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Srinivasa S, Bowman M, Titterton L, Harnett P, Brand A, Kirk J, Ragunathan A. Mainstream genetic testing for high-grade ovarian, tubal and peritoneal cancers: A tertiary referral centre experience. Aust N Z J Obstet Gynaecol 2023; 63:241-246. [PMID: 36785489 DOI: 10.1111/ajo.13650] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 01/17/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Fifteen percent of ovarian, tubal, and peritoneal (OTP) invasive epithelial cancers are linked to an underlying heritable pathogenic variant (PV) in the BRCA1/2 cancer susceptibility genes. Identifying a PV has management implications for an affected individual and relatives. Cancer team-facilitated genetic testing (mainstreaming) aims to provide equitable systematic access to genetic testing for appropriate patients. AIM To evaluate a multi-disciplinary team (MDT)-led mainstream germline genetic testing program for OTP cancer at a tertiary referral centre. MATERIALS AND METHODS We conducted a retrospective review of our MDT-led mainstream genetic testing program initiated in June 2017. We included all patients diagnosed with OTP cancer registered with the hospital gynaecological oncology MDT from program initiation to December 2020. Patients were considered eligible for testing if they were diagnosed with a high-grade epithelial OTP AND ≤70 years, OR if >70 with a first/second degree relative with breast and/or ovarian cancer OR Jewish ancestry. RESULTS Of 205 women diagnosed with high-grade epithelial OTP cancer, 140 were eligible for mainstreaming. Eight-five percent were mainstreamed, with the gynae-oncologists facilitating 64.5% of tests. The overall PV detection rate in BRCA1/2 was 10.1% (BRCA1 n = 9, BRCA2 n = 3). The median turnaround time (TAT) was 44.5 days (range 16-118). All women with PV were referred to the Familial Cancer Service for further assessment and five (of six eligible; 83%) were subsequently treated with polyadenosine diphosphate ribose polymerase inhibitors. Cascade testing was undertaken in 75% of families with a mean of three relatives tested per proband. CONCLUSION Mainstreamed genetic testing is feasible, with an acceptable TAT, ensuring adequate opportunity to inform treatment decisions. Tumour testing and inclusion of moderate-risk cancer predisposition genes in mainstreaming represent potential pathways that will require further exploration.
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Affiliation(s)
- Shweta Srinivasa
- Familial Cancer Service, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - Michelle Bowman
- Familial Cancer Service, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - Leanna Titterton
- Familial Cancer Service, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - Paul Harnett
- Department of Medical Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - Alison Brand
- University of Sydney, Sydney, New South Wales, Australia
- Department of Gynaeoncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - Judy Kirk
- Familial Cancer Service, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Abiramy Ragunathan
- Familial Cancer Service, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
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2
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Huang SJ, Amendola LM, Sternen DL. Variation among DNA banking consent forms: points for clinicians to bank on. J Community Genet 2022; 13:389-397. [PMID: 35834113 DOI: 10.1007/s12687-022-00601-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/07/2022] [Indexed: 11/24/2022] Open
Abstract
Deoxyribonucleic acid (DNA) banking is an important laboratory service that preserves the option of future genetic testing. DNA bank consent forms are a critical tool to facilitate thorough and valid informed consent. The objectives of this study were to assess the level of consistency of current clinical DNA banking consent forms with the American Society of Human Genetics (ASHG) and the American College of Medical Genetics and Genomics (ACMG) guidance and to explore variation among the forms. The content analysis matrix included key points identified from the ASHG and ACMG documents (including benefits/risks, sample storage, access, disposition, and communication) and additional points beyond the ASHG and ACMG documents identified from the consent forms themselves during the analysis process. Forms were assessed for language addressing each point. Five consent forms were identified and analyzed for twelve key points and eight additional points. The average consistency for key points was 10.8/12 (range 8/12 to 12/12). The range for additional points was 1/8 to 5/8. There was variation across forms in the details provided related to key and additional points. Gaps in clinical DNA banking consent forms are barriers to achieving informed consent. Clinicians can consider the consent key and additional points discussed here to supplement and enrich their clinical DNA banking informed consent discussions, promote stewardship, and maximize downstream utility of banked DNA. The identification of multiple additional points beyond the ASHG and ACMG documents' key points indicates a need for this guidance to be updated.
