Abstract
Background/Aims ASCO provisional clinical guidelines (2009) recommend that patients with metastatic colon cancer (mCRC) be tested for mutations in the Kristen ras (KRAS) oncogene, and that those with a mutated KRAS gene (KRAS+) not be offered anti-epidermal growth factor receptor (EGFR) therapy as they are unlikely to benefit from the therapy. For patients without the mutation (KRAS-), anti-EGFR therapy may extend life but it is often associated with severe side-effects. The objectives of this study were to explore mCRC patients’ understanding of KRAS testing vis-à-vis their treatment decision making, including their preferences for aggressive chemotherapy or palliative care.
Methods We conducted 21 semi-structured, in-person or telephone, interviews with mCRC patients (40–70 min duration). We developed a codebook through a reflexive, iterative process, and used the AtlasTi software for coding and data analysis.
Results We identified 115 patients with mCRC who had a KRAS test conducted 6/1/10-4/11/11. Of these, we selected a diverse sample with respect to KRAS status, clinical factors, and demographics. Participants were 63 years old on average, mostly white (57%), and KRAS+ (52%). KRAS+ patients more often recalled having had the test than did KRAS- patients (50% vs. 11%). Most participants felt the test was potentially useful in directing their treatment, because it is “scientific,” although several would question its accuracy if anti-EGFR drugs were contraindicated. A few KRAS+ patients were disappointed in the results. Patients frequently described their physician as “the expert,” and used the internet mainly to validate current treatment. They underscored the importance of their physician’s “fighting” for them. Most patients desired aggressive treatment and had not considered declining chemotherapy.
Discussion Most respondents did not recall having the KRAS test, and most appeared to view the test as inconsequential to their treatment considerations. Confidence in their physician’s optimism and recommendations were of greater consequence. Imaging scans, conducted repeatedly to measure progression of illness, seemed to carry more salience in their treatment experience than did the KRAS test.
