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Khincha PP, Savage SA. When the somatic genome informs the germline: the example of TP53. J Natl Cancer Inst 2024; 116:1190-1192. [PMID: 38908000 PMCID: PMC11308161 DOI: 10.1093/jnci/djae126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 06/03/2024] [Indexed: 06/24/2024] Open
Affiliation(s)
- Payal P Khincha
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Sharon A Savage
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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Droin-Mollard M, Hervouet L, Lahlou-Laforêt K, de Montgolfier S. Narrative review on ethical and psychological issues raised by genetic and genomic testing in pediatric oncology care. J Genet Couns 2024. [PMID: 39075631 DOI: 10.1002/jgc4.1955] [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: 07/28/2023] [Revised: 07/08/2024] [Accepted: 07/17/2024] [Indexed: 07/31/2024]
Abstract
In pediatric oncology, genetic and genomic tests are proposed throughout the care pathway for many reasons (e.g., cancer characterization, identification of the most appropriate treatment, patient selection for clinical trials, identification of tissue/organ donors, or risk of relapse prediction). Despite the many different approaches (somatic or germline testing, targeted gene or genome sequencing), the implicated individuals are confronted with situations that may intersect and that are interesting to compare. No study has identified and analyzed the available works on these new practices in pediatric oncology. The aim of this narrative literature review was to describe the ethical and psychological perspectives of children with cancer, parents, and healthcare professionals when genetic or genomic testing is proposed as part of the cancer management. Eighteen articles met the inclusion criteria and were comprehensively coded using MAXQDA. Their analysis showed that concerning the subjective implications of genetic and genomic testing, the areas of ambivalence (desire of treatment, desire for knowledge, uncertainty, and guilt) reported by patients and their parents seem to mirror the healthcare professionals' concerns. The ethical and psychological issues about predisposition testing, long discussed in the context of hereditary retinoblastoma and Li-Fraumeni syndrome, represent a useful starting point for a wider discussion of a genetic and genomic testing pathway in pediatric oncology more broadly.
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Affiliation(s)
- Marion Droin-Mollard
- UF de Psychologie et Psychiatrie de Liaison et d'Urgences, DMU Psychiatrie et Addictologie, et Département de Génétique, APHP, Centre-Universités de Paris, Paris, France
| | - Lucile Hervouet
- IRIS Institut de Recherche Interdisciplinaire Sur les Enjeux Sociaux (UMR 8156 CNRS - 997 INSERM - EHESS - UPSN), Campus Condorcet, Aubervilliers, France
| | - Khadija Lahlou-Laforêt
- UF de Psychologie et Psychiatrie de Liaison et d'Urgences, DMU Psychiatrie et Addictologie, et Département de Génétique, APHP, Centre-Universités de Paris, Paris, France
- Consultation Multidisciplinaire d'oncogénétique Des Cancers Rares, Hopital européen Georges Pompidou, Paris, France
| | - Sandrine de Montgolfier
- Université Paris Est Créteil, Créteil, France
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
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3
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Grant AM, Signorelli C, Taylor N, de Graves S, Tucker KM, Cruickshank M. Models of care and the advanced practice nurse role in caring for children and adolescents with a cancer predisposition syndrome: a scoping review protocol. JBI Evid Synth 2024; 22:864-873. [PMID: 37930416 DOI: 10.11124/jbies-23-00074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
OBJECTIVE This scoping review will examine the literature describing models of care, barriers and facilitators of care, and gaps in care delivery for children and adolescents with a cancer predisposition syndrome (CPS). It will also explore how advanced practice nurses contribute to the delivery of care for children and adolescents with a CPS. INTRODUCTION Cancer remains a leading cause of death in children and adolescents. Pediatric CPS clinics proactively aim for early diagnosis or prevention of cancer in children and adolescents with a CPS. Additionally, the holistic well-being of individuals requires a multidisciplinary team, including advanced practice nurses, to manage their complex health care needs. INCLUSION CRITERIA This review will consider both published and unpublished literature exploring aspects of models of care and the role of the nurse in pediatric CPS clinics. Literature published in English from 1991 onward will be considered. METHODS This scoping review will follow the JBI methodology for scoping reviews. The review will include searches in MEDLINE, Embase, and CINAHL Complete. Gray literature searches will be conducted in OAIster and Social Science Research Network, as well as websites of hospitals in the USA and the UK with large pediatric cancer centers. Two reviewers will screen titles, abstracts, and full-text articles. An extraction table will be used to extract relevant data from all included articles and facilitate data analysis. Results will be presented in narrative and tabular format. REVIEW REGISTRATION Open Science Framework osf.io/axkp7/.