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Affiliation(s)
- Samuel J Huang
- Division of Medical Genetics, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
| | - Laura M Amendola
- Division of Medical Genetics, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Darci L Sternen
- Department of Laboratories, Seattle Children's Hospital, Seattle, WA, USA
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3
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Buras AL, Barkhurst M, Rutherford TJ, Anderson ML, English DP. The Intersection of Palliative Care and Genetic Counseling in Cancer Care: A Case Discussion. J Palliat Med 2021; 25:167-171. [PMID: 34851746 DOI: 10.1089/jpm.2021.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Up to 10% of cancers have a strong hereditary component. The diagnosis of a hereditary cancer may alter treatment recommendations for the patient. However, the optimal timing and best practices for integrating genetic counseling and testing into the care of women diagnosed with cancer remains unclear. In this study, we demonstrate the potential benefits of discussing genetic testing and counseling in the context of palliative care through two cases. Incorporating referrals for genetic testing into the palliative care context is important. This provides an opportunity to perform previously missed genetic testing. It is also a chance for the patient to leave a legacy while also potentially allowing for alternate targeted treatment possibilities that may be well tolerated and provide a better quality of life for the patients themselves. The benefits of referral to palliative care by the genetics team includes assisting patients with the management of not only physical but also psychological symptoms as well as conducting advanced care planning in patients and families with hereditary mutations.
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Affiliation(s)
- Andrea L Buras
- Department of Gynecologic Oncology, University of South Florida, Tampa, Florida, USA
| | - Meghan Barkhurst
- Department of Palliative Care, Chesapeake Regional Medical Center, Chesapeake, Virginia, USA
| | - Thomas J Rutherford
- Department of Gynecologic Oncology, University of South Florida, Tampa, Florida, USA
| | - Matthew L Anderson
- Department of Gynecologic Oncology, University of South Florida, Tampa, Florida, USA
| | - Diana P English
- Department of Gynecologic Oncology, University of South Florida, Tampa, Florida, USA.,Department of Palliative Medicine, University of South Florida, Tampa, Florida, USA
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4
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Views and experiences of palliative care clinicians in addressing genetics with individuals and families: a qualitative study. Support Care Cancer 2021; 30:1615-1624. [PMID: 34549349 DOI: 10.1007/s00520-021-06569-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE A proportion of people with palliative care needs unknowingly have a genetic predisposition to their disease, placing relatives at increased risk. As end-of-life nears, the opportunity to address genetics for the benefit of their family narrows. Clinicians face numerous barriers addressing genetic issues, but there is limited evidence from the palliative care clinician perspective. Our aims are to (1) explore the views and experiences of palliative care clinicians in addressing genetics with patients and their families and (2) generate suggested strategies that support integration of genetics into palliative care. METHODS An interpretive descriptive qualitative study using semi-structured interviews with palliative care doctors and nurses (N = 14). RESULTS Three themes were identified: (1) Harms and benefits of raising genetics: a delicate balancing act, (2) Navigating genetic responsibility within the scope of palliative care and (3) Overcoming practice barriers: a multipronged approach. Participants described balancing the benefits of addressing genetics in palliative care against potential harms. Responsibility to address genetic issues depends on perceptions of relevance and the scope of palliative care. Suggestions to overcome practice barriers included building genetic-palliative care relationships and multi-layered genetics education, developing clinical resources and increasing organisational support. CONCLUSIONS Integrating aspects of genetics is feasible, but must be balanced against potential harms and benefits. Palliative care clinicians were uncertain about their responsibility to navigate these complex issues to address genetics. There are opportunities to overcome barriers and tailor support to ensure people nearing end-of-life have a chance to address genetic issues for the benefit of their families.
