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Johnson J, Hogan E, Merrill M, Noss R. An analysis of the impact of annual cancer genetic testing guideline updates on a past patient population. J Genet Couns 2023. [PMID: 37907432 DOI: 10.1002/jgc4.1822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 09/14/2023] [Accepted: 10/07/2023] [Indexed: 11/02/2023]
Abstract
Germline genetic testing for cancer predisposition genes has become an essential component of cancer treatment and risk reduction. The National Comprehensive Cancer Network (NCCN) releases annual genetic testing guidelines that identify characteristics of patients that could be affected by a hereditary cancer syndrome. These guidelines have broadened over time and the implications for past patients of cancer genetics clinics are not well understood. This study is a retrospective chart review aimed at determining the percentage and characteristics of past patients that meet updated NCCN guidelines (Breast, Ovarian, and Pancreas [BOP] v1.2022 and Colorectal [CRC] v1.2021), patients that attended a follow-up appointment, and patients who went on to receive genetic testing. Clinical data and characteristics were compared between the study population as a whole and the cohort of patients that met updated NCCN guidelines BOP v1.2022 and CRC v1.2021. The study population consisted of 280 patients with 76 (27.1%) patients meeting updated NCCN guidelines BOP v1.2022 and CRC v1.2021. The year of initial cancer genetic counseling appointment was statistically significant (p = 0.023) with patients more likely to meet NCCN guidelines BOP v1.2022 and CRC v1.2021 with earlier initial cancer genetic counseling appointments. In the cohort that met updated NCCN guidelines BOP v1.2022 and CRC v1.2021, the most common reason was a change in the NCCN guidelines (BOP or CRC) (54/76, 71.1%) with triple-negative breast cancer diagnosed at any age being the most impactful guideline change (19/54, 35.2%). Twenty-one patients attended a follow-up appointment (7.5%) and of those that received genetic testing (17/21, 81%) most received negative results (13/17, 61.9%), with one pathogenic, low penetrance result (1/17, 5.9%, CHEK2 p.I157T). Provider-initiated follow-up was attributed to most follow-up appointments (16/21, 76.2%) implying patients do not tend to follow-up on their own. Education to non-genetics providers as well as targeted implementation of follow-up protocols possibly managed by genetic counseling assistants and utilizing electronic medical record (EMR) patient messaging could lead to improved patient follow-up.
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Affiliation(s)
- Jordan Johnson
- Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Elizabeth Hogan
- Department of Genetics and Genomics, The MetroHealth System, Cleveland, Ohio, USA
| | - Michelle Merrill
- Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Ryan Noss
- Center for Personalized Genetic Healthcare, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Morrow A, Speechly C, Young AL, Tucker K, Harris R, Poplawski N, Andrews L, Nguyen Dumont T, Kirk J, Southey MC, Willis A. "Out of the blue": A qualitative study exploring the experiences of women and next of kin receiving unexpected results from BRA-STRAP research gene panel testing. J Genet Couns 2023. [PMID: 37864663 DOI: 10.1002/jgc4.1803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/23/2023]
Abstract
In the genomic era, the availability of gene panel and whole genome/exome sequencing is rapidly increasing. Opportunities for providing former patients with new genetic information are also increasing over time and recontacting former patients with new information is likely to become more common. Breast cancer Refined Analysis of Sequence Tests-Risk And Penetrance (BRA-STRAP) is an Australian study of individuals who had previously undertaken BRCA1 and BRCA2 genetic testing, with no pathogenic variants detected. Using a waiver of consent, stored DNA samples were retested using a breast/ovarian cancer gene panel and clinically significant results returned to the patient (or next of kin, if deceased). This qualitative study aimed to explore patient experiences, opinions, and expectations of recontacting in the Australian hereditary cancer setting. Participants were familial cancer clinic patients (or next of kin) who were notified of a new pathogenic variant identified via BRA-STRAP. In-depth, semi-structured interviews were conducted approximately 6 weeks post-result. Interviews were transcribed verbatim and analyzed using an inductive thematic approach. Thirty participants (all female; average age = 57; range 36-84) were interviewed. Twenty-five were probands, and five were next of kin. Most women reported initial shock upon being recontacted with unexpected news, after having obtained a sense of closure related to their initial genetic testing experiences and cancer diagnosis. For most, this initial distress was short-lived, followed by a process of readjustment, meaning-making and adaptation that was facilitated by perceived clinical and personal utility of the information. Women were overall satisfied with the waiver of consent approach and recontacting process. Results are in line with previous studies suggesting that patients have positive attitudes about recontacting. Women in this study valued new genetic information gained from retesting and were satisfied with the BRA-STRAP recontact model. Practice implications to facilitate readjustment and promote psychosocial adaptation were identified.
