The current use and attitudes towards tumor genome sequencing in breast cancer.

There is increasing availability of technologies that can interrogate the genomic landscape of an individual tumor; however, their impact on daily practice remains uncertain. We conducted a 28-item survey to investigate the current attitudes towards the integration of tumor genome sequencing in breast cancer management. A link to the survey was communicated via newsletters of several oncological societies, and dedicated mailing by academic research groups. Multivariable logistic regression modeling was carried out to determine the relationship between predictors and outcomes. 215 physicians participated to the survey. The majority were medical oncologists (88%), practicing in Europe (70%) and working in academic institutions (66%). Tumor genome sequencing was requested by 82 participants (38%), of whom 21% reported low confidence in their genomic knowledge, and 56% considered tumor genome sequencing to be poorly accessible. In multivariable analysis, having time allocated to research (OR 3.37, 95% CI 1.84-6.15, p < 0.0001), working in Asia (OR 5.76, 95% CI 1.57 - 21.15, p = 0.01) and having institutional guidelines for molecular sequencing (OR 2.09, 95% 0.99-4.42, p = 0.05) were associated with a higher probability of use. In conclusion, our survey indicates that tumor genome sequencing is sometimes used, albeit not widely, in guiding management of breast cancer patients.

Understanding the effects of extrinsic rewards on intrinsic motivation--uses and abuses of meta-analysis: comment on Deci, Koestner, and Ryan (1999)

Recently, 3 different meta-analytic reviews of the literature concerning the effects of extrinsic rewards on intrinsic motivation have appeared, including that by Deci, Koestner, and Ryan (1999) in this issue. Interestingly, despite their common focus, these reviews have offered dramatically opposed bottom-line conclusions about the meaning and implications of this literature. In this comment, the authors examine differences among these 3 reviews and conclude that the findings of this literature have been more accurately captured by the reviews of Deci et al. and Tang and Hall (1995) than by that of Cameron and Pierce (1994). More broadly, the authors also suggest that there may be significant short- and long-term costs to the unthinking or automatic use of meta-analysis with theoretically derived, procedurally diverse, and empirically complex literatures like that concerning extrinsic rewards and intrinsic motivation.