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5
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Prudent J, Lopez E, Dorshorst D, Cox HC, Bodurtha JN. Demographic and socioeconomic trends in DNA banking utilization in the USA. J Community Genet 2021; 12:593-602. [PMID: 34185264 PMCID: PMC8239484 DOI: 10.1007/s12687-021-00533-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/24/2021] [Indexed: 12/28/2022] Open
Abstract
Demographic and clinical information from de-identified individuals utilizing a single DNA banking service over a 22-year period was assessed using descriptive statistics. The socioeconomic characteristics of the study population were estimated using a zip code–level analysis of US Census data and compared to national US Metrics for 2016. Samples from 4,874 individuals were deposited to a single commercial DNA bank from 1997 to 2019. Samples originated from 31 countries across 6 continents, with the majority of samples originating from the United States (US; 97.37%; n = 4,746). A higher proportion of individuals identifying as females (55.58%; n = 2,709) utilized the service compared to males (41.18%; n = 2,007). The age distribution was bimodal, peaking around 5 years of age and again around 65 years of age. Whole blood was the preferred specimen for submission. Sample deposits peaked in 2015 with 559 annual deposits. Clinical genetic counselors were the most common referral source (41.73%; n = 2,034). Individuals utilizing DNA banking services are estimated to reside in wealthier, more educated and less racially diverse zip codes compared to national metrics. Although direct to consumer DNA banking is being utilized by the general public and clinical genetic counselors in the US, it is not widespread.
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Affiliation(s)
- Joshua Prudent
- Department of Genetic Medicine, Johns Hopkins School of Medicine, 600 N. Wolfe St., Blalock 1012, Baltimore, MD, 21287, USA
| | - Esthermarie Lopez
- Ponce Health Sciences University, 388 Zona Industrial Reparada 2, Ponce, PR, 00716, Puerto Rico
| | - Donna Dorshorst
- Prevention Genetics LLC, 3800 S. Business Park Avenue, WI, 54,449, Marshfield, USA
| | - Hannah C Cox
- Prevention Genetics LLC, 3800 S. Business Park Avenue, WI, 54,449, Marshfield, USA.
| | - Joann N Bodurtha
- Department of Genetic Medicine, Johns Hopkins School of Medicine, 600 N. Wolfe St., Blalock 1012, Baltimore, MD, 21287, USA.
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6
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Moss CA, Cojocaru E, Hanwell J, Ward S, Xu W, van Zyl M, O'Leary L, de Bono JS, Banerji U, Kaye SB, Minchom A, George AJ, Lopez J, McVeigh TP. Multidisciplinary interventions in a specialist Drug Development Unit to improve family history documentation and onward referral of patients with advanced cancer to cancer genetics services. Eur J Cancer 2019; 114:97-106. [PMID: 31078974 DOI: 10.1016/j.ejca.2019.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/26/2019] [Accepted: 04/02/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Molecular aberrations in cancer may represent therapeutic targets, and, if arising from the germline, may impact further cancer risk management in patients and their blood relatives. Annually, 600-700 patients are referred for consideration of experimental drug trials in the Drug Development Unit (DDU) in our institution. A proportion of patients may merit germline genetic testing because of suspicious personal/family history or findings of tumour-based testing. We aimed to assess the impact of different multidisciplinary interventions on family history taking and referral rates from DDU to Cancer Genetics Unit (CGU). METHODS Over 42 months, three interventions were undertaken at different intervals: (1) embedding a genetics provider in the DDU review clinic, (2) 'traffic light' system flagging cancers with a heritable component and (3) virtual multidisciplinary meeting (MDM). Comparative analyses between intervals were undertaken, including referral rates to CGU, investigations and patient outcomes. Family history taking in a sample of 20 patients managed in each interval was assessed by a retrospective chart review. RESULTS Frequency of family history taking and referral to CGU, increased with each intervention, particularly, the virtual MDM (40% vs 85%). Referral rates increased over the study period, from 0.1 referral/week (5/year, 0.36% total referrals) to 1.2/week (projected 63/year, 3.81%). Forty-four (52%) patients referred required germline testing; in three of whom, variants were identified. Non-attendance rates were low (6, 7%). CONCLUSION Patients in the DDU are unique, with long cancer histories and often short estimated life expectancy. Multidisciplinary working between CGU and DDU facilitates germline testing of those patients who may otherwise miss the opportunity.
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Affiliation(s)
- Cathryn A Moss
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, Fulham Road, London, UK
| | - Elena Cojocaru
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Janet Hanwell
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Simon Ward
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, Fulham Road, London, UK
| | - Wen Xu
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Mary van Zyl
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Lorraine O'Leary
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Johann S de Bono
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Udai Banerji
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Stan B Kaye
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Anna Minchom
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Angela J George
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, Fulham Road, London, UK; Gynaecological Oncology Unit, Royal Marsden NHS Foundation Trust, Fulham Road, London, UK
| | - Juanita Lopez
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Terri P McVeigh
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, Fulham Road, London, UK.
