ONA: How can oncology nurses guide patients in the decision to undergo biomarker testing and help them understand what the results mean?
Lee: The nurse is the patient advocate. They can ask the doctor to order the testing, then help the patient understand the significance of the results. Fight CRC has amazing patient resources that are great for the treatment room, particularly with their Biomarked campaign. They keep the information accessible, which is critical for guiding patients during intensely stressful times. Sending patients home with resources that they can reference when they have questions is important. It is also quite critical that patients know what questions to ask. Nurses can help empower patients to be their own advocate by providing information and education on biomarkers, offering take-home materials, and encouraging patients to be an advocate for their own care.
Murff: Good clinician education is critical. Any results that require some kind of genetic biomarker testing are not always clear-cut. Ras testing has become widely implemented and is folded into the FDA recommendations for using EGFR inhibitors. Also, most insurance will cover it. So, in most centers, patients with metastatic CRC will undergo Ras testing, but there are a lot of limitations. There is not necessarily a standard test, as there are a lot of different kits with a range of results. Patients could receive a false positive result, for example, and not receive a therapy. These tests also do not explain all [cases] of nonresponsiveness, so clinicians need to be careful not to mislead patients into thinking they are guaranteed their cancer will respond to therapy. Clinicians need to understand the limitations to these tests and communicate them accordingly with their patients.
ONA: What resources are available to help patients with CRC understand biomarkers?
Murff: Fight CRC has put together a pamphlet that is useful for both clinicians and patients as part of their Biomarked campaign. The need to improve understanding of biomarkers motivated the Biomarked campaign. A lot of patients lacked sufficient knowledge about biomarker tests, so Biomarked delivers a better education message. The National Cancer Institute has some information, and some of the cancer societies will have some blurbs, but Biomarked is delivered in a nice package.
ONA: Is there anything you would like to say in closing?
Lee: One of the things you see as a nurse in oncology is that the level of anxiety patients experience changes learning, memory. Patients often forget questions they intended to ask. Physicians might deliver a lot of information, little of which a stressed patient retains. Nurses can empower patients to know what questions to ask, such as the status of biomarkers. Patients can have an active role in the therapy they receive. Nurses can be tremendously helpful in enabling patient proactivity. Writing notes for patients and keeping Fight CRC materials stocked in the office can help them improve a patient’s experience.
Murff: Part of the reason it’s important to think about this now is because we are probably at the cusp of what will be a much larger explosion of these biomarker tests, particularly for metastatic CRC. Only a few biomarkers are really established in clinical care right now, but many more are being examined. In the next couple of years, we will probably have many more of these coming out. Getting a handle on how that impacts therapy is important as the expected surge of available biomarker tests will increase the complexity of information a clinician needs to communicate to the patient. We prefer to be on the front end of this, educating people.
1. Fight Colorectal Cancer launches Biomarked to educate on the role of biomarkers in cancer treatment [news release]. Springfield, MO: Fight Colorectal Cancer; June 27, 2017. http://www.prnewswire.com/news-releases/fight-colorectal-cancer-launches-biomarked-to-educate-on-the-role-of-biomarkers-in-cancer-treatment-300480065.html?tc=eml_cleartime. Accessed August 24, 2017.
2. Biomarked. https://fightcolorectalcancer.org/biomarked/. Accessed August 24, 2017.
3. Colorectal Cancer Facts and Figures 2017-2019. Atlanta, GA: American Cancer Society; 2017.