Genomic Test Result Confusing to Some Patients

One in three early stage breast cancer patients who received genomic testing when deciding about treatment options felt they did not fully understand their discussions with physicians about their test results and their risk of the disease recurring, a new study has found.

The research, conducted by University of North Carolina (UNC) at Chapel Hill investigators, also revealed about one in four women experienced distress when receiving their test results.

Published online in Cancer, the findings suggest there is room for improvement in the way doctors communicate with patients about cancer recurrence risks and treatment decisions.

Genomic testing is an increasingly important part of care for patients after they are diagnosed with early stage breast cancer. Tests such as the Oncotype DX genomic diagnostic test, which looks at 21 genes in breast tumors that have been removed during surgery, can indicate the chance a woman’s cancer will return. Such information can help guide physicians and patients’ decisions about chemotherapy. Patients with a high risk of recurrence may opt for more aggressive treatment, while those with lower risk may safely avoid over-treatment and potential side effects.

Noel Brewer, PhD, assistant professor of health behavior and health education at the UNC Gillings School of Global Public Health, and Janice Tzeng, who worked on the new study as a graduate student at the school, led a team that examined how women with breast cancer received and understood cancer recurrence risk information after receiving the Oncotype DX test.

To find out more about women’s reactions, investigators mailed surveys to 77 women with early stage, estrogen receptor-positive breast cancer who received the test between 2004 and 2009.

“Almost all women agreed that having the test gave them a better understanding of their treatment options’ chances of success,” Brewer, also a member of UNC’s Lineberger Comprehensive Cancer Center, said in a news release. “Most women said that they would have the test if they had to decide again today, and that they would recommend the test to other women in their same situation. Also, most women accurately recalled their recurrence risk results. The findings suggest that patients have a positive attitude about genomic testing, and testing helps them better understand their treatment options.”

While many women understood discussions about their test results, one third of them reported not fully understanding these discussions. Women who believed they understood less did not receive printed materials about the test.

Although 87% of women received a low or intermediate breast cancer recurrence risk score, about one quarter of them experienced distress when receiving their test results. Distress was more common among women who had intermediate or high recurrence risk scores (only 18% of women classified as having a low recurrence risk were distressed, compared to 30% with intermediate scores and 44% with high risk results). Stronger feelings of distress were also related to getting chemotherapy, not getting radiation, and worrying more frequently about breast cancer recurrence.

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