Individualization of Systemic Therapy in Patients with Estrogen Receptor-Pos

预后良好的乳腺癌患者辅助化疗的决策 考虑到相对较低的边际收益，给临床医生和患者带来了挑战 化疗。基因组图谱分析在早期阶段，雌激素受体阳性的乳腺癌改善了对远处复发风险和化疗相对于单纯内分泌治疗的边际效益的估计，从而加强了对癌症患者的个性化护理。然而，只有在正确的患者中使用化验，并根据化验结果指导接受化疗，才能实现化验的好处。基因组图谱分析在实践中的应用程度以及分析结果对以人群为基础的患者样本接受化疗的影响尚不清楚。这项研究的目的是调查与基因组使用相关的患者和临床医生的因素。 简介，特别是21基因检测，以及该检测对接受化疗的影响。此外，研究结果将为我们的研究成果在肿瘤学家中的创新传播策略提供信息。为了实现这些目标，我们将对新泽西州和佐治亚州监测、流行病学和最终结果(SEER)登记的3200名早期侵袭性雌激素受体阳性乳腺癌患者和他们的治疗肿瘤学家(约270名)进行一项基于人群的前瞻性队列研究。作为候选对象的患者 基因组分析和他们的肿瘤学家将在诊断后几个月进行调查。患者报告的变量、通过小插曲获得的肿瘤学家知识和态度、从肿瘤学家调查中获得的实践特征以及SEER数据将被合并以创建一个独特的数据集。多水平分析将考虑患者、临床医生和实践对化验和接受化疗的影响。该项目的目标将解决我们理解使用和传播的关键障碍 不仅是乳腺癌的测试，这些测试促进了个性化护理，并最终将有助于指导旨在改善护理的政策和干预措施。

Decision-making regarding breast cancer adjuvant chemotherapy in patients with favorable prognoses poses challenges for clinicians and patients alike given the relatively low marginal benefit of chemotherapy. Genomic profile assays in early stage, estrogen receptor-positive breast cancer refine estimates of both the risk of distant recurrence and the marginal benefit of chemotherapy over endocrine therapy alone and thereby enhance individualized care for patients with cancer. The benefits of the assay, however, will be realized only if the assay is used in the right patients and if receipt of chemotherapy is guided by assay results. The extent to which genomic profiling assays are used in practice and the impact of the assay results on receipt of chemotherapy in population-based patient samples are unknown. The aims of this study are to investigate patient and clinician factors associated with the use of genomic profiles, specifically the 21-gene assay, and the impact of the assay on receipt of chemotherapy in at population-based sample. In addition, the study findings will inform innovative dissemination strategies of our research findings among oncologists. To achieve these aims, we will conduct a prospective population-based cohort study of 3,200 patients with early stage invasive, estrogen receptor-positive breast cancer and their treating oncologists (approximately 270) in the state-wide New Jersey and Georgia Surveillance, Epidemiology, and End Results (SEER) registries. Patients who are candidates for the genomic assay and their oncologists will be surveyed several months after diagnosis. Patient-reported variables, oncologist knowledge and attitudes elicited through vignettes, practice characteristics obtained from the oncologist survey, and SEER data will be merged to create a unique dataset. Multilevel analyses will incorporate consideration of patient, clinician, and practice influences on use of the assay and receipt of chemotherapy. The project aims will address critical barriers to our understanding of use and diffusion of tests-not only in breast cancer-^that promote individualized care and will ultimately help guide policies and interventions aimed at improving care.