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Winchar K, Lambert P, McManus KJ, Chodirker B, Kean S, Serfas K, Decker K, Nachtigal MW, Altman AD. Referral, Genetic Counselling, and BRCA Testing in the Manitoba High-Grade Serous Ovarian Cancer Population, 2004-2019. Curr Oncol 2022; 29:9365-9376. [PMID: 36547149 PMCID: PMC9777417 DOI: 10.3390/curroncol29120735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 12/02/2022] Open
Abstract
(1) Background: The primary objective of this study was to examine the rate of genetic referral, BRCA testing, and BRCA positivity amongst all patients with high-grade serous ovarian cancers (HGSOC) from 2004-2019. The secondary objective was to analyze secondary factors that may affect the rates of referral and testing. (2) Methods: This population-based cohort study included all women diagnosed with HGSOC using the Manitoba Cancer Registry, CervixCheck registry, Medical Claims database at Manitoba Health, the Hospital Discharge abstract, the Population Registry, and Winnipeg Regional Health Authority genetics data. Data were examined for three different time cohorts (2004-2013, 2014-2016; 2017-2019) correlating to practice pattern changes. (3) Results: A total of 944 patients were diagnosed with HGSOC. The rate of genetic referrals changed over the three timeframes (20.0% → 56.7% → 36.6%) and rate of genetic testing increased over the entire timeframe. Factors found to increase rates of referral and testing included age, histology, history of oral contraceptive use, and family history of ovarian cancer. Prior health care utilization indicators did not affect genetic referral or testing. (4) Conclusion: The rate of genetic referral (2004-2016) and BRCA1/2 testing (2004-2019) for patients with a diagnosis of HGSOC increased over time. A minority of patients received a consultation for genetics counselling, and even fewer received testing for a BRCA1/2. Without a genetic result, it is difficult for clinicians to inform treatment decisions. Additional efforts are needed to increase genetics consultation and testing for Manitoban patients with HGSOC. Effects of routine tumour testing on rates of genetic referral will have to be examined in future studies.
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Affiliation(s)
- Kelcey Winchar
- Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB R3A 1R9, Canada
| | - Pascal Lambert
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB R3E OV9, Canada
- Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB R3E OV9, Canada
| | - Kirk J. McManus
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB R3E OV9, Canada
- Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB R3E OV9, Canada
| | - Bernie Chodirker
- Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB R3E OV9, Canada
- Pediatrics and Child Health (Section of Genetics and Metabolism), University of Manitoba, Winnipeg, MB R3E OV9, Canada
| | - Sarah Kean
- Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB R3A 1R9, Canada
| | - Kim Serfas
- Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB R3E OV9, Canada
| | - Kathleen Decker
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB R3E OV9, Canada
- Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB R3E OV9, Canada
| | - Mark W. Nachtigal
- Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB R3A 1R9, Canada
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB R3E OV9, Canada
- Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB R3E OV9, Canada
| | - Alon D. Altman
- Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB R3A 1R9, Canada
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB R3E OV9, Canada
- Correspondence: ; Tel.: +1-204-787-2967
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Van de Beek I, Smets EMA, Legdeur MA, de Hullu JA, Lok CAR, Buist MR, Mourits MJE, Kets CM, van der Kolk LE, Oosterwijk JC, Aalfs CM. Genetic counseling of patients with ovarian carcinoma: acceptance, timing, and psychological wellbeing. J Community Genet 2019; 11:183-191. [PMID: 31168696 PMCID: PMC7062983 DOI: 10.1007/s12687-019-00427-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 05/27/2019] [Indexed: 12/15/2022] Open
Abstract
The new Dutch guidelines on hereditary and familial ovarian carcinoma recommend genetic testing of all patients with epithelial ovarian cancer (EOC). With this study, we aimed to obtain insight into (1) the acceptance and timing of the offer of genetic counseling in women with EOC, (2) reasons for accepting or declining genetic counseling, and (3) psychological differences between women who did and did not have genetic counseling. A multicenter questionnaire survey was performed in patients with EOC in four Dutch oncology centers. The questionnaire addressed whether, how, and when genetic counseling was offered, women’s arguments to accept or decline genetic counseling, and included the Cancer Worry Scale (CWS) and the Hospital Anxiety and Depression Scale (HADS). A total of 67 women completed the questionnaire, of which 43 had genetic counseling. Despite a wide variability in the timing of the offer of genetic counseling, 89% of the women were satisfied with the timing. No significant differences were found between the CWS and HADS scores for the timing of the offer of genetic counseling and whether or not women had genetic counseling. Taking the small sample size into account, the results tentatively suggest that genetic counseling may have limited impact on the psychosocial wellbeing of women with EOC. Therefore, we assume that implementation of the new guidelines offering genetic counseling to all patients with EOC will not cause considerable additional burden to these patients.