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Abstract
People with an inherited condition who receive palliative care may be missing out on the opportunity to store a DNA sample for future use by their families and offspring. A DNA sample from a family member affected with an inherited condition can help at-risk relatives to access accurate risk assessment and, where relevant, enhanced surveillance and risk-reducing measures. As genetic and genomic testing becomes increasingly important in all aspects of healthcare, health professionals specialising in palliative care will be asked to communicate about family history risk and testing. This article highlights the importance of discussing genetics and genomics issues for people receiving palliative care, their families and the health professionals caring for them.
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Affiliation(s)
- Chris Jacobs
- Senior Lecturer, Genetic Counselling, University of Technology Sydney (UTS) Ultimo, NSW Australia
| | - Stephanie White
- Associate Genetic Counsellor, Familial Cancer Service, Royal North Shore Hospital, Sydney, NSW Australia
| | - Jane Phillips
- Professor of Palliative Nursing, Director of IMPACCT, University of Technology Sydney (UTS) Ultimo, NSW Australia
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8
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Abusamaan MS, Quillin JM, Owodunni O, Emidio O, Kang IG, Yu B, Ma B, Bailey L, Razzak R, Smith TJ, Bodurtha JN. The Role of Palliative Medicine in Assessing Hereditary Cancer Risk. Am J Hosp Palliat Care 2018; 35:1490-1497. [PMID: 29843526 PMCID: PMC6385866 DOI: 10.1177/1049909118778865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND: Hereditary cancer assessment and communication about family history risks can be critical for surviving relatives. Palliative care (PC) is often the last set of providers before death. METHODS: We replicated a prior study of the prevalence of hereditary cancer risk among patients with cancer receiving PC consultations, assessed the history in the electronic medical record (EMR), and explored patients' attitudes toward discussions about family history. This study was conducted at an academic urban hospital between June 2016 and March 2017. RESULTS: The average age of the 75 adult patients with cancer was 60 years, 49 (55%) male and 49 (65%) white. A total of 19 (25%) patients had no clear documentation of family history in the EMR, sometimes because no family history was included in the admission template or an automatically imported template lacked content. In all, 24 (32%) patients had high-risk pedigrees that merited referral to genetic services. And, 48 (64%) patients thought that PC was an appropriate venue to discuss the implications of family history. The mean comfort level in addressing these questions was high. CONCLUSIONS: At an academic center, 25% of patients had no family history documented in the EMR. And, 32% of pedigrees warranted referral to genetic services, which was rarely documented. There is substantial room for quality improvement for oncologists and PC specialists-often the last set of providers-to address family cancer risk before death and to increase use and ease of documenting family history in the EMR. Addressing cancer family history could enhance prevention, especially among high-risk families.
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Affiliation(s)
| | | | | | | | | | - Brandon Yu
- Johns Hopkins University, Baltimore MD, USA
| | | | | | - Rab Razzak
- Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Thomas J. Smith
- Johns Hopkins University School of Medicine, Baltimore MD, USA
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9
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Morrow A, Jacobs C, Best M, Greening S, Tucker K. Genetics in palliative oncology: a missing agenda? A review of the literature and future directions. Support Care Cancer 2017; 26:721-730. [PMID: 29249060 DOI: 10.1007/s00520-017-4017-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/05/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE In the palliative oncology setting, genetic assessment may not impact on the patient's management but can be of vital importance to their surviving relatives. Despite care of the family being central to the ethos of palliative care, little is known about how hereditary aspects of cancer are addressed in this setting. This review aims to examine current practices, identify practice barriers and determine the genetic information and support needs of patients, family members and health providers. METHODS Key databases were systematically searched to identify both quantitative and qualitative studies that addressed these aims. Data was extracted and coded using thematic analysis. RESULTS Eight studies were included for review. Suboptimal genetic practices were identified, with lack of knowledge and poor confidence amongst providers reported as barriers in both qualitative and quantitative studies. Providers expressed concern about the emotional impact of initiating these discussions late in the disease trajectory; however, qualitative interviews amongst palliative patients suggested there may be emotional benefits. CONCLUSIONS All lines of evidence suggest that genetics is currently missing from the palliative agenda, signifying lost opportunities for mutation detection, genetic counselling and appropriate risk management for surviving relatives. There is an urgent need for interventions to improve provider knowledge and awareness of genetic referral pathways and for research into the genetic information and support needs of palliative care patients.
