Our aim is to understand primary care providers’ experiences, desired roles and precise needs regarding education and practice tools for personalized medicine, specifically related to personalized cancer risk assessment and management, prognostic indicator testing, and awareness of serious potential drug interactions associated with personalized cancer treatments.
Advances in genomic medicine are revolutionizing our approach to cancer risk assessment, screening and treatment. In this project, ‘personalized medicine’ is used to signify:
- stratification of cancer risk with recommendations for screening and risk reduction;
- determination of eligibility for genetic testing;
- awareness of prognostic tests used to guide treatment decisions; and
- potential of serious drug interactions associated with cancer treatments.
Personalized cancer risk assessment has the potential to identify a sub-population of individuals at increased risk on the basis of family history or genetic risk factors. Once identified, early detection and risk-reducing strategies can be offered, such as modified screening protocols, risk-reducing surgery, or chemo-preventive medication.
Several gaps in care exist both in cancer risk assessment and in the management of those at increased risk. Risk assessment tools that exist for cancer are not used consistently in primary care.
While primary care providers wish to play a role in cancer risk assessment they face many challenges. Primary care providers also have a role in providing care for the majority of patients who are not at elevated risk of cancer. Patients not eligible for genetic testing may need reassurance and possibly a reduction in screening frequency rather than referral. In addition, increased attention to genetics in the popular media as well as direct-to-consumer genetic testing encourages patients to seek medical attention. While specialist referral would be inappropriate for most of these patients, they nonetheless need information and reassurance and primary care providers need guidance to help patients make informed and sensible decisions about available tests.
Little is known about what role, if any, primary care providers wish to have in this area and what their educational needs are. New personalized chemotherapy treatments are associated with multiple serious potential drug interactions, including some adverse effects traditionally managed by primary care providers. During cancer treatment, primary care providers are responsible for treating co-existing illness and need information and resources to avoid serious drug interactions.
We plan to develop and evaluate a cancer care toolkit to enable primary care providers to provide better guidance to patients about personalized medicine innovations.