Why are so few eligible patients currently being referred?
Short interview on the difficulties for PCa patients getting the genetic testing and counseling that could provide them with significant treatment benefits.
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From the commentary:
"Significant numbers of prostate cancer patients with an indication for genetic counseling never receive counseling or testing, and the chief reason is doctors' lack of knowledge . . ."
. . .
"Arnab Basu, MD, MPH, of the University of Alabama at Birmingham (UAB), and colleagues examined the records of 57 new prostate cancer patients. Of these, approximately two-thirds (38 patients) had an indication for genetic counseling; only 39% of eligible patients were referred, and just 11% completed testing. A survey of their doctors found that just 30% said they would be comfortable completing genetic counseling themselves, while 60% cited lack of knowledge of genetics and genetic testing as barriers." (emphasis added)
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Take away is that we all need to stay well informed and forever aggressive in advocating for the best available care for us and our friends and families. The reality is that, as Npfisherman likes to say the "Science is coming". However, it is coming at a rate that keeps most MOs behind the research curve. Add in the length of time it takes to get clinical approval for new individual drugs and treatment combinations and "We (us patients, in this case) have a problem Houston."(pick your specific MO/CC locations)
With the constant raids on the Sci-Hub websites I am unable to provide a link to the full report at this time.
Be Safe & Stay Well - K9
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PSFor those who have not read it, here is a companion MedPage piece to the above that discusses the 2019 ASCO Guidelines for Germline Testing for PCa:
Prostate Cancer Genetic Testing Guidelines -- Gaps, Challenges in Clinical Implementation - Needed: programs to empower oncologists to conduct pre-test counseling and initiate testing in the clinic
It is the same issue with Urologists currently prescribing Lupron only despite the STAMPEDE trial results favoring abiraterone with Lupron for initial treatment in 2017. Four years ago !!! C'mon MD's...
Some of it is likely as Nal said....resistance to change....some is due to not being informed....after that, it is sheer laziness... How can the chronic disease state be achieved when MD's perform in this manner?? Only, by being at a Center of Excellence can one get the care that they need. I got a genetics test for free at Cleveland Clinic as part of a trial for test approval for the company.
ADVOCATE for yourself and your loved ones people...!!!!!!
Seems that the science is outrunning either the medical practitioner's ability to stay current or their interest in doing so. Probably a reason to find an MO that does /loves research at least as much as he does treatment. I think I've now got that for my CLL, but am relying somewhat more on the CC brain trust at my PCa treatment center.
Those of use who have an interest in the evolving basic and applied research know what a challenge it is to try to stay up with all the relevant topics. Imagine what it must be like for a practitioner who may be teaching, doing research, and also seeing patients in clinic. AI is already being used to filter the info streams with more use assured for the future.
In the meantime, all we can do is keep sharing the info and pushing for the best available treatments for our particular disease states.
Indeed, AI is the wave of the future with AI's providing treatment regimens, dosing strategies, evaluating drugs for potential use.... I feel bad when I read people are being given Lupron only and have multiple mets... You can see the outcome ahead....
I agree with what you said.....teaching, seeing patients, making rounds, phone calls, etc and trying to keep up on developments... I got tired just thinking about it.....now what about the family, and sleep.... it's a lot...
Thanks why it's called work - and why I'm glad every morning when i wake up that I'm retired from it. And you've got that garden to tend - and some fish might just be biting at the nearest water body. So much to do and so little time to get it done . . .
C'est la vie!
I'm working on perfecting a dog's life of tail-chasing leisure. A work forever in progress, but one well work pursuing.
You do push for genetic testing regularly... They are lucky to have you over there..... Indeed, take control of your care... a key to survival... my MO at C.C. was not in favor of SABR to my one met....Did I listen?? NO!!!
I have been an advocate for SABR in Oligometastatic patients despite naysayers, despite banishment...
I read the results from SABR COMET and knew this was part of the answer in 2018. My MO now says it was one of the best treatment decisions I made... Your fate, your choice....steer your ship !!!
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