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Affiliation(s)
- April Morrow
- Hereditary Cancer Clinic, The Prince of Wales Hospital, Randwick, NSW, 2031, Australia.
| | - Chris Jacobs
- Prince of Wales Clinical School-UNSW Sydney, Randwick, NSW, Australia
| | - Megan Best
- PoCoG, University of Sydney, Camperdown, NSW, Australia
| | - Sian Greening
- Hereditary Cancer Clinic, Wollongong Hospital, Wollongong, NSW, Australia
| | - Kathy Tucker
- Hereditary Cancer Clinic, The Prince of Wales Hospital, Randwick, NSW, 2031, Australia
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10
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Quillin JM, Emidio O, Ma B, Bailey L, Smith TJ, Kang IG, Yu BJ, Owodunni OP, Abusamaan M, Razzak R, Bodurtha JN. High-Risk Palliative Care Patients' Knowledge and Attitudes about Hereditary Cancer Testing and DNA Banking. J Genet Couns 2017; 27:834-843. [PMID: 29204810 DOI: 10.1007/s10897-017-0181-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/17/2017] [Indexed: 02/07/2023]
Abstract
Even at the end of life, testing cancer patients for inherited susceptibility may provide life-saving information to their relatives. Prior research suggests palliative care inpatients have suboptimal understanding of genetic importance, and testing may be underutilized in this clinical setting. These conclusions are based on limited research. This study aimed to estimate genetic testing prevalence among high-risk palliative care patients in a National Cancer Institute-designated comprehensive cancer center. We also aimed to understand these patients' understanding of, and attitudes toward, hereditary cancer testing and DNA banking. Palliative care in-patients with cancer completed structured interviews, and their medical records were reviewed. Among patients at high risk for hereditary cancer, we assessed history of genetic testing/DNA banking; and related knowledge and attitudes. Among 24 high-risk patients, 14 (58.3%) said they/their relatives had genetic testing or they had been referred for a genetics consultation. Of the remaining 10 patients, seven (70%) said they would "probably" or "definitely" get tested. Patients who had not had testing were least concerned about the impact of future testing on their family relationships; two (20%) said they were "extremely concerned" about privacy related to genetic testing. Of patients without prior testing, five (50%) said they had heard or read "a fair amount" about genetic testing. No high-risk patients had banked DNA. Overall, 23 (95.8%) said they had heard or read "almost nothing" or "relatively little" about DNA banking. Written materials and clinician discussion were most preferred ways to learn about genetic testing and DNA banking. Overall, this study demonstrates underutilization of genetics services at the end of life continues to be problematic, despite high patient interest.
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Affiliation(s)
- John M Quillin
- Human & Molecular Genetics, Virginia Commonwealth University, 1101 E. Marshall St, Richmond, VA, 23298-0033, USA.
| | - Oluwabunmi Emidio
- McKusick-Nathans Institute of Genetics Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Brittany Ma
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Thomas J Smith
- Palliative Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - In Guk Kang
- Johns Hopkins University, Baltimore, MD, USA
| | - Brandon J Yu
- Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
| | | | - Mohammed Abusamaan
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Rab Razzak
- Palliative Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Joann N Bodurtha
- McKusick-Nathans Institute of Genetics Medicine, Johns Hopkins University, Baltimore, MD, USA
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11
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Mainstreaming genetics in palliative care: barriers and suggestions for clinical genetic services. J Community Genet 2017; 9:243-256. [PMID: 29159708 DOI: 10.1007/s12687-017-0345-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 11/07/2017] [Indexed: 01/20/2023] Open
Abstract
Palliative healthcare professionals (PHCPs) frequently do not refer their eligible patients for genetic testing. After the death of the affected individual, clinically relevant information for family members is lost. In previous research, PHCPs stated that the end-of-life setting is not appropriate to discuss genetic issues. It is unclear if this has changed due to increasing awareness of genetics in the media and efforts to mainstream genetic testing. Semi-structured interviews of PHCPs were analysed by thematic analysis. Seven PHCPs (four nurses, two consultants, and one clinical psychologist) were interviewed. Participants reported feeling unfamiliar with the role of clinical genetics services, and did not feel confident in addressing genetic issues with their patients. A lack of scientific knowledge and unawareness of existing infrastructure to support their patients were cited. Many stated that palliative patients are interested in exploring a potential hereditary component to their disease, and acknowledged the potential for psychological benefit for their patients and their families. Most stated that addressing genetics fits within their skill set, but expressed concern about issues of consent, logistical difficulties, and ethical dilemmas. These perceptions differ considerably from those reported in existing literature. Importantly, each participant stated that the potential benefits of addressing genetic issues outweighed the potential for harm in most cases. These results suggest a need for clinical genetics staff to develop closer links with their local PHCPs and to provide education. Clinical psychologists may also be a helpful resource to address PHCPs' concerns.
