<p>Cancer Patient-Reported Preferences and Knowledge for Liquid Biopsies and Blood Biomarkers at a Comprehensive Cancer Center</p>

Abstract

Background: Blood-based biomarkers (liquid biopsy) are increasingly used in precision oncology. Yet, little is known about cancer patients' perspectives in clinical practice. We explored patients' depth of preferences for liquid vs tissue biopsies and knowledge regarding the role of blood biomarkers on their cancer. Methods: Three interviewer-administered trade-off scenarios and a 54-item selfadministered questionnaire were completed by cancer outpatients across all disease sites at the Princess Margaret Cancer Centre. Results: Of 413 patients, 54% were female; median age was 61 (range 18-101) years. In trade-off scenario preference testing, 90% (n=372) preferred liquid over tissue biopsy at baseline; when wait times for their preferred test were increased from 2 weeks, patients tolerated an additional mean of 1.8 weeks (SD 2.1) for liquid biopsy before switching to tissue biopsy (with wait time 2 weeks). Patients also tolerated a 6.2% decrease (SD 8.8) in the chance that their preferred test would conclusively determine optimal treatment before switching from the baseline of 80%. 216 patients (58%) preferred liquid biopsy even with no chance of adverse events from tissue biopsy. Patients' knowledge of blood-based biomarkers related to their cancer was low (mean 23%); however, the majority viewed development of blood biomarkers as important. Conclusion: Patients had limited understanding of cancer-specific blood-based biomarkers, but 90% preferred liquid over tissue biopsies to assess biomarkers. There was little tolerance to wait longer for results, or for decreased test-conclusiveness. Developing accurate, low-risk tests for cancer diagnosis and management for blood biomarkers is therefore desirable to patients.

Precision Oncology: a Clinical and Patient Perspective

“…While the vast majority of patients (85%) felt that they understood their treatment as explained to them, only 23% of physicians felt that their patients were fully informed [82]. Likewise, in a separate survey of patients at a cancer network in Canada, patients' understanding regarding their own cancer's blood-based biomarkers was low (23%), yet the majority of patients considered the development of such biomarkers as important [83]. Finally, in order to achieve successful transformative decision-making guided by tumor molecular profiling, it is imperative to build the trust between patients and their physicians; physicians are at the interface between research and real-world medicine, and physician trustworthiness is instrumental in influencing and promoting such programs [84].…”

An Overview of Comprehensive Genomic Profiling Technologies to Inform Cancer Care

“…Patients with cancer have reported they are more likely to prefer liquid biopsies than tissue biopsies, if the technology can provide similar information to guide treatment decisions. 75 In cases in which tissue biopsy is not feasible, liquid biopsy-based CGPs could provide an alternative to people for whom there were no previous options. 9 A study that surveyed people who underwent genomic profiling reported that most overwhelmingly favoured testing if it provides an opportunity to receive tailored treatment and avoid adverse effects of non-targeted therapies that could be less effective.…”

Cost-Effectiveness of Liquid Biopsy for Colorectal Cancer Screening in Patients Who Are Unscreened

“…8 For LB, we assumed patients would agree to receive a blood test for cancer screening and adherence was set to 100%; this assumption was varied broadly in sensitivity analysis. 16 In the C-LB group, 60.6% of patients received colonoscopy, and all unscreened patients underwent LB. Patients at average risk received colonoscopy every 10 years, S-DNA and LB every 3 years, and FIT annually.…”

“…[11][12][13][14] These tests have better performance than previous blood-based cancer detection tests, 15 and LBs may present a more appealing CRC screening option especially among individuals who are unscreened. 16 While there has been increasing investment in LB for its potential to detect early cancer, it remains unclear whether it is a costeffective CRC screening strategy in the US.…”

“…New blood tests or liquid biopsies (LBs) using circulating tumor DNA–based markers are in development for single cancer and multicancer early detection (MCED), including CRC . These tests have better performance than previous blood-based cancer detection tests, and LBs may present a more appealing CRC screening option especially among individuals who are unscreened . While there has been increasing investment in LB for its potential to detect early cancer, it remains unclear whether it is a cost-effective CRC screening strategy in the US.…”