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Using Oncotype DX Results for Decisions about Chemotherapy

Posted 4/25/2014

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  Many of you are familiar with the Oncotype DX test that was developed by Myriad Labs about ten years ago. It was created and has been most often used to help make the wisest decision about the necessity of chemotherapy in addition to hormonal treatments for women with ER positive and node negative breast cancers. Those women have often found themselves in a gray area, and it is helpful to have something individual and specific to assist with the choice. Over the years, there have been studies about expanding this genetic screening test (note: this is different from the BRCA testing) to other women, and that likely will be the wave of the future.

  When my second breast cancer was diagnosed in 2005, this test was so new that insurance was not covering it. My own situation was unusual and murky enough that we dug deep and paid for it ourselves, hoping that the results will bring some clarity. They did, and I proceeded with chemotherapy. Now, and for years, virtually all insurances have paid for this test which is surely helpful to doctors and patients and probably saves the insurance companies a lot of money. Paying for a test is far less expensive than paying for a course of chemotherapy!

  This is an interesting study from Current Oncology about women's perceptions of this test and its value in making the decision. I give you the abstract and then a link to read more:

Patients’ perceptions of gene expression profiling in breast cancer treatment decisions
Y. Bombard phd,*† L. Rozmovits dphil,‡
M.E. Trudeau md ma,*§ N.B. Leighl md msc,*||
K. Deal,# and D.A. Marshall phd**

  Determining the likely benefit of adjuvant chemotherapy
for early-stage breast cancer patients depends on
estimating baseline recurrence risk. Gene expression
profile (gep) testing of tumours informs risk prediction,
but evidence of its clinical utility is limited. We
explored patient perceptions of gep testing and the impact
of those perceptions on chemotherapy decisions.
We conducted one focus group (n = 4) and individual
interviews (n = 24) with patients who used gep testing,
recruited through clinics at two hospitals in
Ontario. Data were analyzed using content analysis
and constant comparison techniques.
Patients’ understanding of gep testing was variable,
and misapprehensions were common. Patients valued
the test because it provided them with certainty
amidst confusion, with options and a sense of empowerment,
and with personalized, authoritative
They commonly believed that the test was better
and fundamentally different from other clinical
tests, attributing to it unique power and truth-value.
This kind of “magical thinking” was derived from
an amplified perception of the test’s validity and
patients’ need for reassurance about their treatment
choices. Despite misperceptions or magical thinking,
gep was widely considered to be the deciding factor
in treatment decisions.
Patients tend to overestimate the truth-value of gep
testing based on misperceptions of its validity. Our  results identify a need to better support patient understanding of the test and its limitations.


illustrate the deep emotional investment patients
make in gep test results and the impact of that investment
on their treatment decisions.


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