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Affiliation(s)
- Andrew M Grant
- Sydney Children's Hospitals Network, Sydney Children's Hospital, Sydney, NSW, Australia
- University of Technology Sydney, Sydney, NSW, Australia
- The New South Wales Centre for Evidence Based Health Care: A JBI Affiliated Group, Western Sydney University, Sydney, NSW, Australia
| | - Christina Signorelli
- Sydney Children's Hospitals Network, Sydney Children's Hospital, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - Natalie Taylor
- University of New South Wales, Sydney, NSW, Australia
- Maridulu Budyari Gumal (SPHERE), Sydney, NSW, Australia
| | - Sharon de Graves
- VCCC (Victorian Comprehensive Cancer Centre) Alliance, Melbourne, Vic, Australia
- University of Melbourne, Melbourne, Vic, Australia
| | - Kathrine M Tucker
- Sydney Children's Hospitals Network, Sydney Children's Hospital, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
- Maridulu Budyari Gumal (SPHERE), Sydney, NSW, Australia
- Prince of Wales Hospital, Sydney, NSW, Australia
| | - Marilyn Cruickshank
- Sydney Children's Hospitals Network, Sydney Children's Hospital, Sydney, NSW, Australia
- University of Technology Sydney, Sydney, NSW, Australia
- Maridulu Budyari Gumal (SPHERE), Sydney, NSW, Australia
- Griffith University, Griffith, Qld, Australia
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4
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Van Hoyweghen S, Bm Claes K, de Putter R, Wakefield C, Van Schoors M, Hellemans S, Verhofstadt L. The psychological impact of genetic testing in childhood cancer: A systematic review. Psychooncology 2024; 33:e6279. [PMID: 38282231 DOI: 10.1002/pon.6279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/29/2023] [Accepted: 12/13/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE Cancer predisposition syndromes are being more frequently recognized in the etiology of pediatric oncology and genetic-related technologies are evolving rapidly, leading to an increasing availability of genetic testing for families. This systematic review assessed the psychological impact of genetic testing on children and parents in the context of childhood cancer. METHODS Searches were performed using three databases (Web of Science, Pubmed and Embase) to identify relevant empirical studies. Following Cochrane guidelines, we screened 3838 articles and identified 18 eligible studies, representing the perspectives of children and/or parents. RESULTS The included studies described the impact of genetic testing in different contexts (e.g. predictive testing and diagnostic testing) and in different subgroups, (e.g. carriers and non-carriers). Overall, the studies did not identify clinically-relevant long-term increases in negative emotions (depression, anxiety, distress, uncertainty, guilt) as a result of genetic testing. Negative emotions were typically time-limited and generally occurred in families with particular characteristics (e.g. those with a history of multiple cancer diagnoses, families receiving an unfavorable result for one child and a favorable result in siblings, and those with pre-existing mental health difficulties). Positive emotions (hopefulness, relief and peace of mind) were also reported. Knowing their genetic risk status appeared to help to foster empowerment among families, regardless of the result and any associated emotions. CONCLUSIONS Genetic testing in pediatric oncology does not appear to cause significant additional harm and can lead to positive outcomes. Clinicians need to be especially attentive when counseling families at increased risk of distress.
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Affiliation(s)
- Sophie Van Hoyweghen
- Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
- Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, University of Ghent, Ghent, Belgium
- Cancer Research Institute Ghent CRIG, Ghent, Belgium
| | - Kathleen Bm Claes
- Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
- Cancer Research Institute Ghent CRIG, Ghent, Belgium
- Center of Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Robin de Putter
- Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
- Cancer Research Institute Ghent CRIG, Ghent, Belgium
- Center of Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Claire Wakefield
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | | | - Sabine Hellemans
- Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
- Center of Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Lesley Verhofstadt
- Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, University of Ghent, Ghent, Belgium
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Howard Sharp KM, Blake A, Flynn J, Brown S, Rashed J, Harrison L, McGee R, Mandrell B, Nichols KE. Adolescent and Young Adult Understanding of Their Childhood Cancer Predisposition Diagnosis: A Qualitative Study. J Pediatr 2023; 261:113538. [PMID: 37279817 DOI: 10.1016/j.jpeds.2023.113538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 06/08/2023]
Abstract
We characterized germline genetic test result understanding in adolescents and young adults (AYAs) (n = 21) with cancer 1-3.9 years post-disclosure using semistructured qualitative interviews. Most AYAs articulated their cancer risk; however, 5 did not remember results and a subset demonstrated misperceptions regarding risk or confusion regarding their medical care. These findings highlight variability in AYA understanding warranting further inquiry.
