Mary Beth Nierengarten
Health literacy may determine treatment choice for favorable?risk prostate cancer
properly selected patients active surveillance considered safe alternative immediate treatment men favorablerisk prostate cancer choosing immediate treatment however difficult decision many men genomic prognostic tests oncotype dx genomic prostate score gps used clinic biomarker predict presence unidentified aggressive cancer gps delivers probability data patient provider make treatment choice instead simple positive negative result question however much influence gps test decisionmaking randomized clinical trial recently published journal clinical oncology provides answers1 engaging newly diagnosed men cancer treatment enact trial conducted assess final step validating gps test affects patient care specifically study tested hypothesis gps test would increase adoption among patients randomized receive gps results counseling making treatment decision comparison patients received standard treatment counseling addition examining gps biomarker affects treatment choice study specifically looked use biomarker racially diverse population high risk prostate cancer see effect clinical decisionmaking important studies used validate prognostic tests gps case expression 12 genes plus clinical features performed relatively highly educated affluent white populations says dr gann 1315 consecutive patients newly diagnosed prostate cancer recruited 3 chicagobased medical centers 200 included enact trial basis eligibility indicated favorable disease risk prostate biopsies 200 patients 70 african american 46 classified low health literacy 16 college degree 12 private insurance patients counseled urologist 3 available treatment choices surgery radiation assess impact gps choice treatment 104 patients randomized treatment gps testing counseling 96 patients randomized control group standardized counseling emphasizing national comprehensive cancer network nccn risk level lowlow favorable intermediate benefitsrisks type intervention patients followed course 3 additional visits enrollment received allotted treatment according intentiontotreat analysis without statistical adjustments important factors study record differences treatment choice based allocated treatment control arm big finding intervention big impact treatment choice looking raw percentages says lead author study adam b murphy md mba msci assistant professor urology preventive medicine northwestern university feinberg school medicine chicago overall study found high acceptance regardless type intervention 77 gps group 88 control group marginal differences 2 groups p 067 planned subgroup analysis differences treatment effect based race found key finding enact trial study impact gps dependent patients level health literacy measured standardized questionnaire although gps test effect treatment choice men high health literacy men low health literacy 7fold less likely choose received gps result comparison controls difference remained present controlled nccn risk level baseline says dr gann dr murphy speculates men low health literacy favorablerisk prostate cancer may initially underestimate risk undetected aggressive prostate cancer presented probability aggressive disease suddenly feel urgency immediate treatment based higher risk thought says another reason may patients urologists might concerned patients would manage prolonged complex surveillance protocol possibility supported observation lack health insurance also independent predictor choosing immediate therapy says dr gann one additional surprising finding according dr gann positive association found family history prostate cancer choosing controlled variables compared patients negative history prostate cancer positive family history 4fold greater odds selecting odds ratio 100 95 ci referent vs 413 95 ci 1061606 unanticipated deserves study says dr murphy dr gann emphasize importance considering low health literacy patient counseling offering patients additional counseling resources would recommend providing additional resources around interpretation results people could low levels health literacy says dr murphy also hope findings illuminate need account population characteristics one predicting effects complex biomarkers gps underscore challenge providers patients interpreting probability estimates offered genomic prognostic tests addition dr murphy underscores need better monitoring men likely develop aggressive disease black men could aggressive tumors even though risk group men