Attitudes of patients with cutaneous melanoma toward prognostic testing using the 31-gene expression profile test

Abstract

Objective: Although most patients diagnosed with early-stage cutaneous melanoma (CM) have excellent outcomes, because of the large number diagnosed each year, many will experience recurrence or death. Prognostic testing for CM using the 31-gene expression profile (31-GEP) test can benefit patients by helping guide risk-appropriate treatment and surveillance plans. We sought to evaluate patients' attitudes toward prognostic testing with the 31-GEP and assess whether patients experience decision regret about having 31-GEP testing.

Methods: A 43-question survey was distributed by the Melanoma Research Foundation in June-August 2021 to CM patients enrolled in their database. Patients were asked questions regarding their decision to undergo 31-GEP testing and the extent to which they experienced decision regret using a validated set of Decision Regret Scale questions.

Results: We analyzed responses from patients diagnosed in 2014 or later (n = 120). Of these, 28 had received 31-GEP testing. Most respondents (n = 108, 90%) desired prognostic information when diagnosed. Of those who received 31-GEP testing, most felt the results were useful (n = 22 out of 24) and had regret scores significantly less than neutral regret, regardless of their test results (Class 1: p < 0.001; Class 2: p = 0.036). Further, decision regret scores were not significantly different between patients who received a Class 1 31-GEP result and those who received a Class 2 result (mean Class 1 = 1.39 and mean Class 2 = 1.90, p = 0.058).

Conclusions: Most newly diagnosed CM patients desired prognostic information about their tumors. Patients who received 31-GEP testing felt it was useful and did not regret their decision to undergo 31-GEP testing.

Keywords: 31-GEP test; cancer; gene expression profiling; melanoma; oncology; prognosis; surveys and questionnaires.

FIGURE 1

Reasons patients decided to have 31‐GEP testing. Respondents were asked to select the reasons that they chose to have 31‐GEP testing. Respondents were asked to choose all reasons that applied, and the graph indicates the percentage of respondents who selected each answer. Respondents were also asked to select their top reason for having testing, and the number of respondents who selected each reason as their top reason is shown in parentheses (top choice). Internally driven reasons are shown in black, and externally driven reasons are shown in gray (only respondents who answered that their healthcare provider asked if they wanted 31‐GEP testing were included, n = 13 respondents).

FIGURE 2

Benefits of 31‐GEP testing for patients. Respondents who received 31‐GEP testing were asked what benefits they felt they received from their 31‐GEP test results. Respondents were first asked to select all of the benefits they felt they gained with 31‐GEP testing (allowed to select as many responses as applied), and the percent of respondents that selected a given choice is shown. The patients were then asked to select what they most gained from the test results (select only one option), and the number of respondents who selected a particular option is indicated in parentheses (top choice).

FIGURE 3

Decision Regret Scale Score. Respondents were asked a series of five validated questions that gage patients' level of regret regarding health care decisions. Questions are scored on a 1–5 scale, with answers of 1 or 2 indicating little or no regret, 3 being neutral, and 4 or 5 indicating some or high regret, and the answers were averaged. Averages <3.0 were considered to not have regret. Blue (Class 1) and red (Class 2) circles represent each respondent's mean decision regret score. Black circles indicate the median decision regret score for all Class 1 or Class 2 respondents. The dashed line indicates decision regret (3.05). *Statistically significant; n.s., not significant.