Not long ago, most people with a particular type of cancer were classified and treated similarly based on stage of disease. We now know that not all cancer cells and tumors are alike. Each individual tumor, even among people with the same disease type, can have unique characteristics.1 These cancer biomarkers-genes, proteins, and other substances found in blood, other body fluids, or tissue-can provide important information for treatment decision making and prognosis. Hundreds of biomarkers have become actionable, more are being discovered, and existing biomarkers are gaining new implications for patient care at a rapid pace.1
However, it can be challenging for healthcare providers to keep track of the ever-evolving field of precision oncology. To help oncology nurses understand and keep updated with new scientific evidence of biomarkers and their utility in practice, the Oncology Nursing Society (ONS) developed an online Biomarker Database-the first ever made by nurses, for nurses. The resource is an online repository of key information about hundreds of cancer biomarkers to support nursing practice. As a clinical decision support tool, this evidence-based database can serve as a resource to support clinical decisions and a foundation for patient education before and after biomarker testing.2 Another use case of the database is for personal education and professional development.
Based on the evolution of precision oncology evidence and application in cancer care to date, an online tool that is easily updated and referenced at the point-of-care was critical for seamless integration into oncology nursing practice. Research has shown that decision-support systems improve clinical practice, particularly when they are accessible at the time and place of clinical decision making, are computer based, and are easy to integrate into daily workflow.3 With those principles in mind, the tool is easily accessible on any computer or smart phone with Internet access so that it is readily and immediately available. Registration is required but free to anyone. The user-friendly resource is easy to navigate and read, and it is searchable by biomarker name, cancer type, or associated targeted therapy. The information is based on the best evidence currently available, which was collated and analyzed by experts in their subspecialties.
DEVELOPING THE BIOMARKER DATABASE
The ONS is a professional association with more than 35 000 members. Founded in 1975, the society is committed to promoting excellence in oncology nursing and the transformation of cancer care.4 In 2020, the organization conducted a survey of 700 members and found that almost half did not feel confident talking to patients or colleagues about genomics.5 The ONS soon began strategic planning to address this practice gap and decided to put a multipronged approach into action, including development of the database.
The project kept the end user, the oncology nurse, at the forefront of planning. Oncology nurses play many different roles in patient care, and the goal was to ensure that the database met the needs of nurses in varying roles and with varying levels of experience and knowledge. Nurses were involved in each step: discovery of what should be included about each biomarker, how that information should be displayed, and what else should be included on the Web site.
Discovery included one-on-one interviews of oncology nurses in different roles, including outpatient nurses, clinic nurses, nurse navigators, nurse practitioners, nurse educators, and administrators. At various points in development, nurses were engaged to review not only content but the visual layout and functionality. All the feedback resulted in the Web site design and user experience of the Biomarker Database found at http://biomarkers.ons.org.
For each disease type, a content lead and a team of expert content contributors were selected from the membership. Content experts conducted literature searches to identify all biomarkers for each disease type and the strongest current evidence associated with the biomarkers. Background materials included peer-reviewed clinical studies and clinical practice guidelines, such as treatment guidelines from the National Comprehensive Cancer Network. A lead content expert guided the initial draft of the content, and then all materials went through two rounds of peer review by additional experts. The expert reviewers assessed quality, completeness, and accuracy. Finally, all the contributors and experts participated in a consensus meeting for each disease type to revise and approve final content. The Biomarker Database was launched on June 8, 2022.
OUTCOMES
Since launch, anecdotal feedback has been overwhelmingly positive from oncology nurses, other healthcare professionals, and other professional organizations. More than 6000 users have accessed the database as of December 31, 2022, with more than 46 000 page views. The work was also recognized at JADPRO Live, the annual meeting of the Advanced Practitioner Society for Hematology and Oncology, with an award for Outstanding Clinical Poster.5
The ONS Biomarker Database is the first tool of its kind for oncology nurses. It contains the latest information about precision oncology and associated biomarkers in nine disease types, inclusive of 164 biomarkers with a goal to make this tool comprehensive. More cancer types are planned for development. Each biomarker has its own page with clearly defined subtopics:
* Definition and mechanism that drives cancer growth
* Implications for patient care
* Specific targeted therapies available, with links to package inserts and patient education materials, where available
* Testing considerations like when to test and which testing technology to use
* Additional information, including prevalence of the biomarker and related clinical trials
* References used and date of last update
User-preferred functionality was implemented throughout the platform, such as pop-up windows that provide key definitions that might be unfamiliar to users (eg, monitoring biomarker, predictive biomarker, polymerase chain reaction, and next-generation sequencing). The platform also enhances the user experience by offering multiple views of the content to meet users where they are, whether they know the specific biomarker they are searching for or just want to see all biomarkers associated with the cancer population they primarily care for. In addition, each biomarker details page is stamped with the last date it was updated, and each page is printer friendly.
Because the database is part of a larger set of resources in the ONS Genomics and Precision Oncology Learning Library (https://www.ons.org/learning-libraries/precision-oncology), users also have access to additional tools, which are listed along the right side of each page. For example, the page explaining BRCA1 in breast cancer offers links to a guide on when to refer a patient to a genetics counselor and a patient video titled "Genetic Counseling and You."
NEXT STEPS IN DATABASE DEVELOPMENT
Review and maintenance of biomarker content will occur on a regular basis to ensure updated information reflective of the current state of the science. In addition, new cancer types and their associated biomarkers are routinely being added. Data are being collected through a voluntary user survey to measure the database's usability and relevance to practice, as well as users' satisfaction and changes to practice. Results will guide further revisions and updates to the tool.
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