Men diagnosed with low- to intermediate-risk prostate cancer — meaning cancers which are less prone to cause problems over time, even when left untreated — face a difficult alternative. Is: Should they be treated immediately, or should they be monitored with lively surveillance? Treated provided that the cancer shows evidence of growth? Tests that measure the activity of certain genes and other cancer-related biomarkers may also help with this decision.
One such test, called Oncotype DX, measures the activity of 17 genes related to prostate cancer in a biopsy sample. A low rating on the test indicates that an individual's cancer is growing slowly, making lively surveillance an inexpensive option. Higher scores reflect more aggressive cancers which may be considered for early interventions, because without treatment, these cancers usually tend to spread or turn into symptomatic.
The Oncotype DX test is becoming more widely used, and has been validated in repeated studies showing that it could actually predict the extent of cancer in men who've had their prostate gland surgically removed. was given Evidence from these studies shows that the test provides useful details about a person's overall diagnosis.
now, A new study have investigated for the primary time how Oncotype DX test results are influencing treatment decisions amongst ethnically diverse men with prostate cancer within the United States. Dr. Adam Murphy, a urologist at Northwestern University's Feinberg School of Medicine in Chicago, led the study.
Murphy and his colleagues enrolled 200 men with newly diagnosed, favorable-risk prostate cancer, and gave each the identical counseling on treatment options. During this primary visit, the lads were randomly allocated into two groups: a gaggle that received the Oncotype DX test with results explained, and a control group that didn't receive the test. The Oncotype DX test evaluates the likelihood that the cancer is aggressive and prone to spread beyond the prostate gland, in addition to the likelihood that a person's cancer will spread to other parts of the body inside 10 years ( metastasize).
Unexpected results of the study
After two to a few weeks, the lads returned for a second visit to make your mind up on a treatment strategy. Murphy and his colleagues were surprised to seek out that the lads who took the test tended to lean. far off from lively surveillance, even when the outcomes suggest that that is an inexpensive strategy. Specifically, 77% of men who received the Oncotype DX test selected lively surveillance, compared with 88% of men who weren't offered the test—a difference of 11%.
This difference was much more pronounced amongst men with low health literacy, a term that describes a person's ability to acquire, process, and understand medical information when making treatment selections. Men with low health literacy were seven times less prone to select lively surveillance after receiving the Oncotype DX test than men within the control group, no matter race, ethnicity, age, and other aspects. However, no such difference was observed amongst men with higher health literacy.
What explains the contradiction? Murphy suggests that this has to do with how Oncotype DX test scores are interpreted for patients. “If people have trouble interpreting probabilities, what they focus on instead are the words themselves—metastases and death—and the data show that the risks of really bad things happening. are.” says Murphy. In other words, “The information can be scary, so men say, 'Let me go ahead and treat the cancer right up front,'” says Murphy.
In addition to showing that difficulty understanding complex information may prompt some men to hunt immediate treatment, the study reached other interesting findings. For example, having a family history was related to 4 times greater odds of selecting lively surveillance, a conclusion Murphy draws on personal experience of knowing someone who may experience unintended effects from treatment. , akin to incontinence or erectile dysfunction. Men who had medical insurance were 3 times more prone to select lively surveillance than men who didn't.
But for Murphy and his colleagues, the disparity amongst men with low health literacy is the study's important finding. “You want people to be educated when making choices about active surveillance,” he says. “Physicians should consider education tools and give patients time to inform themselves before making a decision.”
“This study has far-reaching implications not only for counseling men with prostate cancer, but also for physician-patient communication in general. Physicians can often lose sight of the fact that patients do not fully understand the clinical explanation. Understanding, and most importantly, such misconceptions further emphasizes the need to provide more easily understood patient support to increase and improve basic medical and health literacy. “