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37 The use of molecular and genomic analysis of a cancer as a means to define a patient-specific treatment is interchangeably referred to as Precision Medicine, Personalized Medicine, or Genomically-directed medicine (herein, collectively PMED). In the foregoing commentary we have focused on PMED approaches related to treatment selection and do not prioritize the development of novel molecular assays used to guide patient diagnostics or prognostication. At every step in the delivery PMED as an innovative and complex approach to guide selection of treatments for patients, new knowledge and awareness is uncovering gaps in the PMED field, that when addressed will allow PMED to be more broadly applied across cancer types for both human and veterinary cancer patients. The speed of change in this field is dramatic and includes the resolution of prior gaps, almost as quickly as new gaps become understood. Despite this rapid advancement of the field, the current level of evidence for value of PMED in veterinary patients is very limited. We nonetheless believe that as these gaps are resolved and solutions published with transparency that PMED will be part of the future of veterinary cancer medicine. As is the case for human patients, adoption of this approach to cancer care in veterinary oncology will not be uniform, with some patients and clinicians seeking this approach sooner than others.

The Challenge of Cognitive Dissonance in the Delivery of Precision Medicine in Veterinary Oncology