Communication and Education in Tumor Profiling (COMET)

According to 2022 estimates, about 623,000 people are living with metastatic breast, prostate, lung, colorectal, or bladder cancer or metastatic melanoma in the United States, and that number is expected to increase to about 693,000 by 2025. Tumor genetic testing can reveal information (e.g., biomarkers) about an individual patient’s cancer and thus help the patient and the doctor select the best option for cancer treatment. Doctors usually suggest genomic biomarker testing for people with advanced cancer.

There is a need for improved education for patients before they undergo tumor genetic testing to align expectations and improve patient outcomes. With a limited workforce of genetic providers and the time sensitivity of genetic results for treatment planning, a web-based genetic education intervention can be a timely delivery strategy to deliver patient-centered, high-quality precision oncology care.

Communication and Education in Tumor Profiling (COMET) is a self-directed genetic education intervention. The intervention uses a layered approach to education that supports the patient’s individual learning preferences.

Patients undergoing tumor genetic testing are registered in the COMET education program and complete the program prior to receiving their test results. The program materials explain what the tumor gene testing may reveal: gene abnormalities that arise over a lifetime (somatic changes), potential inherited abnormalities, neither, or both. Intervention components are as follows:

-- Written content: Six linear modules address genetics and cancer; tumor genetic changes; tumor genetic testing; the difference between somatic and germline genetics; possible test results and their implications; and the benefits, risks, and limitations of tumor genetic testing.

-- Videos: Five optional videos feature a genetic counselor explaining the same content provided in the written modules. The videos are designed to provide an alternative learning method.

The study reviewed for this summary used a web-based version of the intervention.

The estimated time to complete the self-directed online education intervention is 15 minutes.

The intervention is intended for patients with advanced cancer undergoing tumor genetic testing.

The program is suitable for implementation in the home.

Required resources to implement the program include the following:

-- Genetic education PowerPoint presentation with six modules
-- Five genetic education videos

For costs associated with this program, click on Contact Program Developer on the Program Materials page.

Patients with advanced cancer undergoing tumor-only genetic sequencing were randomly assigned to the intervention group receiving a web-based version of the COMET intervention (n=293) or the usual care group (n=301). The usual care group was intended as a real-world comparison group and consisted of any usual-care education from providers or information sought through usual resources. Eligible patients were English-speaking adults who were enrolled in the National Cancer Institute Molecular Analysis for Therapy Choice (NCI-MATCH) trial (or met NCI-MATCH criteria), had email and web access, and had not yet received their genetic test results.

Nearly half (45%) of participants were older than 65 years old. Most of the participants were White (94%), 4% were African American, and 2% were “other.” A little over half (56%) of the participants were female; 44% were male.

The primary outcome was genetic knowledge, which was evaluated using an adapted version of ClinSeq, an existing knowledge scale. Patients in the intervention group were asked to complete a survey at baseline, a survey either after completion of the education intervention or 9 days after baseline for patients who did not participate in the education (post-test), and a survey after receiving their tumor results (follow-up). Patients in the usual care group were asked to complete a survey at baseline, a survey 6 days after baseline (post-test), and a survey after receiving their tumor results (follow-up).

Other assessed outcomes were depression, state anxiety, and distress. Depression was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS), a tool developed by the National Institutes of Health that evaluates physical, mental, and social health. State anxiety was assessed using the State-Trait Anxiety Inventory. Cancer-specific distress was assessed using an adapted version of the Impact of Events Scale, an instrument commonly used to measure subjective distress caused by traumatic events. Health literacy, included as a moderating variable, was assessed using an adapted short version of the Short Test of Functional Health Literacy in Adults, a functional literacy assessment tool designed to evaluate adult literacy in the health care setting.

• Compared with patients in the usual care group, patients in the intervention group had increases in genetic knowledge from baseline to post-test (p<.0001) and baseline to follow-up (p=.003).

Additional Findings

• Among patients with lower health literacy, those in the intervention group had greater increases in cancer-specific distress (p=.004) and less decline in general anxiety (p=.049) from baseline to post-test compared with those in the usual care group. They also had greater increases in depression (p=.02) from baseline to follow-up compared with those in the usual care group.