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Confronting the Care Delivery Challenges Arising from Precision Medicine

Understanding the biology of cancer at the cellular and molecular levels, and the application of such knowledge to the patient, has opened new opportunities and uncovered new obstacles to quality cancer care delivery. Benefits include our ability to now understand that many, if not most, cancers are...

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Autores principales: Kohn, Elise C., Ivy, S. Percy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4846663/
https://www.ncbi.nlm.nih.gov/pubmed/27200294
http://dx.doi.org/10.3389/fonc.2016.00106
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author Kohn, Elise C.
Ivy, S. Percy
author_facet Kohn, Elise C.
Ivy, S. Percy
author_sort Kohn, Elise C.
collection PubMed
description Understanding the biology of cancer at the cellular and molecular levels, and the application of such knowledge to the patient, has opened new opportunities and uncovered new obstacles to quality cancer care delivery. Benefits include our ability to now understand that many, if not most, cancers are not one-size-fits-all. Cancers are a variety of diseases for which intervention may be very different. This approach is beginning to bear fruit in gynecologic cancers where we are investigating therapeutic optimization at a more focused level, that while not yet precision care, is perhaps much improved. Obstacles to quality care for patients come from many directions. These include incomplete understanding of the role of the mutant proteins in the cancers, the narrow spectrum of agents, broader mutational profiles in solid tumors, and sometimes overzealous application of the findings of genetic testing. This has been further compromised by the unbridled use of social media by all stakeholders in cancer care often without scientific qualification, where anecdote sometimes masquerades as a fact. The only current remedy is to wave the flag of caution, encourage all patients who undergo genetic testing, either germline or somatic, to do so with the oversight of genetic counselors and physician scientists knowledgeable in the pathways involved. This aspiration is accomplished with well-designed clinical trials that inform next steps in this complex and ever evolving process.
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spelling pubmed-48466632016-05-19 Confronting the Care Delivery Challenges Arising from Precision Medicine Kohn, Elise C. Ivy, S. Percy Front Oncol Oncology Understanding the biology of cancer at the cellular and molecular levels, and the application of such knowledge to the patient, has opened new opportunities and uncovered new obstacles to quality cancer care delivery. Benefits include our ability to now understand that many, if not most, cancers are not one-size-fits-all. Cancers are a variety of diseases for which intervention may be very different. This approach is beginning to bear fruit in gynecologic cancers where we are investigating therapeutic optimization at a more focused level, that while not yet precision care, is perhaps much improved. Obstacles to quality care for patients come from many directions. These include incomplete understanding of the role of the mutant proteins in the cancers, the narrow spectrum of agents, broader mutational profiles in solid tumors, and sometimes overzealous application of the findings of genetic testing. This has been further compromised by the unbridled use of social media by all stakeholders in cancer care often without scientific qualification, where anecdote sometimes masquerades as a fact. The only current remedy is to wave the flag of caution, encourage all patients who undergo genetic testing, either germline or somatic, to do so with the oversight of genetic counselors and physician scientists knowledgeable in the pathways involved. This aspiration is accomplished with well-designed clinical trials that inform next steps in this complex and ever evolving process. Frontiers Media S.A. 2016-04-27 /pmc/articles/PMC4846663/ /pubmed/27200294 http://dx.doi.org/10.3389/fonc.2016.00106 Text en Copyright © 2016 This work is authored by Elise C. Kohn and S. Percy Ivy on behalf of the U.S. Government and, as regards Dr. Kohn, Dr. Percy and the U.S. Government, is not subject to copyright protection in the United States. Foreign and other copyrights may apply. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Kohn, Elise C.
Ivy, S. Percy
Confronting the Care Delivery Challenges Arising from Precision Medicine
title Confronting the Care Delivery Challenges Arising from Precision Medicine
title_full Confronting the Care Delivery Challenges Arising from Precision Medicine
title_fullStr Confronting the Care Delivery Challenges Arising from Precision Medicine
title_full_unstemmed Confronting the Care Delivery Challenges Arising from Precision Medicine
title_short Confronting the Care Delivery Challenges Arising from Precision Medicine
title_sort confronting the care delivery challenges arising from precision medicine
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4846663/
https://www.ncbi.nlm.nih.gov/pubmed/27200294
http://dx.doi.org/10.3389/fonc.2016.00106
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