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Affiliation(s)
- I Van de Beek
- Department of Clinical Genetics, Amsterdam UMC, location VUmc, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. .,Department of Clinical Genetics, Amsterdam UMC, location AMC, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - E M A Smets
- Department of Clinical Genetics, Amsterdam UMC, location AMC, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.,Department of Medical Psychology, Amsterdam UMC, location AMC, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - M A Legdeur
- Department of Clinical Genetics, Amsterdam UMC, location AMC, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - J A de Hullu
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - C A R Lok
- Department of Obstetrics and Gynaecology, Center of Gynaecologic Oncology Amsterdam, PO Box 90203, 1006 BE, Amsterdam, The Netherlands
| | - M R Buist
- Department of Obstetrics and Gynaecology, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - M J E Mourits
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
| | - C M Kets
- Department of Human Genetics, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - L E van der Kolk
- Family Cancer Clinic, Netherlands Cancer Institute, PO Box 90203, 1006 BE, Amsterdam, the Netherlands
| | - J C Oosterwijk
- Department of Genetics, University Medical Center, University of Groningen, PO Box 30001, 9700 RB, Groningen, the Netherlands
| | - C M Aalfs
- Department of Clinical Genetics, Amsterdam UMC, location VUmc, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.,Department of Clinical Genetics, Amsterdam UMC, location AMC, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
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Burling MJ, Gamet K, Eva L, Tan AL. Referral patterns for genetic counselling of women diagnosed with tubo‐ovarian or peritoneal high‐grade serous carcinoma (
HGSC
) within the Auckland Gynaecological Oncology Centre. Aust N Z J Obstet Gynaecol 2019; 59:444-449. [DOI: 10.1111/ajo.12964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 01/13/2019] [Indexed: 01/05/2023]
Affiliation(s)
- Michael J Burling
- Westmead Public Hospital, Gynaeoncology Unit Sydney New South Wales Australia
| | | | - Lois Eva
- Auckland City Hospital Auckland New Zealand
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Shaw J, Bulsara C, Cohen PA, Gryta M, Nichols CB, Schofield L, O'Sullivan S, Pachter N, Hardcastle SJ. Investigating barriers to genetic counseling and germline mutation testing in women with suspected hereditary breast and ovarian cancer syndrome and Lynch syndrome. PATIENT EDUCATION AND COUNSELING 2018; 101:938-944. [PMID: 29273311 DOI: 10.1016/j.pec.2017.12.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 12/01/2017] [Accepted: 12/11/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The aim of the current study was to explore barriers to genetic counseling and testing in women with gynecological cancers deemed at significant risk of carrying a germline mutation. METHODS A qualitative study using semi-structured interviews and inductively analysed thematically. Eight patients with ovarian or endometrial cancer participated in individual semi-structured telephone interviews that assessed motivation for genetic counseling and testing, perceived benefits and barriers, timing of the approach, perceptions of the referral process to genetic services and locus of control in relation to cancer and health. RESULTS Analysis of the interview transcripts revealed five themes relating to perceptions of genetic counseling and testing: Lack of importance; Level of information received; Timing of referral processes; Fear and anxiety; Resistance to and perceptions of counseling. CONCLUSIONS Participants had a limited understanding of hereditary cancer syndromes and did not appreciate the benefits of genetic testing. A consistent approach at the time of referral to genetic services is needed to ensure that the level and format of information is appropriate for patients. PRACTICE IMPLICATIONS The rationale for genetic testing needs to be better explained to patients and the timing of referral should be based both on treatment priorities and patient preferences.
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Affiliation(s)
- Josephine Shaw
- St. John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Caroline Bulsara
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Paul A Cohen
- St. John of God Subiaco Hospital, Subiaco, Western Australia, Australia; Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia; Division of Women's and Infants' Health, School of Medicine, University of Western Australia, Crawley, Western Australia, Australia.
