Personalizing the Treatment of Women with Ductal Carcinoma In Situ (DCIS) Using the DCIS Score: A Qualitative Study on Score Use

TL;DR

This study explores how radiation oncologists and other healthcare professionals use the DCIS score to personalize treatment for women with low-risk DCIS.

Contribution

The study provides new insights into the practical use and perceived value of the DCIS score in clinical decision-making.

Findings

Most radiation oncologists are concerned about overtreatment but lack certainty in identifying low-risk patients who can avoid radiation.

The DCIS score is seen as a valuable tool for providing personalized risk information in treatment decisions.

Implementation of the DCIS score requires guidelines developed with input from the oncology team.

Abstract

Background: A twelve-gene molecular expression assay (DCIS score) may help guide radiation oncology treatment under specific circumstances. We undertook a study to examine radiation oncologist (RO), surgeon, and decision maker views on implementing the DCIS score in practice for women with low-risk DCIS. Methods: We conducted a qualitative study involving telephone interviews that were audio-recorded and transcribed. Two researchers conducted a thematic analysis of transcripts. Results: Twenty-eight individuals (ROs, breast cancer surgeons, and cancer policy decision makers) were invited to participate; 22 out of the 28 people (79%) agreed. The final sample included 20 participants: 11 of 13 (85%) ROs, 5 of 7 (71%) surgeons, and 4 of 8 (50%) decision makers. Most ROs expressed concerns about overtreatment but could not predict with certainty which low-risk patients could safely avoid radiation. The DCIS score was viewed as contributing valuable personalized risk information as part of treatment decision making that included clinicopathological factors and women’s preferences. Future implementation would require guidelines with input from the oncology team. Conclusions: ROs had concerns about the overtreatment of women with DCIS, but lacked the tools to reliably predict which women could safely avoid radiation. By providing oncologists and women with personalized tumor information, the DCIS score was an important component of treatment decision making.