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Affiliation(s)
- Katianne M Howard Sharp
- Department of Psychology & Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN.
| | - Alise Blake
- Division of Cancer Predisposition, St. Jude Children's Research Hospital, Memphis, TN
| | - Jessica Flynn
- Department of Psychology & Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Sydney Brown
- Department of Psychology & Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Jihan Rashed
- Department of Psychology & Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Lynn Harrison
- Division of Cancer Predisposition, St. Jude Children's Research Hospital, Memphis, TN
| | - Rose McGee
- Division of Cancer Predisposition, St. Jude Children's Research Hospital, Memphis, TN
| | - Belinda Mandrell
- Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, TN
| | - Kim E Nichols
- Division of Cancer Predisposition, St. Jude Children's Research Hospital, Memphis, TN
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6
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Howard Sharp KM, Li C, Lu Z, Clark ME, Jurbergs N, Ouma A, Harrison L, Gerhardt E, Taylor L, Hamilton KV, McGee RB, Nuccio R, Hines-Dowell S, Gattuso JS, Pritchard M, Mandrell BN, Tercyak KP, Nichols KE, Johnson LM. Parent Quality of Life After Disclosure of Pediatric Oncology Germline Sequencing Results. JCO Precis Oncol 2023; 7:e2300159. [PMID: 37944075 DOI: 10.1200/po.23.00159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/06/2023] [Accepted: 08/22/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE To characterize parents' quality of life (QoL) after germline genomic sequencing for their children with cancer. METHODS Participants were n = 104 parents of children with cancer enrolled in a prospective study of clinical tumor and germline genomic sequencing. Parents completed surveys at study consent (T0), before disclosure of their child's germline results (T1), and again ≥5 weeks after results disclosure (T2). Bivariate associations with QoL were examined, followed by a multivariable regression model predicting parents' psychological distress. RESULTS At T2, parental distress significantly differed by their children's germline result type (positive, uncertain, negative; P = .038), parent relationship status (P = .04), predisclosure genetics knowledge (P = .006), and predisclosure worry about sequencing (P < .001). Specifically, parents of children with positive (ie, pathogenic or likely pathogenic) results experienced greater distress than those of children with negative results (P = .029), as did parents who were single, more knowledgeable about genetics, and with greater worry. In the adjusted regression model, a positive germline result remained significantly associated with parents' lower QoL at T2 follow-up (F [4,92] = 9.95; P < .001; R2 = .30; β = .19; P = .031). CONCLUSION Germline genomic sequencing for children with cancer is associated with distress among parents when revealing an underlying cancer predisposition among their affected children. Genetic education and counseling before and after germline sequencing may help attenuate this impact on QoL by addressing parents' concerns about test results and their health implications. Assessing parents' worry early in the testing process may also aid in identifying those most likely in need of psychosocial support.
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Affiliation(s)
- Katianne M Howard Sharp
- Department of Psychology and Biobehavioral Sciences, St Jude Children's Research Hospital, Memphis, TN
| | - Chen Li
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN
| | - Zhaohua Lu
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN
| | - Mary Egan Clark
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Niki Jurbergs
- Department of Psychology and Biobehavioral Sciences, St Jude Children's Research Hospital, Memphis, TN
| | - Annastasia Ouma
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Lynn Harrison
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Elsie Gerhardt
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Leslie Taylor
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Kayla V Hamilton
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Rose B McGee
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Regina Nuccio
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Stacy Hines-Dowell
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Jami S Gattuso
- Division of Nursing Research, St Jude Children's Research Hospital, Memphis, TN
| | - Michelle Pritchard
- Division of Nursing Research, St Jude Children's Research Hospital, Memphis, TN
| | - Belinda N Mandrell
- Division of Nursing Research, St Jude Children's Research Hospital, Memphis, TN
| | - Kenneth P Tercyak
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Kim E Nichols
- Division of Cancer Predisposition, St Jude Children's Research Hospital, Memphis, TN
| | - Liza-Marie Johnson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
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7
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Lima E, Esplen MJ, Martins F, Alves M, Sales CMD. Communication about hereditary cancer risk to offspring: A systematic review of children's perspective. Psychooncology 2023. [PMID: 37114280 DOI: 10.1002/pon.6141] [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: 10/03/2022] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE The present review describes how children experience hereditary cancer risk communication within the family. METHODS Searches for studies between 1990 and 2020 on PubMed and EBSCO were undertaken, and 15 studies met the inclusion criteria, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The findings informed: (1) how, when and what is discussed about hereditary cancer risk in the family; (2) how does family communication about hereditary cancer risk impact children on psychosocial and behavioral outcomes; (3) what are the child's preferences regarding hereditary cancer risk communication within the family. RESULTS Disclosure is done mostly by both parents, or mothers only, which is in accordance with the children's preferences. Children value open communication about cancer risk with their parents, although they report experiences of fear, surprise, feeling unhappy, and concern about the increased risk of cancer. Regardless of the method of disclosure, children may be particularly sensitive to their parent's emotional state at the time of disclosure, and they learn from their parents' experiences the potential implications of cancer risk. Children also report that it would be helpful to learn more about genetic cancer syndromes via written materials, and/or meet a genetic counselor. CONCLUSIONS Children rely on their parents as the primary models of the hereditary cancer experience. Therefore, parents play a central role in the psychological adjustment of children. Findings point to the relevance of family-centered care in hereditary cancer risk that targets not only the mutation carrier individually but also their children and partners.
