Burden of genetic testing in an academic biobank by pathological and family history-based criteria in prostate cancer (PCa)

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Background: Approximately 5% of localized PCa and 12% of metastatic PCa are associated with germline mutations in DNA repair genes. The National Comprehensive Cancer Network (NCCN) issued genetic testing guidelines to identify PCa patients (pts) likely to harbor a germline DNA repair mutation. The overall burden of this guideline-based, resource-intensive genetic testing is unknown. Using supervised phenotype-genotype information extraction algorithms, we determined the projected genetic testing burden at a single institution adhering to NCCN PCa genetic testing guidelines. Methods: A PCa cohort of 2127 pts was identified from the Penn Medicine BioBank via ICD 9/10 codes. Phenotypic data were extracted from the Penn Medicine Cancer Registry and electronic health record systems via natural language processing and manual chart review. Pts were classified based on 9 germline genetic testing criteria outlined in the NCCN PCa guidelines (Version 4.2019). Results: 895/2127 pts met at least 1 of the 9 NCCN genetic testing criteria, corresponding to a 42.1% overall genetic testing burden. 35.2% qualified for testing via high-risk localized PCa and 6.4% qualified via metastatic disease. Of the pts with localized PCa (n=2014), 15.1% qualified for genetic testing via high Gleason score, 5.1% via high-risk family history, 3.7% via PSA>20ng/mL, 8.7% via Ashkenazi Jewish descent, and 0.8% via intraductal/ductal histology. Conclusions: In this single-center PCa cohort, germline genetic testing was NCCN-guideline recommended for a larger proportion of pts than would otherwise be expected based on previously published reports. Future studies are needed to validate the sensitivity and specificity of these criteria for identifying germline mutations. Our study also highlights a need for novel methods to improve the efficiency of genetic testing for a large cohort. [Table: see text]

Genetic testing experiences and emotional reactions among individuals with variant of uncertain significance results from cancer multiplex genetic testing

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Background: Multiplex genetic testing (MGT) simultaneously analyzes multiple cancer susceptibility genes and can reveal genetic variants of uncertain significance (VUS) that have unclear associations with cancer risks. Little is known about how people are prepared for receiving VUS results from MGT, or whether their emotional reactions differ based on the levels of cancer risk to which they may be susceptible. Methods: We recruited participants from the online Prospective Registry of Multiplex Testing (PROMPT). Those with only a VUS in a cancer predisposition gene completed a survey including measures of their MGT experience, distress (range 0-30; α = .87), uncertainty (0-45; α = .83), and positive experiences (0-20; α = .75). We used generalized linear modeling to examine how demographics, awareness of the possibility of VUS before testing, and level of cancer risks associated with their VUS gene were related to emotional outcomes. Results: Data were available from 661 individuals (40% response rate, 95% female, 90% white, 78% college graduate, 69% cancer history, age 23-93) with VUS in a gene of high risk (47%), moderate/low risk (35%) or limited evidence of risk (18%). Among the sample, 80.8% reported ever receiving cancer genetic counseling, and only 50.8% reported being aware of the possibility of VUS when deciding about testing. Participants reported low current distress ( M± SD= 3.25±5.19), uncertainty (9.18±8.35) and positive experiences (7.83±5.98). Distress was associated with younger age, less family cancer history, and being unaware of the possibility of VUS before testing; distress was also higher among those with VUS in a gene of high risk than those with VUS in a gene of moderate/low risk or limited evidence of risk ( ps≤.023). Uncertainty was associated with younger age, non-white race, less education, and being unaware of the possibility of VUS; uncertainty was also higher among those with VUS in a gene of high risk than those with VUS in a gene with limited evidence of risk ( ps≤.05). Fewer positive experiences were associated with more education and more family cancer history; those with VUS in a gene of high risk had fewer positive experiences than those with VUS in a gene with limited evidence of risk ( ps≤.03). Conclusions: Many individuals undergoing MGT may not fully understand the prospect of receiving VUS. Clinicians should consider patients’ background, preparation, and level of cancer risk to which they are potentially susceptible, as these factors may affect their emotional adaptation.

Evaluation of a Peer-led Asthma Self-management Group Intervention for Urban Adolescents

PURPOSE

This paper describes the acceptability and generalizability of an evidenced-based peer-led asthma self-management program.

