Patient perspectives on testing for clonal hematopoiesis of indeterminate potential

Abstract

Clonal hematopoiesis of indeterminate potential (CHIP), an emerging biomarker for personalized risk-directed interventions, has increased prevalence in cancer survivors. Little is known about patients' preferences regarding CHIP testing. We surveyed participants in an ongoing prospective cohort study of young women with breast cancer (BC). The emailed survey included an introduction to CHIP and a clinical vignette eliciting participants' preferences for CHIP testing considering sequentially: 1) population-based 10-year risk of BC recurrence, hematological malignancy and heart disease; 2) increased CHIP-associated risks; 3) current CHIP management; 4) dedicated CHIP clinic; 5) hypothetical CHIP treatment. Preference changes were evaluated with McNemar's test. Survey response rate was 82.2%(528/642). Median age at survey was 46 years (range: 31-54), time from diagnosis 108 months (range: 60-168). Only 5.9% had prior knowledge of CHIP. After vignette presentation, most survivors (87.1%) recommended CHIP testing for the vignette patient. Presented next with CHIP-independent, population-based risks, 11.1% shifted their preference from testing to not testing (p<0.001). After information about CHIP-associated risks, an additional 10.1% shifted preference to testing (p<0.001). Preference for testing (p<0.001) increased if vignette patient was offered a CHIP clinic or hypothetical CHIP treatment, with 7.2% and 14.1% switching preferences towards testing, respectively. Finally, 75.8% desired CHIP testing for themselves. 28.2% reported learning about CHIP caused at least moderate anxiety. Most young survivors favored CHIP testing with preferences influenced by risk presentation and potential management strategies. Our findings highlight the importance of effective risk communication and adequate psychosocial support when considering biomarkers of future risks in cancer survivors. This trial is registered at www.clinicaltrials.gov as NCT01468246.

Molecular and clinical aspects relevant for counseling individuals with clonal hematopoiesis of indeterminate potential

“…A study involving over 500 young breast cancer survivors gauged their perspective on testing for CHIP mutations. Being presented with a case vignette, 78.6% of respondents opted for CHIP testing (182). The interest in testing increased to 85.8% if the possibility of consultation in a specialized CHIP clinic was introduced, and further rose to 92.7% if the scenario included the availability of a hypothetical CHIP treatment (182).…”

“…Being presented with a case vignette, 78.6% of respondents opted for CHIP testing (182). The interest in testing increased to 85.8% if the possibility of consultation in a specialized CHIP clinic was introduced, and further rose to 92.7% if the scenario included the availability of a hypothetical CHIP treatment (182). Patients expressed a strong desire to receive information about CHIP through printed material (62.7%) or website-based resources (60.2%) (182).…”

“…The interest in testing increased to 85.8% if the possibility of consultation in a specialized CHIP clinic was introduced, and further rose to 92.7% if the scenario included the availability of a hypothetical CHIP treatment (182). Patients expressed a strong desire to receive information about CHIP through printed material (62.7%) or website-based resources (60.2%) (182). Above all, in-person discussions, particularly with oncologists or cancer specialists, were the preferred mode of communication (88.1%) (182).…”

“…Patients expressed a strong desire to receive information about CHIP through printed material (62.7%) or website-based resources (60.2%) (182). Above all, in-person discussions, particularly with oncologists or cancer specialists, were the preferred mode of communication (88.1%) (182). Upon receiving a CHIP diagnosis, patients indicated their interest in periodic communications, lifestyle modifications, annual blood tests, and possible treatment (182).…”

“…Above all, in-person discussions, particularly with oncologists or cancer specialists, were the preferred mode of communication (88.1%) (182). Upon receiving a CHIP diagnosis, patients indicated their interest in periodic communications, lifestyle modifications, annual blood tests, and possible treatment (182). The preferred setting for CHIP follow-up care was predominantly a specialized breast oncology clinic (39.6%) or a CHIP-focused clinic (32.8%) (182).…”