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Affiliation(s)
- April Morrow
- Implementation to Impact (i2i), School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Catherine Speechly
- Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Alison Luk Young
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Kathy Tucker
- Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
- UNSW Prince of Wales Clinical School, Randwick, New South Wales, Australia
| | - Rebecca Harris
- Westmead Hospital Familial Cancer Service, Crown Princess Mary Cancer Centre, Westmead, New South Wales, Australia
| | - Nicola Poplawski
- Adult Genetics Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Lesley Andrews
- Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Tu Nguyen Dumont
- Department of Clinical Pathology, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Judy Kirk
- Westmead Hospital Familial Cancer Service, Crown Princess Mary Cancer Centre, Westmead, New South Wales, Australia
| | - Melissa C Southey
- Department of Clinical Pathology, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Amanda Willis
- Clinical Translation and Engagement Platform, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine & Health, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
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Macklin‐Mantia SK, Clift KE, Maimone S, Hodge DO, Riegert‐Johnson D, Hines SL. Patient uptake of updated genetic testing following uninformative
BRCA1
and
BRCA2
results. J Genet Couns 2022. [DOI: 10.1002/jgc4.1665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022]
Affiliation(s)
| | | | - Santo Maimone
- Department of Radiology Mayo Clinic Jacksonville Florida USA
| | - David O. Hodge
- Department of Health Sciences Research Mayo Clinic Jacksonville Florida USA
| | - Douglas Riegert‐Johnson
- Department of Clinical Genomics Mayo Clinic Jacksonville Florida USA
- Department of Gastroenterology Mayo Clinic Jacksonville Florida USA
| | - Stephanie L. Hines
- Division of Diagnostic & Consultative Medicine, Department of Medicine Mayo Clinic Florida Jacksonville USA
- Department of General Internal Medicine Mayo Clinic Scottsdale Arizona USA
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4
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Opinions and experiences of recontacting patients: a survey of Australasian genetic health professionals. J Community Genet 2022; 13:193-199. [PMID: 35013911 DOI: 10.1007/s12687-021-00570-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022] Open
Abstract
The issue of recontacting past genetics patients is increasingly relevant, particularly with the introduction of next-generation sequencing. Improved testing can provide additional information on the pathogenicity and prevalence of genetic variants, often leading to a need to recontact patients. Some international genetics societies have position statements and recommendations to guide genetic health professionals (GHPs) navigating the legal, ethical and practical issues of recontacting. In the absence of a standardised Australasian protocol, we explored the experiences and opinions of Australasian GHPs regarding patient follow-up and recontacting practices. Forty-five respondents completed an online survey. Most respondents indicated that recontacting occurred on an ad hoc basis, but most genetic services relied on patients (or family) initiating recontact. Implementation of a routine recontacting system was widely dismissed by 73% of respondents, citing lack of resources, limited information on legal responsibility and setting unrealistic expectations as common barriers. If recontact was contemplated, e-communication was an acceptable first step. This study identified the need for integrated familial cancer registries to assist under-resourced genetic services to maintain up-to-date patient records. Developing a standard recontacting protocol with flexibility to account for patient individuality and circumstances might enable provision of equitable service within Australasia.
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Dahle Ommundsen RM, Strømsvik N, Hamang A. Assessing the relationship between patient preferences for recontact after BRCA1 or BRCA2 genetic testing and their monitoring coping style in a Norwegian sample. J Genet Couns 2021; 31:554-564. [PMID: 34716741 DOI: 10.1002/jgc4.1526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 10/09/2021] [Accepted: 10/14/2021] [Indexed: 12/19/2022]
Abstract
Recontacting former patients regarding new genetic information is currently not standard care but might be implemented in the future. Little information is available on the implications of this practice from the point of view of former patients. The aim of this study was to investigate preferences for recontact when new genetic information becomes available among patients tested for BRCA pathogenic variants. We further wanted to investigate whether having a high or low information-seeking coping style (monitoring) impacts preferences. Preferences for recontact were assessed using a self-constructed questionnaire. The Threatening Medical Situations Inventory (TMSI) was used to measure monitoring coping style. The questionnaires were sent to 500 randomly selected patients who had previously been tested for BRCA pathogenic variants within the time frame 2001-2014 at one genetic clinic in Norway. We received 323 completed questionnaires. Most respondents wanted to be recontacted with advances in genetic medicine (81.1%) and to receive highly personalized updates. Genetic counselors/geneticists were believed to be most responsible for recontact. There was a significant relationship between being a high monitor and wanting recontact to learn about own cancer risk and receive ongoing support. Patients have a high interest in being recontacted. The findings indicated a tendency for high monitors to prefer more detailed and personalized information.
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Affiliation(s)
- Randi Marlene Dahle Ommundsen
- Department of Medical Genetics, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Global Health and Primary Care, University of Bergen, Bergen, Norway
| | - Nina Strømsvik
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Medical Genetics, Northern Norway Familial Cancer Center, University Hospital of North-Norway, Tromsø, Norway
| | - Anniken Hamang
- Department of Medical Genetics, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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