Genomic Testing for Relapsed and Refractory Lymphoid Cancers: Understanding Patient Values

Area of Science:

• Oncology
• Genomics
• Health Services Research

Background:

• Clinical genomic assays offer improved disease stratification for lymphoid cancers.
• Limited evidence on clinical and cost-effectiveness hinders widespread implementation.
• Understanding patient values is crucial for prioritizing precision oncology.

Purpose of the Study:

• To explore patient preferences and attitudes towards prognostic-based genomic testing in lymphoid cancers.
• To inform priority-setting for precision oncology implementation.

Main Methods:

• Qualitative focus groups with 26 lymphoid cancer patients diagnosed between 2000-2018 in British Columbia.
• Maximum variation sampling to ensure diverse patient perspectives.
• Analysis using NVivo qualitative analysis software.

Main Results:

• Significant heterogeneity in patient willingness to undergo genomic testing for relapsed lymphoid cancers.
• Patient preferences are strongly influenced by personal experiences with disease and treatment.
• Willingness to pay for testing depends on invasiveness, potential for treatment de-escalation, and perceived personal health benefit.

Conclusions:

• Patients accept evidentiary uncertainty until quality/length of life trade-offs are required.
• Demand for precision medicine hinges on expected benefits and implementation costs.
• Clinical implementation must address uncertainty in personal benefit and ensure equitable access.