Genomic testing in cancer: Patient knowledge, attitudes, and expectations

Authors

  • Phillip S. Blanchette MSc, MD,

    1. Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • Anna Spreafico MD, PhD,

    1. Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
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  • Fiona A. Miller PhD,

    1. Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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  • Kelvin Chan MD,

    1. Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    2. Division of Medical Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
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  • Jessica Bytautas BA,

    1. Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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  • Steve Kang HBSc,

    1. Department of Physiology, University of Toronto, Toronto, Ontario, Canada
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  • Philippe L. Bedard MD,

    1. Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    2. Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
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  • Andrea Eisen MD,

    1. Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    2. Division of Medical Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
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  • Larissa Potanina MD,

    1. Research Ethics Board, University Health Network, University of Toronto, Toronto, Ontario, Canada
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  • Jack Holland MD,

    1. Research Ethics Board, University Health Network, University of Toronto, Toronto, Ontario, Canada
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  • Suzanne Kamel-Reid PhD,

    1. Department of Laboratory Medicine and Pathobiology, University Health Network, University of Toronto, Toronto, Ontario, Canada
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  • John D. McPherson PhD,

    1. Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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  • Albiruni R. Razak MD,

    1. Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    2. Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
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  • Lillian L. Siu MD

    Corresponding author
    1. Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    2. Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
    • Corresponding author: Lillian L. Siu, MD, Princess Margaret Cancer Center, Drug Development Program, 610 University Avenue, Suite 5-718, Toronto, Ontario, M5G 2M9, Canada; Fax: (416)-946-4467; lillian.siu@uhn.ca

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  • Presented in part as a poster at the 2013 European Cancer Congress; September 27 to October 3, 2013; Amsterdam, the Netherlands.

  • We acknowledge all members of the Drug Development Program at Princess Margaret Cancer Centre for their help with data collection and thank all the patients for their important and valuable contribution to our research.

Abstract

BACKGROUND

Genomic testing in cancer (GTC) characterizes genes that play an important role in the development and growth of a patient's cancer. This form of DNA testing is currently being studied for its ability to guide cancer therapy. The objective of the current study was to describe patients' knowledge, attitudes, and expectations toward GTC.

METHODS

A 42-item self-administered GTC questionnaire was developed by a multidisciplinary group and patient pretesting. The questionnaire was distributed to patients with advanced cancer who were referred to the Princess Margaret Cancer Center for a phase 1 clinical trial or GTC testing.

RESULTS

Results were reported from 98 patients with advanced cancer, representing 66% of the patients surveyed. Seventy-six percent of patients were interested in learning more about GTC, and 64% reported that GTC would significantly improve their cancer care. The median score on a 12-item questionnaire to assess knowledge of cancer genomics was 8 of 12 items correct (67%; interquartile range, 7-9 of 12 items correct [58%-75%]). Scores were associated significantly with patients' education level (P < .0001). Sixty-six percent of patients would consent to a needle biopsy, and 39% would consent to an invasive surgical biopsy if required for GTC. Only 48% of patients reported having sufficient knowledge to make an informed decision to pursue GTC whereas 34% of patients indicated a need for formal genetic counseling.

CONCLUSIONS

Patients with advanced cancer are motivated to participate in GTC. Patients require further education to understand the difference between somatic and germline mutations in the context of GTC. Educational programs are needed to support patients interested in pursuing GTC. Cancer 2014;120:3066–3073. © 2014 American Cancer Society.

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