Multigene expression profile testing in breast cancer: is there a role for family physicians?

  • M.A. O'Brien University of Toronto
  • J.C. Carroll University of Toronto; Sinai Health System
  • D.P. Manca University of Alberta
  • B. Miedema Dalhousie University
  • P.A. Groome Cancer Research Institute at Queen’s University
  • T. Makuwaza University of Toronto; Sinai Health System
  • J. Easley Dalhousie University
  • N. Sopcak University of Alberta
  • L. Jiang Cancer Research Institute at Queen’s University
  • K. Decker CancerCare Manitoba
  • M.L. McBride BC Cancer Agency
  • R. Moineddin University of Toronto;
  • J.A. Permaul Sinai Health System
  • R. Heisey Women’s College Hospital
  • E.A. Eisenhauer Kingston General Hospital;, Queen’s University
  • M.K. Krzyzanowska Princess Margaret Cancer Centre; University of Toronto
  • S. Pruthi Mayo Clinic
  • C. Sawka University of Toronto
  • N. Schneider Independent
  • J. Sussman McMaster University
  • R. Urquhart Beatrice Hunter Cancer Research Institute
  • C. Versaevel Independent
  • E. Grunfeld University of Toronto
  • for the Canadian Team to Improve Community-Based Cancer Care Along the Continuum
Keywords: Personalized medicine, gene expression profile testing, breast cancer

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.


Author Biographies

M.A. O'Brien, University of Toronto
Department of Family and Community Medicine
J.C. Carroll, University of Toronto; Sinai Health System
Department of Family and Community Medicine; Ray D. Wolfe Department of Family Medicine
D.P. Manca, University of Alberta
Department of Family Medicine
B. Miedema, Dalhousie University
Department of Family Medicine
P.A. Groome, Cancer Research Institute at Queen’s University
Division of Cancer Care and Epidemiology
T. Makuwaza, University of Toronto; Sinai Health System
Department of Family and Community Medicine; Ray D. Wolfe Department of Family Medicine,
J. Easley, Dalhousie University
Department of Family Medicine
N. Sopcak, University of Alberta
Department of Family Medicine
L. Jiang, Cancer Research Institute at Queen’s University
Division of Cancer Care and Epidemiology
R. Moineddin, University of Toronto;
Department of Family and Community Medicine
J.A. Permaul, Sinai Health System
Ray D. Wolfe Department of Family Medicine
R. Heisey, Women’s College Hospital
Department of Family and Community Medicine
E.A. Eisenhauer, Kingston General Hospital;, Queen’s University
Department of Oncology
M.K. Krzyzanowska, Princess Margaret Cancer Centre; University of Toronto
Department of Medical Oncology and Hematology; Institute of Health Policy, Management and Evaluation
S. Pruthi, Mayo Clinic
General Internal Medicine
C. Sawka, University of Toronto
Institute of Health Policy, Management and Evaluation
J. Sussman, McMaster University
Department of Oncology
E. Grunfeld, University of Toronto
Department of Family and Community Medicine
Published
2017-04-27
How to Cite
O’Brien, M., Carroll, J., Manca, D., Miedema, B., Groome, P., Makuwaza, T., Easley, J., Sopcak, N., Jiang, L., Decker, K., McBride, M., Moineddin, R., Permaul, J., Heisey, R., Eisenhauer, E., Krzyzanowska, M., Pruthi, S., Sawka, C., Schneider, N., Sussman, J., Urquhart, R., Versaevel, C., Grunfeld, E., & Community-Based Cancer Care Along the Continuum, for the C. T. to I. (2017). Multigene expression profile testing in breast cancer: is there a role for family physicians?. Current Oncology, 24(2), 95-102. https://doi.org/10.3747/co.24.3457
Section
Medical Oncology