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12
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Adams LS, Miller JL, Grady PA. The Spectrum of Caregiving in Palliative Care for Serious, Advanced, Rare Diseases: Key Issues and Research Directions. J Palliat Med 2016; 19:698-705. [PMID: 27249541 DOI: 10.1089/jpm.2015.0464] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Rare diseases are often life-limiting conditions, the majority of which require constant caregiving needs. The realization of a spectrum of palliative care throughout the trajectory of rare diseases could ensure individualized and caregiver-focused approaches to the care of patients and families. In June 2015, the National Institute of Nursing Research (NINR), the lead institute at the National Institutes of Health for end-of-life research, in conjunction with the National Center for Advancing Translational Sciences, Office of Rare Diseases Research (ORDR) held an interdisciplinary workshop on the unique challenges of caregiving and palliative care in adult and pediatric rare diseases. The panel identified gaps in current knowledge, and afforded suggestions for research opportunities in palliative care science to improve the care of individuals with serious, advanced, rare diseases and their caregivers. This meeting provided an in-depth opportunity to incorporate new concepts into palliative and end-of-life care for individuals with a range of rare diseases and their caregivers. This report presents a summary of the workshop.
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Affiliation(s)
- Lynn S Adams
- National Institute of Nursing Research, National Institutes of Health , Bethesda, Maryland
| | - Jeri L Miller
- National Institute of Nursing Research, National Institutes of Health , Bethesda, Maryland
| | - Patricia A Grady
- National Institute of Nursing Research, National Institutes of Health , Bethesda, Maryland
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13
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Delikurt T, Williamson GR, Anastasiadou V, Skirton H. A systematic review of factors that act as barriers to patient referral to genetic services. Eur J Hum Genet 2014; 23:739-45. [PMID: 25205405 DOI: 10.1038/ejhg.2014.180] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 07/23/2014] [Accepted: 08/07/2014] [Indexed: 11/09/2022] Open
Abstract
Patients who might benefit from genetic services may be denied access through failure to be referred. To investigate the evidence on barriers to referral to genetic services, we conducted a systematic review of empirical evidence on this topic. Nine studies were included in the review. Barriers related to non-genetic healthcare professionals were: lack of awareness of patient risk factors, failure to obtain adequate family history, lack of knowledge of genetics and genetic conditions, lack of awareness of genetic services, inadequate coordination of referral and lack of genetics workforce. Those related to individuals affected by or at risk of a genetic condition were: lack of awareness of personal risk, lack of knowledge and/or awareness of medical history of family members and lack of knowledge of genetic services. Research on access to genetic services is heterogeneous; stronger empirical evidence is needed on factors that are barriers, and further research is needed to develop 'targeted interventions' for equitable access to genetic services in a range of populations.
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Affiliation(s)
- Türem Delikurt
- 1] Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK [2] Clinical Genetics Clinic, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | | | - Violetta Anastasiadou
- Clinical Genetics Clinic, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Heather Skirton
- Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
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14
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Fashoyin-Aje L, Sanghavi K, Bjornard K, Bodurtha J. Integrating genetic and genomic information into effective cancer care in diverse populations. Ann Oncol 2013; 24 Suppl 7:vii48-54. [PMID: 24001763 DOI: 10.1093/annonc/mdt264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This paper provides an overview of issues in the integration of genetic (related to hereditary DNA) and genomic (related to genes and their functions) information in cancer care for individuals and families who are part of health care systems worldwide, from low to high resourced. National and regional cancer plans have the potential to integrate genetic and genomic information with a goal of identifying and helping individuals and families with and at risk of cancer. Healthcare professionals and the public have the opportunity to increase their genetic literacy and communication about cancer family history to enhance cancer control, prevention, and tailored therapies.