| | - Madeleine Gryta
- School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Cassandra B Nichols
- Genetic Services of Western Australia, Subiaco, Western Australia, Australia; Inherited Cancer Connect Partnership (ICCon)
| | - Lyn Schofield
- Genetic Services of Western Australia, Subiaco, Western Australia, Australia
| | - Sarah O'Sullivan
- Genetic Services of Western Australia, Subiaco, Western Australia, Australia; WOMEN Centre, West Leederville, Western Australia, Australia
| | - Nicholas Pachter
- Genetic Services of Western Australia, Subiaco, Western Australia, Australia; School of Paediatrics and Child Health, University of Western Australia, Australia; School of Medicine and Pharmacology, University of Western Australia, Australia
| | - Sarah J Hardcastle
- Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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Willis A, Smith S, Meiser B, Ballinger M, Thomas D, Young MA. Sociodemographic, psychosocial and clinical factors associated with uptake of genetic counselling for hereditary cancer: a systematic review. Clin Genet 2016; 92:121-133. [DOI: 10.1111/cge.12868] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/09/2016] [Accepted: 09/13/2016] [Indexed: 01/01/2023]
Affiliation(s)
- A.M. Willis
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine; University of New South Wales; Sydney Australia
| | - S.K. Smith
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine; University of New South Wales; Sydney Australia
| | - B. Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine; University of New South Wales; Sydney Australia
| | - M.L. Ballinger
- The Kinghorn Cancer Centre and Cancer Division; Garvan Institute of Medical Research; Darlinghurst Australia
| | - D.M. Thomas
- The Kinghorn Cancer Centre and Cancer Division; Garvan Institute of Medical Research; Darlinghurst Australia
| | - M.-A. Young
- Familial Cancer Centre; Peter MacCallum Cancer Centre; Melbourne Australia
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Batte BAL, Bruegl AS, Daniels MS, Ring KL, Dempsey KM, Djordjevic B, Luthra R, Fellman BM, Lu KH, Broaddus RR. Consequences of universal MSI/IHC in screening ENDOMETRIAL cancer patients for Lynch syndrome. Gynecol Oncol 2014; 134:319-25. [PMID: 24933100 DOI: 10.1016/j.ygyno.2014.06.009] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/05/2014] [Accepted: 06/07/2014] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Determine factors impacting the uptake of genetic counseling and results of genetic testing following universal tumor testing for Lynch syndrome in patients with endometrial cancer. METHODS The study population consisted of two unselected cohorts of endometrial cancer patients, 408 identified retrospectively and 206 identified prospectively. Immunohistochemistry for mismatch repair protein expression and/or microsatellite instability analysis was performed on these tumors. MLH1 methylation analysis was performed on tumors with loss of MLH1 protein. Tumor studies were considered suggestive of Lynch Syndrome if they showed immunohistochemical loss of MSH2, MSH6 or PMS2, loss of MLH1 without MLH1 promoter methylation, and/or microsatellite instability. Participants with suggestive tumor studies were contacted and offered genetic counseling and testing. RESULTS In the retrospective cohort, 11% had tumor studies suggestive of Lynch syndrome, and 42% was seen for genetic counseling. A germline mutation was detected in 40%, and one had a variant of uncertain significance. In the prospective cohort, 8.7% of patients had tumor testing suggestive of Lynch syndrome; 72% were seen for genetic counseling. Germline mutations were found in 40%, and one had a variant of uncertain significance. Common challenges included timing of re-contact, age, perceived lack of relevance, inability to travel and limited insurance coverage. CONCLUSIONS There are several barriers to genetic counseling and testing follow-up after universal tumor testing, and uninformative genetic test results present a management challenge. It is important to consider these limitations when implementing an approach to screening endometrial cancer patients for Lynch syndrome.
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Affiliation(s)
- Brittany A L Batte
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amanda S Bruegl
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Molly S Daniels
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kari L Ring
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Katherine M Dempsey
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bojana Djordjevic
- Department of Pathology and Laboratory Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | - Rajyalakshmi Luthra
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bryan M Fellman
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karen H Lu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Russell R Broaddus
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Patrick-Miller L, Egleston BL, Daly M, Stevens E, Fetzer D, Forman A, Bealin L, Rybak C, Peterson C, Corbman M, Bradbury AR. Implementation and outcomes of telephone disclosure of clinical BRCA1/2 test results. PATIENT EDUCATION AND COUNSELING 2013; 93:413-419. [PMID: 24075727 PMCID: PMC4199583 DOI: 10.1016/j.pec.2013.08.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 08/05/2013] [Accepted: 08/11/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES With an increasing demand for genetic services, effective and efficient delivery models for genetic testing are needed. METHODS In this prospective single-arm communication study, participants received clinical BRCA1/2 results by telephone with a genetic counselor and completed surveys at baseline, after telephone disclosure (TD) and after in-person clinical follow-up. RESULTS Sixty percent of women agreed to participate; 73% of decliners preferred in-person communication. Anxiety decreased from baseline to post-TD (p=0.03) and satisfaction increased (p<0.01). Knowledge did not change significantly from baseline to post-TD, but was higher post-clinical follow-up (p=0.04). Cancer patients had greater declines in state anxiety and African-American participants reported less increase in satisfaction. 28% of participants did not return for in-person clinical follow-up, particularly those with less formal education, and higher post-disclosure anxiety and depression (p<0.01). CONCLUSIONS Telephone disclosure of BRCA1/2 test results may not be associated with negative cognitive and affective responses among willing patients, although some subgroups may experience less favorable responses. Some patients do not return for in-person clinical follow-up and longitudinal outcomes are unknown. PRACTICE IMPLICATIONS Further evaluation of longitudinal outcomes of telephone disclosure and differences among subgroups can inform how to best incorporate telephone communication into delivery of genetic services.
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Affiliation(s)
- Linda Patrick-Miller
- Department of Medicine, Division of Hematology–Oncology, The University of Chicago, Chicago, USA
- Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, USA
| | | | - Mary Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, USA
| | - Evelyn Stevens
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, USA
| | - Dominique Fetzer
- Department of Medicine, Division of Hematology–Oncology, University of Pennsylvania, Philadelphia, USA
| | - Andrea Forman
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, USA
| | - Lisa Bealin
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, USA
| | - Christina Rybak
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, USA
| | - Candace Peterson
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, USA
| | - Melanie Corbman
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, USA
| | - Angela R. Bradbury
- Department of Medicine, Division of Hematology–Oncology, University of Pennsylvania, Philadelphia, USA
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, USA
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