Any diagnosis that contains the word “cancer” can be a heartstopper. Even less aggressive cancers carry a unique weight. However the word attained that gravity, it makes it one of the scariest diagnoses a human being can get.
People’s experiences of different cancers are shaped by the way they manifest. For example, womanhood is the highest risk factor for breast cancer, and the diagnosis can thus seem like an attack on a core part of a woman’s identity.
Perhaps similarly, significant relationships have been found between work stress and colorectal, lung, and esophageal cancer. Receiving one of these diagnoses may make someone internalize specific negative perceptions. They may feel that the diagnosis is an indictment of their professional choices and identity.
In some cases, social stigma causes people with cancer to blame themselves. Perhaps one of the most salient examples is lung cancer. With patients and those around them assuming that the cancer was brought on by a smoking habit, the self-blame worsens every facet of the disease experience. Other cancer-related stigmas can have severe effects on a cancer patient’s personal relationships.
Additionally, across categories, people’s experiences of cancer are shaped by their own cultural perceptions of it. In some cases, we don’t yet have complete notions of what culturally competent cancer care looks like, which impedes on the healthcare industry’s ability to raise awareness around screenings and preventive care. In a similar vein, people of different ethnicities have differing expectations of providers after receiving a diagnosis. Not receiving the right kind of attention can leave them feeling unmoored and isolated while coping with the disease.
The point is: Each person’s relationship to a cancer diagnosis is incredibly personal.
But, historically, treatment and care have been far from individualized. Enduring the personal nature of the disease while receiving one-size-fits-most treatment may intensify someone’s feelings of hopelessness. With the way we experience a diagnosis and a disease being so personal, how we choose to approach treatment should be equally individualized. And with personalized medicine and comprehensive genetic profiling (CGP), medicine is at last catching up, offering person-level cures.
We’ve been hearing about personalized medicine—in which highly individualized treatment decisions are made based on analysis of a person’s genes—for some time, but it’s now making great strides in cancer. In fact, personalized medicine as a whole is undergoing a transformation with comprehensive genomic profiling (CGP).
Previously, multiple, sequential tests were needed to see just some of a person’s genetic biomarkers. But CGP enables us to see all of a person’s genetic biomarkers with just a single test. And this one biopsy does a lot more than just save time: by evaluating all biomarkers simultaneously, providers can more accurately determine the most efficacious available treatment choice. Sometimes, it can point people to the right clinical trial or just the right medication for them. A whole lot of trial and error—and patient suffering—can perhaps be avoided.
CGP can also be performed on the tumor itself, to better understand its makeup and the best way to fight it. Circulating tumor profiling, using a liquid biopsy, has also increased in sensitivity in recent years, often obviating the need for primary-site biopsies. With more and more types of therapies emerging, CGP can be invaluable in identifying the optimal choice for an individual.
In oncology, CGP is often able to characterize cancerous cells better than a single test or tests with narrower foci. This can identify more appropriate targeted treatments, which can lead to fewer or less intense side effects than conventional, broad-spectrum treatments. So, using CGP is as much about prescribing what will potentially work as it is about not prescribing something that will cause the patient more harm than good, improving patient quality of life. It also helps people learn their personal risks of developing cancer and get the right screenings done in a timely fashion. Providers can create an action plan earlier and potentially avoid chemotherapy.
For example, in many types of breast cancer, patients often undergo chemotherapy as adjunct therapy in addition to tamoxifen. This is true even though chemo is understood to improve outcomes in just a small fraction of patients, approximately 4% according to one study. With CGP—and resultant understandings of the key genetic components of a person’s cancer—providers are coming to see an individual’s level of risk and adjust treatment accordingly. According to a study, adding chemotherapy to low-risk breast cancer patients offers no benefit. And for medium-risk patients, it decreases the chance of recurrence by just 2%. But in the highest-risk patients, it decreases recurrence by 28%. Providers are thus empowered to add chemotherapy to a patient’s treatment regimen only when their genetic profile places them at high risk. In another study, CGP helped identify new categories of risk in triple-negative breast cancers, informing treatment decisions and helping establish clinical trial subgroups.
This is just one example of how CGP can help treat people receive individualized care that’s best for them. Across categories, in addition to improved outcomes and quality of life, CGP allows for more confident patients who truly understand their cancer, the foundation of an overall improved healthcare experience. It offers people a personalized path through their most tightly held fears.
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