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Affiliation(s)
- Esperança Lima
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- Center for Psychology, University of Porto, Porto, Portugal
| | - Mary Jane Esplen
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Filipa Martins
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- Center for Psychology, University of Porto, Porto, Portugal
| | - Marisa Alves
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Célia M D Sales
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Gereis J, Hetherington K, Ha L, Robertson EG, Ziegler DS, Barlow-Stewart K, Tucker KM, Marron JM, Wakefield CE. Parents' understanding of genome and exome sequencing for pediatric health conditions: a systematic review. Eur J Hum Genet 2022; 30:1216-1225. [PMID: 35999452 PMCID: PMC9626631 DOI: 10.1038/s41431-022-01170-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 07/13/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023] Open
Abstract
Genome and exome sequencing (GS/ES) are increasingly being used in pediatric contexts. We summarize evidence regarding the actual and perceived understanding of GS/ES of parents of a child offered testing for diagnosis and/or management of a symptomatic health condition. We searched four databases (2008-2021) and identified 1264 unique articles, of which 16 met inclusion criteria. We synthesized data from qualitative and quantitative studies and organized results using Ayuso et al. (2013)'s framework of key elements of information for informed consent to GS/ES. Many of the parents represented had prior experience with genetic testing and accessed a form of genetic counseling. Parents' understanding was varied across the domains evaluated. Parents demonstrated understanding of the various potential direct clinical benefits to their child undergoing GS/ES, including in relation to other genetic tests. We found parents had mixed understanding of the nature of potential secondary findings, and of issues related to data privacy, confidentiality, and usage of sequencing results beyond their child's clinical care. Genetic counseling consultations improved understanding. Our synthesis indicates that ES/GS can be challenging for families to understand and underscores the importance of equipping healthcare professionals to explore parents' understanding of ES/GS and the implications of testing for their child.
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Affiliation(s)
- Jessica Gereis
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia ,grid.414009.80000 0001 1282 788XBehavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW Australia
| | - Kate Hetherington
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia ,grid.414009.80000 0001 1282 788XBehavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW Australia
| | - Lauren Ha
- grid.414009.80000 0001 1282 788XBehavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432School of Health Sciences, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia
| | - Eden G. Robertson
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia
| | - David S. Ziegler
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia ,grid.414009.80000 0001 1282 788XKids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432Children’s Cancer Institute, UNSW Sydney, Sydney, NSW Australia
| | - Kristine Barlow-Stewart
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432Children’s Cancer Institute, UNSW Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XNorthern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Katherine M. Tucker
- grid.1005.40000 0004 4902 0432Prince of Wales Clinical School, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia
| | - Jonathan M. Marron
- grid.65499.370000 0001 2106 9910Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA USA ,grid.2515.30000 0004 0378 8438Division of Hematology/Oncology, Boston Children’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XCenter for Bioethics, Harvard Medical School, Boston, MA USA
| | - Claire E. Wakefield
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia ,grid.414009.80000 0001 1282 788XBehavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW Australia
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9
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Bon SBB, Wouters RHP, Hol JA, Jongmans MCJ, van den Heuvel‐Eibrink MM, Grootenhuis MA. Parents' experiences with large-scale sequencing for genetic predisposition in pediatric renal cancer: A qualitative study. Psychooncology 2022; 31:1692-1699. [PMID: 35962481 PMCID: PMC9804506 DOI: 10.1002/pon.6016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/12/2022] [Accepted: 08/07/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE In pediatric oncology, large-scale genetic sequencing contributes to the identification of cancer predisposition, which can facilitate surveillance and family counseling. Our qualitative study explores families' motives, knowledge, and views regarding germline genetic sequencing to improve future counseling and support. METHODS Semi-structured interviews were conducted with parents of children with renal tumors participating in a national center, germline sequencing study. An inductive thematic analysis approach was used. Twenty nine parents participated, 17 mothers and 12 fathers. The median age of the affected children was 4 years. RESULTS Parents were generally positive about sequencing and reported a combination of individual and altruistic motives to participate. Some families counseled about sequencing shortly after cancer diagnosis felt overwhelmed. Many parents had difficulties distinguishing between panel and exome-wide analysis. Families in which no predisposition was identified felt reassured. Most families did not experience distress after a predisposition was disclosed, although sometimes stress following disclosure of a predisposition added to pre-existing (cancer-related) stress. CONCLUSIONS Even though families reported positive experiences with germline genetic sequencing to detect cancer predisposition, timing of consent for sequencing as well as parents' understanding of genetic concepts can be further improved.
