased patients’ decisional conflict.
Highlights
In patients with early-stage breast cancer, adjuvant systemic therapy is administered to reduce the risk of cancer recurrence and to improve overall survival [1]
We aimed to explore the perceived decisional conflict during decisionmaking and gain insight in patients’ understanding of 70-gene signature (70-GS) testing
A total of 106 ER+ /HER2- negative breast cancer patients were enrolled in the study
Summary
In patients with early-stage breast cancer, adjuvant systemic therapy is administered to reduce the risk of cancer recurrence and to improve overall survival [1]. The advice to administer adjuvant chemotherapy (CT) is based on. Extended author information available on the last page of the article patients’ estimated risk of recurrence. Prognostic tools such as ‘Adjuvant!Online’ and ‘UK.Predict’ incorporate clinical and pathological risk factors to determine the recurrence risk and to guide clinical decision-making [2, 3]. Even with the aid of these algorithms individual risk assessment remains challenging as patients with comparable tumors may have different outcomes
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