Impact of biomarkers and genetic profiling on breast cancer prognostication: A comparative analysis of the 8th edition of breast cancer staging system

Yoon, Esther; Schwartz, Christopher; Ventura, Katia; Wen, Hannah Y.; Darvishian, Farbod

doi:10.1111/tbj.13352

Cited by 9 publications

(7 citation statements)

References 45 publications

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“…We emphasize that the creation of risk groups or strata that are relevant to clinical practice is entirely feasible and appropriate once the fundamental components (including TNM categories, biological variables and others) are established. Composite risk or prognostic groups of this type are often helpful, although they also have limitations [35][36][37] . Such risk groups are usually not generalizable across the full spectrum of disease and tend to be specific to anatomy and time-dependent scenarios 21,[38][39][40] .…”

Section: Amalgamation Of Other Prognostic Factorsmentioning

confidence: 99%

Global Consultation on Cancer Staging: promoting consistent understanding and use

et al. 2019

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Disease burden is the most important determinant of survival in patients with cancer. This domain, reflected by the cancer stage and codified using the tumour-node-metastasis (TNM) classification, is a fundamental determinant of prognosis. Accurate and consistent tumour classification is required for the development and use of treatment guidelines and to enable clinical research (including clinical trials), cancer surveillance and control. Furthermore, knowledge of the extent and stage of disease is frequently important in the context of translational studies. Attempts to include additional prognostic factors in staging classifications, in order to facilitate a more accurate determination of prognosis, are often made with a lack of knowledge and understanding and are one of the main causes of the inconsistent use of terms and definitions. This effect has resulted in uncertainty and confusion, thus limiting the utility of the TNM classification. In this Position paper, we provide a consensus on the optimal use and terminology for cancer staging that emerged from a consultation process involving representatives of several major international organizations involved in cancer classification. The consultation involved several steps: a focused literature review; a stakeholder survey ; and a consultation meeting. This aim of this Position paper is to provide a consensus that should guide the use of staging terminology and secure the classification of anatomical disease extent as a distinct aspect of cancer classification.

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Section: Amalgamation Of Other Prognostic Factorsmentioning

confidence: 99%

Global Consultation on Cancer Staging: promoting consistent understanding and use

et al. 2019

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“…For example, cytogenetic analysis of tumour cells enables reliable life expectancy estimates in several cancers. 5 , 6 , 7 , 8 , 9 However, advances in prediction are not always accompanied by treatment development, and poor prognoses sometimes cannot be effectively ameliorated. 1 Receipt of accurate but irreversible poor prognoses can cause potentially severe psychological distress.…”

Section: Introductionmentioning

confidence: 99%

“…Historically, prognostic estimates have often been uncertain, 4 but recent technical developments, particularly in genetics, are driving a trend toward greater accuracy. For example, cytogenetic analysis of tumour cells enables reliable life expectancy estimates in several cancers 5‐9 . However, advances in prediction are not always accompanied by treatment development, and poor prognoses sometimes cannot be effectively ameliorated 1 .…”

Section: Introductionmentioning

confidence: 99%

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‘I Don't Like Uncertainty, I Like to Know’: How and why uveal melanoma patients consent to life expectancy prognostication

Brown

Fisher

Morgan

et al. 2022

Health Expectations

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Background: Technological advances have led to cancer prognostication that is increasingly accurate but often unalterable. However, a reliable prognosis of limited life expectancy can cause psychological distress. People should carefully consider offers of prognostication, but little is known about how and why they decide on prognostication.Using uveal melanoma (UM) patients, we aimed to identify (i) how and why do people with UM decide to accept prognostication and (ii) alignment and divergence of their decision-making from conceptualizations of a 'well-considered' decision.Methods: UM provides a paradigm to elucidate clinical and ethical perspectives on prognostication, because prognostication is reliable but prognoses are largely nonameliorable. We used qualitative methods to examine how and why 20 UM people with UM chose prognostication. We compared findings to a template of 'well-considered' decisionmaking, where 'well-considered' decisions involve consideration of all likely outcomes.Results: Participants wanted prognostication to reduce future worry about uncertain life expectancy. They spontaneously spoke of hoping for a good prognosis when making their decisions, but largely did not consider the 50% possibility of a poor prognosis. When pressed, they argued that a poor outcome at least brings certainty.Conclusions: While respecting decisions as valid expressions of participants' wishes, we are concerned that they did not explicitly consider the realistic possibility of a poor outcome and how this would affect them. Thus, it is difficult to see their

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“…Patients frequently show interest in prognostication [3]. Researchers are striving for greater prognostic accuracy through biomarker identification, gene profiling and cytogenetic analysis [4][5][6][7][8]. In some cancers, trustworthy life-expectancy estimates are available [9].…”

Section: Introductionmentioning

confidence: 99%

Is accurate routine cancer prognostication psychologically harmful? 5-year outcomes of life expectancy prognostication in uveal melanoma survivors

et al. 2021

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Purpose Prognostication in cancer is growing in importance as increasingly accurate tools are developed. Prognostic accuracy intensifies ethical concerns that a poor prognosis could be psychologically harmful to survivors. Uveal melanoma (UM) prognostication allows survivors to be reliably told that life expectancy is either normal (good prognosis) or severely curtailed because of metastatic disease (poor prognosis). Treatment cannot change life expectancy. To identify whether prognosis is associated with psychological harm, we compared harm in UM survivors with good and poor prognoses and those who declined testing and compared these outcomes to general population norms. Methods Non-randomized 5-year study of a consecutive series of 708 UM survivors (51.6% male, mean age 69.03, SD=12.12) with observations at 6, 12, 24, 36, 48 and 60 months. We operationalized psychological harm as anxiety and depression symptoms, worry about cancer recurrence (WREC) and poor quality of life (QoL). Results Compared to other groups, survivors with poor prognoses showed initially elevated anxiety and depression and consistently elevated worry about local or distant recurrence over 5 years. Good prognoses were not associated with outcomes. Generally, no prognostic groups reported anxiety, depression and WREC or QoL scores that exceeded general population norms. Conclusions Using a large sample, we found that harm accruing from a poor prognosis was statistically significant over 5 years, but did not exceed general non-cancer population norms. Implications for Cancer Survivors Survivors desire prognostic information. At a population level, we do not believe that our findings show sufficiently strong links between prognostication outcome and psychological harm to deny patients the option of knowing their prognosis. Nonetheless, it is important that patients are informed of potential adverse psychological consequences of a poor prognosis.

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Impact of biomarkers and genetic profiling on breast cancer prognostication: A comparative analysis of the 8th edition of breast cancer staging system

Cited by 9 publications

References 45 publications

Global Consultation on Cancer Staging: promoting consistent understanding and use

Global Consultation on Cancer Staging: promoting consistent understanding and use

‘I Don't Like Uncertainty, I Like to Know’: How and why uveal melanoma patients consent to life expectancy prognostication

Is accurate routine cancer prognostication psychologically harmful? 5-year outcomes of life expectancy prognostication in uveal melanoma survivors

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