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Affiliation(s)
| | | | - Janna A. Hol
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
| | - Marjolijn C. J. Jongmans
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands,Department of GeneticsUniversity Medical Center UtrechtUtrechtThe Netherlands,Division of Child HealthUMCU‐Wilhelmina's Children's HospitalUtrechtThe Netherlands
| | - Marry M. van den Heuvel‐Eibrink
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands,Division of Child HealthUMCU‐Wilhelmina's Children's HospitalUtrechtThe Netherlands
| | - Martha A. Grootenhuis
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands,Division of Child HealthUMCU‐Wilhelmina's Children's HospitalUtrechtThe Netherlands
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10
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Guilmatre A, Davous D, Sigy ADHD, Asselain B, Chevret S, Petit A. Quelles sont les pratiques en génétique des pédiatres onco-hématologues de la SFCE ? Une enquête du groupe socle éthique CONECT-AML. Bull Cancer 2022; 109:1162-1176. [DOI: 10.1016/j.bulcan.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/09/2022] [Indexed: 10/14/2022]
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Li KA, Sloat LM, Kung J, Jung J, Li A, Smith CH, Schratz KE, Cooper SL, Pratilas CA, Frankenfield P, Bodurtha J. Considerations in Methods and Timing for Delivery of Genetic Counseling Information to Pediatric Oncology Patients and Families. J Pediatr Hematol Oncol 2022; 44:313-317. [PMID: 34966100 DOI: 10.1097/mph.0000000000002376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 11/01/2021] [Indexed: 11/26/2022]
Abstract
Many pediatric oncology patients and their families may benefit from genetic counseling and testing; however, identifying the best timing and delivery method for these referrals is sometimes a challenge. The goal of this study was to understand how and when caregivers prefer to receive information about genetic counseling and testing. A total of 56 surveys completed by caregivers at The Johns Hopkins Hospital Pediatric Oncology unit in Baltimore, Maryland were analyzed. A sizeable subset of respondents was interested in receiving information about the availability of genetic counseling from an oncology doctor or nurse, but not a genetic counselor (n=13/55, 24%). Most respondents preferred to be informed about genetic services at diagnosis (n=28/54, 52%) or within 1 to 2 months of diagnosis (n=14/54, 26%). In conclusion, patients and their families may benefit from prompt and early recognition of the risk of cancer predisposition syndromes, preferably within the first 2 months following diagnosis. Oncology professionals are an important source of information, and can introduce the availability of genetic counseling services and motivate families to undergo genetic testing, though alternative communication methods such as brochures may also be useful.
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Affiliation(s)
| | | | | | | | | | | | - Kristen E Schratz
- Pediatrics
- Oncology, The Johns Hopkins University School of Medicine
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Stacy L Cooper
- Pediatrics
- Oncology, The Johns Hopkins University School of Medicine
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Christine A Pratilas
- Pediatrics
- Oncology, The Johns Hopkins University School of Medicine
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | | | - Joann Bodurtha
- Departments of Genetic Medicine
- Pediatrics
- Oncology, The Johns Hopkins University School of Medicine
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Droin-Mollard M, Hervouet L, Lahlou-Laforêt K, de Montgolfier S. Les propositions génomiques en oncopédiatrie : bouleversements des temporalités et des repères éthiques — points de vue des patients, des parents et des professionnels. PSYCHO-ONCOLOGIE 2022. [DOI: 10.3166/pson-2022-0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectif : Expliciter les enjeux complexes associés à l’expansion de la génomique en oncopédiatrie.