DESIGN AND METHODS

Adolescents with persistent asthma (n = 259, ages 12-17 years) from three urban cities participated in a one day camp led by either trained peer leaders (n = 35, ages 16-20 years; intervention group) or healthcare professionals (control group). Participants completed a camp evaluation form, and the peer leader quality survey.

RESULTS

Overall program evaluation showed high acceptability with average score of 4.5 (±0.87) out of 5 and no treatment group differences were found. Campers highly rated peer leaders' qualification, particularly trustworthiness (98%), knowledge (97%), and sense of humor (95%). Participants from low income families (annual income < $30,000) reported higher satisfaction with their camp experience being enjoyable compared to their counterparts from higher income families (X² = 4.23, p ≤ .04).

CONCLUSIONS

This study supports the acceptability and generalizability of a peer-led asthma self-management program across different urban community locations, seasons and venues.

PRACTICE IMPLICATIONS

Trained peers can be as effective as adult educators in teaching adolescents asthma self-management.

Interobserver agreement in describing adnexal masses using the International Ovarian Tumor Analysis simple rules in a real-time setting and using three-dimensional ultrasound volumes and digital clips

OBJECTIVE

To estimate the agreement between an expert and a non-expert examiner using the International Ovarian Tumor Analysis (IOTA) simple rules for classifying adnexal masses on real-time ultrasound and when using three-dimensional (3D) ultrasound volumes and digital clips.

METHODS

Forty-two non-consecutive women diagnosed as having an adnexal mass were evaluated by transvaginal power Doppler ultrasound as part of their diagnostic work-up. In each woman, examination was first performed by a non-expert examiner (a trainee) and immediately afterwards by an expert examiner. Both used the IOTA simple rules to describe the mass, blinded to each other's results. After finishing the examination, each examiner classified the mass as benign, malignant or inconclusive, according to the IOTA simple rules. Additionally, the expert recorded a short videoclip and acquired a static 3D volume of each mass, which were subsequently assessed by four trainees in obstetrics and gynecology with different levels of training, who also classified the mass as benign, malignant or inconclusive according to the IOTA simple rules. Agreement was assessed by calculating weighted and standard kappa index values with 95% CI and the percentage of agreement between observers.

RESULTS

Agreement between the observers who performed real-time ultrasound examination was good (weighted kappa = 0.76; 95% CI, 0.61-0.90; agreement = 78.6%). Agreement between trainees using videoclips plus 3D volumes was moderate (kappa values ranged from 0.45 to 0.58, depending on pair comparison).

CONCLUSION

Interobserver agreement of the IOTA simple rules for classifying adnexal masses as benign, malignant or inconclusive using real-time ultrasound, between an expert and a non-expert examiner, might be considered good. Agreement using a videoclip plus a 3D volume was moderate for trainees with different degrees of training.

Long-term white matter changes after severe traumatic brain injury: a 5-year prospective cohort

BACKGROUND AND PURPOSE

Extensive white matter damage has been documented in patients with severe traumatic brain injury, yet how this damage evolves in the long term is not well understood. We used DTI to study white matter changes at 5 years after traumatic brain injury.

MATERIALS AND METHODS

There were 8 healthy control participants and 13 patients with severe traumatic brain injury who were enrolled in a prospective observational study, which included clinical assessment and brain MR imaging in the acute setting (< 6 weeks) and 2 years and 5 years after injury. Only subjects with mild to moderate disability or no disability at 1 year were included in this analysis. DTI parameters were measured in 20 different brain regions and were normalized to values obtained in an age-matched control group.

RESULTS

In the acute setting, fractional anisotropy was significantly lower in the genu and body of the corpus callosum and in the bilateral corona radiata in patients compared with control participants, whereas radial diffusivity was significantly (P < .05) higher in these tracts. At 2 years, fractional anisotropy in these tracts had further decreased and radial diffusivity had increased. No significant changes were detected between 2 and 5 years after injury. The baseline radial diffusivity and fractional anisotropy values in the anterior aspect of the brain stem, genu and body of the corpus callosum, and the right and left corona radiata were significantly (P < .05) associated with neurocognitive sequelae (including amnesia, aphasia, and dyspraxia) at year 5.

CONCLUSIONS

DTI changes in major white matter tracts persist up to 5 years after severe traumatic brain injury and are most pronounced in the corpus callosum and corona radiata. Limited structural change is noted in the interval between 2 and 5 years.