%0 Journal Article
%T Psychosocial and Quality of Life in Women Receiving the 21-Gene Recurrence Score Assay: The Impact of Decision Style in Women with Intermediate RS
%A Nadiyah Sulayman
%A Elizabeth Spellman
%A Kristi D. Graves
%A Beth N. Peshkin
%A Claudine Isaacs
%A Marc D. Schwartz
%A Suzanne C. OĄŻNeill
%J Journal of Cancer Epidemiology
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/728290
%X Multigene assays such as the 21-gene recurrence score (RS) quantify risk for recurrence and potential benefit from chemotherapy in early-stage, ER+ breast cancers. Few studies have assessed the impact of testing on patient-reported outcomes such as cancer-related distress or quality of life. The few studies that have assessed these outcomes do not consider potential modifiers, such as the patientsĄŻ level of involvement in the treatment decision-making process. In the current study, 81 breast cancer patients who received the RS assay completed cross-sectional surveys. We used linear multiple regression to assess whether test result, decision-making role (passive versus shared/active), and their interaction contributed to current levels of distress, quality of life, and decisional conflict. There were no associations between these variables and test result or decision-making role. However, women who received an intermediate RS and took a passive role in their care reported higher-cancer-related distress and cancer worry and lower quality of life than those who took a shared or active role. These data should be confirmed in prospective samples, as these poorer outcomes could be amenable to intervention. 1. Introduction Improvements in our understanding of the molecular mechanisms of breast cancer progression, diagnosis, and treatment represent a major advance [1]. Genomic profiling of breast tumors increasingly is being used clinically to refine recurrence estimates and guide adjuvant treatment decisions in early-stage, hormone-receptor positive breast cancer [2] and has been integrated into clinical guidelines for this group of patients [3, 4]. The 21-gene recurrence score (RS) assay (Oncotype DX; Genomic Health Inc., Redwood City, CA) quantifies risk of recurrence in patients with early stage, estrogen-receptor- (ER-) positive breast cancer treated with tamoxifen. While data have accumulated to support treatment recommendations for the 25% of women who receive high RS and 50% who receive low RS, [5, 6] recommendations for the remaining quarter of patients with intermediate RS remain less clear pending additional trials, presenting a clinical challenge [7]. Like other cancer treatment decisions which involve more than one appropriate treatment option [8, 9], the uncertainty related to this clinical equipoise could require patients to take more active roles in their treatment decision-making than those who receive a high or low RS. Several studies demonstrate that the RS impacts treatment decisions for physicians and patients [10¨C14]. Specifically, RS
%U http://www.hindawi.com/journals/jce/2012/728290/