Exploring Cancer Patients' and Caregivers' Perspectives and Knowledge Regarding Biomarker Testing in Canada

Abstract

While biomarker testing can provide various benefits for cancer patient outcomes, numerous challenges persist that cause inequities in access across Canada. An online survey consisting of 51 questions was disseminated to evaluate biomarker testing and precision medicine knowledge and experiences from Canadian patients and caregivers. Responses were recorded between June 2023 and January 2024 and assessed various aspects of the biomarker testing experience including the expectations and challenges of patients. Quantitative and qualitative analyses were conducted using Microsoft Excel and R for descriptive and correlative data analysis, respectively. Among the 74 responses, patients reported an overall moderate experience with positive outcomes for those who underwent biomarker testing, including changes to treatment plans and the shrinking of tumours. The main challenges identified included knowledge gaps, a lack of testing availability, turnaround time for results, and financial constraints, all of which contribute to the disparities in biomarker testing access. Qualitative analysis of responses further emphasized a strong patient desire for patient-centred care and collaborative decision-making for biomarker testing options and treatment planning. Addressing these challenges through increased education, policy advocacy, and advancing infrastructure can help to reduce interprovincial inequities in biomarker testing and contribute to improving cancer patient outcomes.

Keywords: biomarker testing; cancer; cancer outcomes; colorectal cancer; genomic sequencing; patient-centred care; precision medicine; tumour.

Figure A1

Type of cancer diagnoses. Note, “Other” cancers that were diagnosed but were not included as answer options for the multiple-choice question included myeloma, metastatic neuroendocrine, lymphatic, appendix, anus, and neuroendocrine tumours with the lung as the primary site.

Figure A2

Cancer treatments received since diagnosis. Note, most respondents underwent more than one treatment following their diagnosis.

Figure A3

Biomarkers tested, as reported by patients. Other biomarkers that were tested for, but not listed included hormone receptor ER/PR, translocation biomarkers, homologous recombination repair deficiency (HRD), Inhibin b, antimullerian hormone (AMH), CA125, MutL protein homologue 1 MLH1, and carcinoembryonic antigen (CEA).

Figure 1

(a) The percentage composition of the respondents who reported being familiar with the terms “biomarker” and “personalized medicine”, stratified by age group. (b) The percentage composition of respondents who reported being familiar with the terms “biomarker” and “personalized medicine”, stratified by educational attainment.

Figure 2

Level of informedness about biomarker testing and its impact on cancer treatment, between respondents who had spoken to their oncologists and respondents who had not.

Figure 3

Waiting times for results after the doctor ordered biomarker testing.

Figure 4

The types of treatment(s) selected by the respondents’ oncologists after they had biomarker testing. The types of treatment(s) that were selected but not listed among response options include hormone therapy, maintenance medication (post-chemotherapy), and panitumumab.

Figure 5

The effects respondents expected and/or hoped that biomarker testing results would have on their cancer and their prognoses.

Figure 6

The distribution of sample ratings on access to biomarker testing at their institution. The mean rating was 5.06.

Figure 7

Reported difficulties regarding accessing biomarker testing. Other reported difficulties that were not listed among response options include insufficient biopsy samples and the unavailability of testing in the respondent’s area. Frequently reported difficulties were related to a lack of knowledge and awareness of biomarker testing.