Méthodologie : Différents matériaux d’enquêtes qualitatives pour analyser les avis des enfants, de leurs parents et des professionnels.
Résultats : Ce travail permet de décrire l’intrication entre cancer et génomique dans le soin qui entraîne une compression des temporalités, l’implication d’un plus grand nombre d’acteurs et bouleverse les repères éthiques de la génétique.
Conclusion : Les acteurs proposent des points d’amélioration pour repenser la temporalité et le consentement.
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13
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Schmidt JA, Hornhardt S, Erdmann F, Sánchez-García I, Fischer U, Schüz J, Ziegelberger G. Risk Factors for Childhood Leukemia: Radiation and Beyond. Front Public Health 2021; 9:805757. [PMID: 35004601 PMCID: PMC8739478 DOI: 10.3389/fpubh.2021.805757] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/06/2021] [Indexed: 12/20/2022] Open
Abstract
Childhood leukemia (CL) is undoubtedly caused by a multifactorial process with genetic as well as environmental factors playing a role. But in spite of several efforts in a variety of scientific fields, the causes of the disease and the interplay of possible risk factors are still poorly understood. To push forward the research on the causes of CL, the German Federal Office for Radiation Protection has been organizing recurring international workshops since 2008 every two to three years. In November 2019 the 6th International Workshop on the Causes of CL was held in Freising and brought together experts from diverse disciplines. The workshop was divided into two main parts focusing on genetic and environmental risk factors, respectively. Two additional special sessions addressed the influence of natural background radiation on the risk of CL and the progress in the development of mouse models used for experimental studies on acute lymphoblastic leukemia, the most common form of leukemia worldwide. The workshop presentations highlighted the role of infections as environmental risk factor for CL, specifically for acute lymphoblastic leukemia. Major support comes from two mouse models, the Pax5+/- and Sca1-ETV6-RUNX1 mouse model, one of the major achievements made in the last years. Mice of both predisposed models only develop leukemia when exposed to common infections. These results emphasize the impact of gene-environment-interactions on the development of CL and warrant further investigation of such interactions - especially because genetic predisposition is detected with increasing frequency in CL. This article summarizes the workshop presentations and discusses the results in the context of the international literature.
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Affiliation(s)
- Janine-Alison Schmidt
- Department of Effects and Risks of Ionizing and Non-ionizing Radiation, Federal Office for Radiation Protection (BfS), Neuherberg, Germany
| | - Sabine Hornhardt
- Department of Effects and Risks of Ionizing and Non-ionizing Radiation, Federal Office for Radiation Protection (BfS), Neuherberg, Germany
| | - Friederike Erdmann
- Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, World Health Organization (IARC/WHO), Lyon, France
| | - Isidro Sánchez-García
- Experimental Therapeutics and Translational Oncology Program, Instituto de Biología Molecular y Celular del Cáncer, CSIC/Universidad de Salamanca, Salamanca, Spain
| | - Ute Fischer
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Joachim Schüz
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, World Health Organization (IARC/WHO), Lyon, France
| | - Gunde Ziegelberger
- Department of Effects and Risks of Ionizing and Non-ionizing Radiation, Federal Office for Radiation Protection (BfS), Neuherberg, Germany
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14
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Knoll J, Li A, Smith CH, Schratz K, Cooper SL, Meah T, Helmke E, Pratilas CA, Bodurtha J. Improving Detection of Cancer Predisposition Syndromes in Pediatric Oncology. J Pediatr Hematol Oncol 2021; 43:e891-e896. [PMID: 33370000 DOI: 10.1097/mph.0000000000001987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/28/2020] [Indexed: 11/27/2022]
Abstract
Implementation and adherence to consensus statement criteria for referral of pediatric cancer patients for genetic evaluation are critical to identify the 5% to 10% with a genetic cancer predisposition syndrome. The authors implemented a Plan-Do-Study-Act quality improvement initiative aimed at increasing referrals of at-risk patients. Retrospective chart review was followed by educational intervention-with impact assessed over a 9-month prospective chart review. Referral rate improved >2-fold and there was an improvement in documented oncologic history to at least a third-degree relative. The integration of quality improvement can be an effective tool to improve the referral of patients with an elevated risk for a cancer predisposition syndrome.
