Personalized Medicine in Oncology: Ethical Implications for the Delivery of Healthcare

Nathalie Egalite; Iris Jaitovich Groisman; Beatrice Godard

Disclosures

Personalized Medicine. 2014;11(7):659-668. 

In This Article

Conclusion & Future Perspective

Working towards personalized medicine in oncology has implications for decision-making, resource allocation and access to healthcare. As genetic characterization and targeted therapies become more commonplace, there will be sustained debate both in the medical community and in society at large on shouldering the costs of these advances. In fact, the rapid emergence of personalized medicine approaches in oncology provides a crucial 'early warning system' for managing the potential difficulties that may emerge as healthcare paradigms shift.[22] Investigations at the bedside appear to be a worthwhile pursuit, such as seeking out the views of providers, clinicians and patients as to how they perceive the implications for the patient–provider relationship. Assessments of personalized medicine could be enhanced with findings on how key actors perceive ethical concerns. Developing therapeutic alliances in which clinicians and patients utilize shared decision-making in order to determine the best healthcare options for the patient may be aspirational for many clinicians and patients.[36] To that end, we must also address inequities in healthcare access, otherwise even the best genomic tests will provide limited benefits. The rapid clinical integration of genomics in oncology makes the resolution of these inequities and the ethical challenges that have been addressed in this article even more urgent and gives their resolution by oncologists a precedent-setting role with respect to the larger field. For instance, the ESMO recognizes that the medical oncology specialty has a central role to play and carries a double duty: to raise awareness of the current achievements of targeted therapies and to guide patients in seeking out clinical trials so that they can gain access to novel treatments.[18] Issues related to regulation also provoke ethical concerns. Because funding or reimbursement is critical in personalized medicine, recommendations from credible bodies would help us to avoid the current situation of access inequities for patients and reliance on research or pharmaceutical company programs in order to support test funding. Regulators continue to debate how best to handle the new and anticipated complexities and the extent to which agencies have the legal authority to create new rules.

Building on their experience working with stakeholders, ethicists with expertise in personalized medicine will be well suited to contribute to this debate and to the delivery of personalized healthcare. Engaging in "constructive ethical monitoring," according to Schleigden and Marckmann, entails "including all of the actual and/or potential concerns that are ethically relevant in order to allow balancing them against the actual and potential ethically relevant benefits of personalized medicine".[37] Ethicists could play an important role in supporting the use of the combination therapy of known pharmacological agents in promoting a personalized disease management. While such decisions could be perceived to be against the interests of developing new therapeutic agents, it would enable a faster successful management of oncology-resistant cases, as combinations of known cytotoxic agents and targeted therapies have shown positive results.[38] Ethicists could also be instrumental in guiding stakeholders in the continued implementation of personalized medicine, as well as in the review of the evidence and issue of recommendations.

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