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Multigene expression profile testing in breast cancer: is there a role for family physicians?
M A O'Brien1, J C Carroll1, D P Manca2
1Ontario: Department of Family and Community Medicine, University of Toronto, Toronto (Carroll, Grunfeld, Heisey, Makuwaza, Moineddin, O'Brien); Ray D. Wolfe Department of Family Medicine, Sinai Health System, Toronto (Carroll, Makuwaza, Permaul); Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston (Groome, Jiang); Department of Family and Community Medicine, Women's College Hospital, Toronto (Heisey); Department of Oncology, Kingston General Hospital, Kingston (Eisenhauer); Department of Oncology, Queen's University, Kingston (Eisenhauer); Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (Krzyzanowska); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Krzyzanowska, Sawka); Cancer Care Ontario, Toronto (Krzyzanowska); Department of Oncology, McMaster University, Hamilton (Sussman); Ontario Institute for Cancer Research, Toronto (Grunfeld).
Background:
Family physicians (fps) play a role in aspects of personalized medicine in cancer, including assessment of increased risk because of family history. Little is known about the potential role of fps in supporting cancer patients who undergo tumour gene expression profile (gep) testing.
Methods:
We conducted a mixed-methods study with qualitative and quantitative components. Qualitative data from focus groups and interviews with fps and cancer specialists about the role of fps in breast cancer gep testing were obtained during studies conducted within the pan-Canadian canimpact research program. We determined the number of visits by breast cancer patients to a fp between the first medical oncology visit and the start of chemotherapy, a period when patients might be considering results of gep testing.
Results:
The fps and cancer specialists felt that ordering gep tests and explaining the results was the role of the oncologist. A new fp role was identified relating to the fp-patient relationship: supporting patients in making adjuvant therapy decisions informed by gep tests by considering the patient's comorbid conditions, social situation, and preferences. Lack of fp knowledge and resources, and challenges in fp-oncologist communication were seen as significant barriers to that role. Between 28% and 38% of patients visited a fp between the first oncology visit and the start of chemotherapy.
Conclusions:
Our findings suggest an emerging role for fps in supporting patients who are making adjuvant treatment decisions after receiving the results of gep testing. For success in this new role, education and point-of-care tools, together with more effective communication strategies between fps and oncologists, are needed.
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