M A O'Brien1, J C Carroll1, D P Manca2, B Miedema3, P A Groome1, T Makuwaza1, J Easley3, N Sopcak2, L Jiang1, K Decker4, M L McBride5, R Moineddin1, J A Permaul1, R Heisey1, E A Eisenhauer1, M K Krzyzanowska1, S Pruthi6, C Sawka1, N Schneider7, J Sussman1, R Urquhart8, C Versaevel7, E Grunfeld1. 1. Ontario: 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). 2. Alberta: Department of Family Medicine, University of Alberta, Edmonton (Manca, Sopcak). 3. New Brunswick: Department of Family Medicine, Dalhousie University, Fredericton (Miedema, Easley). 4. Manitoba: CancerCare Manitoba, Winnipeg (Decker); Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg (Decker). 5. British Columbia: BC Cancer Agency, Vancouver (McBride). 6. United States: General Internal Medicine, Mayo Clinic, Rochester, MN (Pruthi). 7. Independent (Schneider, Versaevel). 8. Nova Scotia: Beatrice Hunter Cancer Research Institute, Halifax (Urquhart); Department of Surgery, Dalhousie University, Halifax (Urquhart).
Abstract
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.
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 cancerpatients 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 cancerpatients 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.
Entities:
Keywords:
Personalized medicine; breast cancer; gene expression profile testing
Authors: Fiona A Miller; June C Carroll; Brenda J Wilson; Jessica P Bytautas; Judith Allanson; Mario Cappelli; Sonya de Laat; Fred Saibil Journal: Fam Pract Date: 2010-06-09 Impact factor: 2.267
Authors: I Pellegrini; M Rapti; J-M Extra; A Petri-Cal; T Apostolidis; J-M Ferrero; T Bachelot; P Viens; C Julian-Reynier; F Bertucci Journal: Eur J Cancer Care (Engl) Date: 2011-11-09 Impact factor: 2.520
Authors: Li Jiang; Aisha Lofters; Rahim Moineddin; Kathleen Decker; Patti Groome; Cynthia Kendell; Monika Krzyzanowska; Dongdong Li; Mary L McBride; Nicole Mittmann; Geoff Porter; Donna Turner; Robin Urquhart; Marcy Winget; Yang Zhang; Eva Grunfeld Journal: Can Fam Physician Date: 2016-10 Impact factor: 3.275
Authors: Julie Easley; Baukje Miedema; June C Carroll; Donna P Manca; Mary Ann O'Brien; Fiona Webster; Eva Grunfeld Journal: Can Fam Physician Date: 2016-10 Impact factor: 3.275
Authors: Fatima Cardoso; Laura J van't Veer; Jan Bogaerts; Leen Slaets; Giuseppe Viale; Suzette Delaloge; Jean-Yves Pierga; Etienne Brain; Sylvain Causeret; Mauro DeLorenzi; Annuska M Glas; Vassilis Golfinopoulos; Theodora Goulioti; Susan Knox; Erika Matos; Bart Meulemans; Peter A Neijenhuis; Ulrike Nitz; Rodolfo Passalacqua; Peter Ravdin; Isabel T Rubio; Mahasti Saghatchian; Tineke J Smilde; Christos Sotiriou; Lisette Stork; Carolyn Straehle; Geraldine Thomas; Alastair M Thompson; Jacobus M van der Hoeven; Peter Vuylsteke; René Bernards; Konstantinos Tryfonidis; Emiel Rutgers; Martine Piccart Journal: N Engl J Med Date: 2016-08-25 Impact factor: 91.245
Authors: Mark N Levine; Jim A Julian; Philippe L Bedard; Andrea Eisen; Maureen E Trudeau; Brian Higgins; Louise Bordeleau; Kathleen I Pritchard Journal: J Clin Oncol Date: 2015-11-23 Impact factor: 44.544
Authors: J C Carroll; M Cappelli; F Miller; B J Wilson; E Grunfeld; C Peeters; A G W Hunter; C Gilpin; P Prakash Journal: Community Genet Date: 2008-01-15
Authors: Michael J Hassett; Samuel M Silver; Melissa E Hughes; Douglas W Blayney; Stephen B Edge; James G Herman; Clifford A Hudis; P Kelly Marcom; Jane E Pettinga; David Share; Richard Theriault; Yu-Ning Wong; Jonathan L Vandergrift; Joyce C Niland; Jane C Weeks Journal: J Clin Oncol Date: 2012-05-14 Impact factor: 44.544
Authors: A Goldhirsch; E P Winer; A S Coates; R D Gelber; M Piccart-Gebhart; B Thürlimann; H-J Senn Journal: Ann Oncol Date: 2013-08-04 Impact factor: 32.976
Authors: Patti Ann Groome; Mary L McBride; Li Jiang; Cynthia Kendell; Kathleen M Decker; Eva Grunfeld; Monika K Krzyzanowska; Marcy Winget Journal: Int J Popul Data Sci Date: 2018-11-12