New position statements give guidance on personalized medicine in cardiology, oncology
Two recently published position papers from the European Society of Cardiology (ESC) and the European Society for Medical Oncology (ESMO) summarized the current state of personalized medicine, future challenges, and next steps that are needed to make progress for individualizing medicine in cardiology and oncology, respectively.
European Society of Cardiology Position Statement
Authors of the ESC position statement published in European Heart Journal proposed specific actions needed to expand and implement a personalized approach in cardiology.1 Specifically, these included the following:
- Increased access to DNA samples and data from randomized controlled trials;
- Improved education of patients and providers about genetic testing;
- Increased ability to integrate data across multiple platforms (e.g., for data storage, management and analysis, information technology capacity, and accessibility);
- Adaptable clinical trial designs that allow for stratification of patients at enrollment; and
- Improved mechanisms to include the patient in decisions of care.
Authors also pointed out the dilemma facing evidence-based medicine and cardiology in personalized medicine. Notably, since large randomized controlled trials are designed to identify the best treatment strategies for the population at large, they often exclude subgroups of patients (or outliers) that could benefit most from targeted therapies. Authors further noted that the practice of cardiology already takes an individualized approach to therapeutics by targeting drug therapies based on risk factor assessment; as such a personalized medicine approach is an extension of this current practice.
European Society for Medical Oncology Position Statement
The ESMO position statement, published in Annals of Oncology, defined personalized medicine and acknowledged that “nowhere in medicine has the impact of personalized medicine been greater than in oncology.”2 Authors pointed to the availability of widespread whole genome sequencing as being a key to opening opportunities for use of targeted therapies in cancer treatment.
Authors also acknowledged, though, that while costs of whole genome sequencing are expected to decrease, an increased use of this technology will bring increased needs for education, training, infrastructure development, and support for implementation of new therapies. Meeting these needs will be associated with additional costs to the health care system overall.
Position statement authors advocated for use of an evidence-based model that incorporates patient involvement in clinical decision making within a multidisciplinary team led by a medical oncologist. Finally, authors reinforced the need for continued development of professional education opportunities that meet trainee and practitioner needs, including residencies, fellowships, e-learning opportunities, continuing medical education, and other resources developed by professional organizations, educators, and other stakeholders.
- Kirchhof P et al. The continuum of personalized cardiovascular medicine: a position paper of the European Society of Cardiology. Eur Heart J. 2014 [Epub ahead of print].
- European Society for Medical Oncology. Delivering precision medicine in oncology today and in future – the promise and challenges of personalized cancer medicine: a position paper by the European Society for Medical Oncology. Ann Oncol. 2014;25:1673-8.