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Confronting the Care Delivery Challenges Arising from Precision Medicine
1Cancer Therapy Evaluation Program, Division of Cancer Therapy and Diagnosis, National Cancer Institute , Rockville, MD , USA.
Abstract:
Understanding the biology of cancer at the cellular and molecular levels, and the application of such knowledge to the patient, has opened new opportunities and uncovered new obstacles to quality cancer care delivery. Benefits include our ability to now understand that many, if not most, cancers are not one-size-fits-all. Cancers are a variety of diseases for which intervention may be very different. This approach is beginning to bear fruit in gynecologic cancers where we are investigating therapeutic optimization at a more focused level, that while not yet precision care, is perhaps much improved. Obstacles to quality care for patients come from many directions. These include incomplete understanding of the role of the mutant proteins in the cancers, the narrow spectrum of agents, broader mutational profiles in solid tumors, and sometimes overzealous application of the findings of genetic testing. This has been further compromised by the unbridled use of social media by all stakeholders in cancer care often without scientific qualification, where anecdote sometimes masquerades as a fact. The only current remedy is to wave the flag of caution, encourage all patients who undergo genetic testing, either germline or somatic, to do so with the oversight of genetic counselors and physician scientists knowledgeable in the pathways involved. This aspiration is accomplished with well-designed clinical trials that inform next steps in this complex and ever evolving process.
Insights
Cancer care is advancing with personalized medicine, but challenges remain in understanding mutations and applying genetic testing results. Genetic counselors and physician scientists are crucial for navigating complex cancer biology and treatment optimization.
Area of Science:
- Oncology
- Molecular Biology
- Genetics
Background:
- Cancer is increasingly understood as a diverse group of diseases at the cellular and molecular levels.
- This nuanced understanding offers new opportunities but also presents obstacles to delivering high-quality cancer care.
- Advances are particularly noted in gynecologic cancers, moving towards optimized, focused therapeutic strategies.
Purpose of the Study:
- To explore the evolving landscape of cancer care, highlighting both advancements and challenges.
- To emphasize the need for careful application of genetic testing in oncology.
- To advocate for expert guidance in interpreting complex cancer biology and treatment options.
Main Methods:
- Review of current understanding in cancer biology and its clinical application.
- Analysis of challenges in therapeutic optimization, including understanding mutant proteins and mutational profiles.
- Discussion of the impact of social media on cancer information dissemination.
- Emphasis on the role of genetic counseling and physician-scientist oversight.
Main Results:
- Recognition that many cancers are not uniform, necessitating tailored interventions.
- Identification of obstacles such as incomplete understanding of mutant protein roles and broad mutational profiles.
- Concerns regarding the overzealous application of genetic testing findings.
- The pervasive influence of unqualified information on social media.
Conclusions:
- Genetic testing for cancer, whether germline or somatic, requires oversight from genetic counselors and physician scientists.
- Well-designed clinical trials are essential for informing future steps in personalized cancer care.
- A cautious approach is advised due to the complexity and rapid evolution of cancer biology and treatment.
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