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Affiliation(s)
- L Fashoyin-Aje
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 600 N. Wolfe St., Baltimore, MD 21287, USA.
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Quillin JM, Bodurtha JN, Siminoff LA, Smith TJ. Physicians' current practices and opportunities for DNA banking of dying patients with cancer. J Oncol Pract 2013; 7:183-7. [PMID: 21886501 DOI: 10.1200/jop.2010.000190] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2010] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The availability of genetic tests for cancer susceptibility is increasing. Current tests, however, have limited clinical sensitivity. Even when clinically valid tests are available, the genetic counseling and informed consent process might not be feasible for dying patients with cancer. DNA banking preserves the opportunity for future research or clinical testing and may provide critical opportunities for surviving relatives. This study explored the current practices and potential for DNA banking for cancer susceptibility among oncologists specializing in palliative care. METHODS Palliative care oncologists actively providing clinical care for dying patients with cancer were recruited for an online survey. Descriptive statistics for DNA banking practices, perceived qualification to recommend banking, and potential predictors were assessed. RESULTS Data were collected from 49 physicians (37% recruitment rate). Eighty percent reported assessing at least some patients for genetic cancer susceptibility in the past 12 months. No participants reported banking DNA for patients in the past 12 months. Only 5% reported feeling at least somewhat qualified to order DNA banking. A Web-based risk assessment tool and genetic counselor on staff were perceived as the most helpful potential resources. CONCLUSION Despite its potential, DNA banking is not being used by palliative care oncologists.
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Affiliation(s)
- John M Quillin
- Department of Human & Molecular Genetics, Department of Social & Behavioral Health, and Department of Medicine, Massey Cancer Center, Commonwealth University, Richmond, VA
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Riley BD, Culver JO, Skrzynia C, Senter LA, Peters JA, Costalas JW, Callif-Daley F, Grumet SC, Hunt KS, Nagy RS, McKinnon WC, Petrucelli NM, Bennett RL, Trepanier AM. Essential elements of genetic cancer risk assessment, counseling, and testing: updated recommendations of the National Society of Genetic Counselors. J Genet Couns 2011; 21:151-61. [PMID: 22134580 DOI: 10.1007/s10897-011-9462-x] [Citation(s) in RCA: 222] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 11/16/2011] [Indexed: 12/28/2022]
Abstract
Updated from their original publication in 2004, these cancer genetic counseling recommendations describe the medical, psychosocial, and ethical ramifications of counseling at-risk individuals through genetic cancer risk assessment with or without genetic testing. They were developed by members of the Practice Issues Subcommittee of the National Society of Genetic Counselors Familial Cancer Risk Counseling Special Interest Group. The information contained in this document is derived from extensive review of the current literature on cancer genetic risk assessment and counseling as well as the personal expertise of genetic counselors specializing in cancer genetics. The recommendations are intended to provide information about the process of genetic counseling and risk assessment for hereditary cancer disorders rather than specific information about individual syndromes. Essential components include the intake, cancer risk assessment, genetic testing for an inherited cancer syndrome, informed consent, disclosure of genetic test results, and psychosocial assessment. These recommendations should not be construed as dictating an exclusive course of management, nor does use of such recommendations guarantee a particular outcome. These recommendations do not displace a health care provider's professional judgment based on the clinical circumstances of a client.
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A clinical perspective on genetic counseling and testing during end of life care for women with recurrent progressive ovarian cancer: opportunities and challenges. Fam Cancer 2011; 10:193-7. [PMID: 21246292 DOI: 10.1007/s10689-011-9418-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
10-15% of invasive epithelial ovarian cancer is attributable to hereditary breast and ovarian cancer. The identification of BRCA1/BRCA2 mutations in women with ovarian cancer allows for accurate predictive genetic testing of their at-risk relatives, who can then avail themselves of early detection and risk reduction strategies. In the case of women with recurrent progressive ovarian cancer, the window of opportunity for genetic testing can be particularly limited. Here we describe our perspective on providing genetic counseling during these patients' end of life care, incorporating two illustrative examples from our clinical practice. While these situations pose unique challenges, they also present a significant opportunity to benefit the patient and her family. Further attention and research should be directed towards provision of genetic counseling and testing during end of life care.
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