Does biomarker information impact breast cancer patients’ preferences and physician recommendation for adjuvant chemotherapy?
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This study aimed to examine how biomarker information would impact patients’ preferences and physicians’ recommendations for adjuvant breast cancer therapy.
At the 18-month follow-up, participants in a large, double-blind randomized controlled trial of adjuvant chemotherapy with bevacizumab or placebo (E5103) were surveyed about their preferred treatment (either chemotherapy A alone or chemotherapy A+B) in two hypothetical scenarios: (1) without biomarker information; and (2) after learning that they tested positive for a “B-receptor” which modestly increased both the benefit and toxicity expected with chemotherapy A+B. We performed a cross-sectional analysis of the prospectively collected survey data and used the McNemar’s test to examine changes in treatment preferences. A one-time survey of clinical investigators who enrolled patients on the trial evaluated physician recommendations in response to the same biomarker information.
439 patients completed both scenarios on 18-month survey. Most participants preferred A+B in both scenario 1 and 2 (77 and 76% respectively). The increase in benefit and toxicity associated with the positive biomarker information in scenario 2 led 60/439 (14%) of patients to switch their treatment preference. The corresponding physician survey revealed that most physicians chose regimen A+B in scenario 1 (77%), and moreso after the biomarker information was available in scenario 2 (84%).
Information about a positive biomarker indicating increased benefit and toxicity from additional chemotherapy did not change many participants’ preferred treatment. The majority preferred the most effective course in both scenarios. Similarly, most investigators discounted increased toxicity and valued increased benefit. Parent Trial Registration: NCT00433511
KeywordsBreast cancer Biomarkers Patient preferences Adjuvant therapy Risk Toxicity
This study was coordinated by the ECOG-ACRIN Cancer Research Group (Robert L. Comis, MD and Mitchell D. Schnall, MD, PhD, Group Co-Chairs) and supported by the National Cancer Institute of the National Institutes of Health under the following award numbers: CA180820, CA21115, CA180794, CA23318, CA66636, CA025224, CA031946, CA077651, CA180821, CA180790, CA13650, CA180791, CA180795, CA49883, CA180816, CA180867. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government. Also supported by a Susan G. Komen for the Cure, Promise Award (Bryan P. Schneider).
Compliance with ethical standards
Conflict of interest
Ann Partridge declares that she has no conflict of interest. Karen Sepucha declares that she has no conflict of interest. Anne O’Neill declares that she has no conflict of interest. Kathy D. Miller declares that she has no conflict of interest. Emily Baker declares that she has no conflict of interest. Chau T. Dang reports funding from Roche/Genentech. Donald W. Northfelt declares that he has no conflict of interest. George W. Sledge declares that he has no conflict of interest. Bryan P. Schneider declares that he has no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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