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Affiliation(s)
- Jasmine Knoll
- Department of Pediatrics
- Department of Genetic Medicine, The Johns Hopkins University School of Medicine
| | | | - Christy H Smith
- Department of Genetic Medicine, The Johns Hopkins University School of Medicine
| | - Kristen Schratz
- Department of Pediatrics
- Department of Oncology, The Johns Hopkins University School of Medicine
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Stacy L Cooper
- Department of Pediatrics
- Department of Oncology, The Johns Hopkins University School of Medicine
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | | | | | - Christine A Pratilas
- Department of Pediatrics
- Department of Oncology, The Johns Hopkins University School of Medicine
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Joann Bodurtha
- Department of Pediatrics
- Department of Genetic Medicine, The Johns Hopkins University School of Medicine
- Department of Oncology, The Johns Hopkins University School of Medicine
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15
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Nevin SM, Wakefield CE, Barlow‐Stewart K, McGill BC, Bye A, Palmer EE, Dale RC, Gill D, Kothur K, Boggs K, Le Marne F, Beavis E, Macintosh R, Sachdev R. Psychosocial impact of genetic testing on parents of children with developmental and epileptic encephalopathy. Dev Med Child Neurol 2021. [DOI: 10.1111/dmcn.14971] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Suzanne M Nevin
- School of Women’s and Children’s Health UNSW Medicine UNSW Sydney Sydney NSWAustralia
- Behavioural Sciences Unit Kids Cancer Centre Sydney Children’s Hospital Randwick NSWAustralia
| | - Claire E Wakefield
- School of Women’s and Children’s Health UNSW Medicine UNSW Sydney Sydney NSWAustralia
- Behavioural Sciences Unit Kids Cancer Centre Sydney Children’s Hospital Randwick NSWAustralia
| | - Kristine Barlow‐Stewart
- School of Women’s and Children’s Health UNSW Medicine UNSW Sydney Sydney NSWAustralia
- Northern Clinical School Faculty of Medicine and Health University of Sydney Sydney NSW Australia
| | - Brittany C McGill
- School of Women’s and Children’s Health UNSW Medicine UNSW Sydney Sydney NSWAustralia
- Behavioural Sciences Unit Kids Cancer Centre Sydney Children’s Hospital Randwick NSWAustralia
| | - Ann Bye
- School of Women’s and Children’s Health UNSW Medicine UNSW Sydney Sydney NSWAustralia
- Department of Neurology Sydney Children’s HospitalRandwick NSW Australia
| | - Elizabeth E Palmer
- School of Women’s and Children’s Health UNSW Medicine UNSW Sydney Sydney NSWAustralia
- Centre for Clinical Genetics Sydney Children’s HospitalRandwick NSW Australia
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Leedman N, Princehorn M, Gottardo N, Franklin C, D'Souza R, Kiraly-Borri CE. A surveillance clinic for children and adolescents with, or at risk of, hereditary cancer predisposition syndromes. Med J Aust 2021; 214:335-335.e1. [PMID: 33772786 DOI: 10.5694/mja2.51002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Nicholas Gottardo
- University of Western Australia, Perth, WA, Australia.,Telethon Kids Cancer Centre, Brain tumour Research Program, Telethon Kids Institute, Perth, WA, Australia
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17
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Nevin SM, McLoone J, Wakefield CE, Kennedy SE, McCarthy HJ. Genetic Testing in the Pediatric Nephrology Clinic: Understanding Families' Experiences. J Pediatr Genet 2020; 11:117-125. [DOI: 10.1055/s-0040-1721439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/15/2020] [Indexed: 02/07/2023]
Abstract
AbstractGenomics is rapidly being integrated into the routine care of children and families living with renal disease, principally as a diagnostic tool but also to direct therapy, identify at-risk relatives, and facilitate family planning. However, despite significant progress in understanding the genetic heterogeneity of inherited renal disease, the impact of genetic testing on parents and families of affected children is not well understood. This study aimed to investigate the experiences of families undergoing genetic testing, the psychosocial impact of receiving a genetic test result, and parent information and support needs. In-depth semistructured interviews were conducted with 26 parents of pediatric patients (<18 years of age) who had undergone genomic investigation for a suspected genetic renal disease at two tertiary pediatric nephrology services. Interviews were transcribed verbatim, coded, using NVivo software, and thematic analysis was undertaken. Key themes included emotional adjustment to a genetic diagnosis, the importance of parent-provider relationships, empowerment through social connection, and the value of family-centered care. Results highlighted the wide-ranging psychosocial impact of genetic testing on parents, as well as the importance of patient-support networks in enabling parents/families to cope and adapt. Targeted approaches to enhance communication of genetic information and the development of tailored resources to address parents' genetics and health service needs may lead to more satisfactory experiences of genetic testing.
