In the past several years, researchers and physicians have made several significant advances in understanding how cancer affects the body—namely what happens to it after treatment. Minimal residual disease (MRD) describes the small number of cancer cells left over in the body after treatment. and is becoming an area of interest for many hematology and oncology doctors when considering outcomes from certain types of care.
An MRD positive test results indicates there is still disease present in the body after treatment. It is a major cause of relapse in cancer and leukemia, but there are some patients with traces of MRD who achieve complete remission. While researchers are still trying to understand exactly what the threshold is to measuring MRD and its direct impact on relapse.
This type of testing is highly specialized, and your patients will more than likely have a lot of questions about it—namely how it works. Talking through this type of care—both what we know and what we don’t know about it—can be critical to their care.
Explaining the Process
Studies show that effective doctor-patient communication is the most important aspect of high quality health care. Cellular therapy and transplantation is an advanced form of medicine—one patients might find difficult understanding—so it’s extremely important to give them the tools to understand their care.
Walk your patients through the process of what an MRD test is, and why the results are important to creating a care plan. This specialized guide is helpful when breaking down how the tests are performed and how doctors can interpret those results.
It’s also important to talk through your patients what they can expect from an MRD test beyond a positive or negative result. What are the wait times for a test? Where can a patient get an MRD test, and is it within reasonable distance of where they currently receive care?
Understanding the Results
Researchers and physicians know MRD testing is not perfect. While a negative result is good news, it’s not fool-proof. Having a negative MRD test means you have less than one cancer cell per million bone marrow cells in your body. Tests show those with this type of test are less likely to experience a relapse than those with more cancer cells in their body—not that they won’t ever relapse. Though research does show those with negative tests have longer remission and longer survival.
On the other side, though, a positive test doesn’t signal an impending relapse. An MRD test gives physicians insight into what is happening on a cellular level. If there are certain levels of MRD in someone’s body—whether low or high—it can inform the care team what types of treatments need to happen and when.
Physicians need to talk through results with the understanding each individual person is different, and a positive or negative test isn’t all good or all bad news. According to a paper from the Journal of American Medical Association, a therapy could decrease the amount of MRD but not necessarily affect the outcome.
Making a Plan Moving Forward
Just as explaining the process before an MRD test is important, it’s equally as important to discuss a future plan for care. Based on how MRD is presenting in a patient will help doctors determine a course of care—it will also help researchers gather information about how it interacts with cancer cells overall.
It’s important for patients to understand why their MRD tests indicate whether there’s a need for treatment intensification or consolidation.