Biomedical Engineering Reference
In-Depth Information
A second report involved a prospective trial which included 89
assessable patients who were treated by 17 medical oncologists
at one community and three academic practices.
The oncologists
stated their adjuvant treatment recommendations before and after
obtaining a RS, and patients likewise indicated their treatment choice
before and after being informed of the RS result. The treatment
recommendations of the physicians changed in 32% of the cases
with the knowledge of the RS, usually (23%) from chemotherapy
plus endocrine therapy to endocrine therapy alone. Likewise, 27%
of patients changed their treatment decision with knowledge of the
RS, including 10% who chose endocrine therapy alone instead of
chemotherapy followed by endocrine therapy. Physician's confidence
in their treatment recommendation increased with the RS in 68%
of cases. More importantly patient anxiety and decisional conflicts
were significantly lower with the knowledge of their recurrence
score. This is consistent with past research that demonstrated that
women with breast cancer want to participate in treatment decision
making.
A third report described a survey of 160 medical oncologists
who had ordered an Oncotype DX assay for patients with node-
positive disease, were invited to participate in a survey, and agreed
to participate.
29
30
The majority of the respondents (71%) were in
the community and had practiced for a median of 11 years. The
proportion of patients who had 1, 2, 3, or 4 or more positive lymph
nodes was 69%, 18%, 6%, and 3% of patients, respectively. Eighty-six
percent made treatment recommendations before obtaining the RS,
of whom 51% changed their recommendation after receiving the RS.
The treatment recommendation was changed from chemotherapy
plus endocrine therapy to endocrine therapy alone in 33%, and from
endocrine therapy alone to chemoendocrine therapy in 9%.
13.8
Gene Expression Profiles and Expert
Panels
Two expert reviews have indicated that evidence supporting the
clinical utility of gene expression profiles for breast cancer is
insufficient.
On the other hand, expert panels convened by
the American Society of Clinical Oncology (ASCO) and National
Comprehensive Cancer Network (NCCN) concluded that certain
31,32