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Affiliation(s)
- Suzanne M. Nevin
- School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales Sydney, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Jordana McLoone
- School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales Sydney, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Claire E. Wakefield
- School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales Sydney, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Sean E. Kennedy
- School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales Sydney, Australia
- Department of Nephrology, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Hugh J. McCarthy
- School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales Sydney, Australia
- Department of Nephrology, Sydney Children's Hospital, Randwick, New South Wales, Australia
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18
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Juarez OA, Pencheva BB, Bellcross C, Schneider KW, Turner J, Porter CC. Cancer genetic counseling for childhood cancer predisposition is associated with improved levels of knowledge and high satisfaction in parents. J Genet Couns 2020; 30:710-719. [PMID: 33179831 DOI: 10.1002/jgc4.1357] [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: 02/16/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/28/2022]
Abstract
Previous surveys of adults with cancer have revealed increased levels of genetic knowledge, varying levels of worry, and high satisfaction with cancer genetic counseling. We sought to determine the impact of cancer genetic counseling on parental levels of genetic knowledge, worry about cancer, and satisfaction in the context of suspected cancer predisposition in a child. We hypothesized that parents would be satisfied with cancer genetic counseling and that cancer genetic counseling would improve baseline parental genetic knowledge and decrease levels of worry. Parents were recruited from a pediatric cancer predisposition clinic in the United States. A survey was administered to two cohorts: One cohort had received cancer genetic counseling in the past and only completed one survey (post-only, n = 26), and another cohort completed the survey before and after cancer genetic counseling (pre/post, n = 23). The survey included questions on demographics, knowledge of genetics, worry levels, and satisfaction with the cancer genetic counseling service. The post-genetic counseling survey also contained a free-text section for parents to indicate what they took away from the sessions. Parental levels of genetics knowledge increased by an average of 1.9 points (p = .01), with 65.2% of parents demonstrating an increase in genetics knowledge score. Average worry levels did not change significantly (p = .37), with 52.2% of parents indicating decreased worry, and 34.8% indicating increased worry. Overall, 91.8% of parents reported high levels of satisfaction. Our results show that cancer genetic counseling in a pediatric cancer predisposition clinic improves parental levels of genetics knowledge. Satisfaction rates suggest that parents find this service beneficial. These results demonstrate the positive impacts of cancer genetic counseling on parents of children in which a hereditary cancer syndrome is known or suspected.
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Affiliation(s)
| | - Bojana B Pencheva
- Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | - Kami W Schneider
- Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Joyce Turner
- Children's National Health System Rare Disease Institute, Washington, DC, USA
| | - Christopher C Porter
- Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA, USA
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19
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Schienda J, Stopfer J. Cancer Genetic Counseling-Current Practice and Future Challenges. Cold Spring Harb Perspect Med 2020; 10:cshperspect.a036541. [PMID: 31548230 DOI: 10.1101/cshperspect.a036541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Cancer genetic counseling practice is rapidly evolving, with services being provided in increasingly novel ways. Pretest counseling for cancer patients may be abbreviated from traditional models to cover the elements of informed consent in the broadest of strokes. Genetic testing may be ordered by a cancer genetics professional, oncology provider, or primary care provider. Increasingly, direct-to-consumer testing options are available and utilized by consumers anxious to take control of their genetic health. Finally, genetic information is being used to inform oncology care, from surgical decision-making to selection of chemotherapeutic agent. This review provides an overview of the current and evolving practice of cancer genetic counseling as well as opportunities and challenges for a wide variety of indications in both the adult and pediatric setting.
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Affiliation(s)
- Jaclyn Schienda
- Division of Cancer Genetics and Prevention, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Jill Stopfer
- Division of Cancer Genetics and Prevention, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
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20
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Forbes Shepherd R, Werner-Lin A, Keogh LA, Delatycki MB, Forrest LE. “I need to know if I’m going to die young”: Adolescent and young adult experiences of genetic testing for Li–Fraumeni syndrome. J Psychosoc Oncol 2020; 39:54-73. [DOI: 10.1080/07347332.2020.1768199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Rowan Forbes Shepherd
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Allison Werner-Lin
- School of Social Policy and Practice, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Louise A. Keogh
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Martin B. Delatycki
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Victorian Clinical Genetics Service, Parkville, Victoria, Australia
| | - Laura E. Forrest
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
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