{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T14:20:22Z","timestamp":1791469222625,"version":"4.3.4"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2023,7,5]],"date-time":"2023-07-05T00:00:00Z","timestamp":1688515200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007880","name":"Johns Hopkins University","doi-asserted-by":"publisher","award":["SAC170001"],"award-info":[{"award-number":["SAC170001"]}],"id":[{"id":"10.13039\/100007880","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000056","name":"National Institute of Nursing Research","doi-asserted-by":"publisher","award":["R01NR019058"],"award-info":[{"award-number":["R01NR019058"]}],"id":[{"id":"10.13039\/100000056","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,1,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Tumor biomarkers are regularly used to guide breast cancer treatment and clinical trial enrollment. However, there remains a lack of knowledge regarding physicians\u2019 perspectives towards biomarkers and their role in treatment optimization, where treatment intensity is reduced to minimize toxicity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Thirty-nine academic and community oncologists participated in semi-structured qualitative interviews, providing perspectives on optimization approaches to chemotherapy treatment. Interviews were audio-recorded, transcribed, and analyzed by 2 independent coders utilizing a constant comparative method in NVivo. Major themes and exemplary quotes were extracted. A framework outlining physicians\u2019 conception of biomarkers, and their comfortability with their use in treatment optimization, was developed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In the hierarchal model of biomarkers, level 1 is comprised of standard-of-care (SoC) biomarkers, defined by a strong level of evidence, alignment with national guidelines, and widespread utilization. Level 2 includes SoC biomarkers used in alternative contexts, in which physicians expressed confidence, yet less certainty, due to a lack of data in certain subgroups. Level 3, or experimental, biomarkers created the most diverse concerns related to quality and quantity of evidence, with several additional modulators.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>This study demonstrates that physicians conceptualize the use of biomarkers for treatment optimization in successive levels. This hierarchy can be used to guide trialists in the development of novel biomarkers and design of future trials.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/oncolo\/oyad198","type":"journal-article","created":{"date-parts":[[2023,7,5]],"date-time":"2023-07-05T19:26:46Z","timestamp":1688585206000},"page":"e38-e46","source":"Crossref","is-referenced-by-count":2,"title":["Physicians\u2019 Hierarchy of Tumor Biomarkers for Optimizing Chemotherapy in Breast Cancer Care"],"prefix":"10.1093","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1031-4372","authenticated-orcid":false,"given":"Halle H","family":"Thannickal","sequence":"first","affiliation":[{"name":"University of Alabama at Birmingham Heersink School of Medicine , Birmingham, AL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noon","family":"Eltoum","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology; Birmingham , AL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole L","family":"Henderson","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology; Birmingham , AL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren P","family":"Wallner","sequence":"additional","affiliation":[{"name":"University of Michigan, Departments of Internal Medicine and Epidemiology, Rogel Cancer Center , Ann Arbor, MI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynne I","family":"Wagner","sequence":"additional","affiliation":[{"name":"Wake Forest School of Medicine , Winston Salem, NC , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio C","family":"Wolff","sequence":"additional","affiliation":[{"name":"Johns Hopkins Sidney Kimmel Comprehensive Cancer Center , Baltimore, MD , 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