The nurse is discussing the current use of genetic testing and tamoxifen with a client who has breast cancer. Which information should the nurse include in this discussion?

Question

Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. The United States Agency of Healthcare Research and Quality recommends genetic testing for clients starting tamoxifen.
2. Insurance providers in the United States do not support the use of CYP2D6 testing prior to prescribing tamoxifen.
3. Dutch researchers support CYP2D6 testing prior to prescribing tamoxifen.
4. Some European groups recommend using medications other than tamoxifen for women whose CYP2D6 testing reveals intermediate metabolizer status.
5. Recommendations from across the globe vary as to the benefit of genetic testing prior to prescribing tamoxifen.

Answer 1

3,4,5
Rationale 1: A Technology Assessment Report funded by the Agency of Healthcare Research and Quality and published in 2010 indicated there was insufficient evidence to recommend CYP2D6 testing prior to prescribing tamoxifen.
Rationale 2: A Blue Cross Blue Shield Association Technical Paper published in 2011 does not support testing, but Medco does offer CYP2D6 testing.
Rationale 3: In 2011, the Pharmacogenetics Working Group of the Royal Dutch Association for the Advancement of Pharmacy published clinical guidelines recommending the use of CYP2D6 testing.
Rationale 4: The recommendation is for aromatase inhibitor therapy rather than tamoxifen therapy.
Rationale 5: Recommendations from Europe vary from those from the U.S.