1
|
Caeser R, Chiang J, Tan ES, Tai ES, Ngeow J. Cascade testing for hereditary cancer in Singapore: how population genomics help guide clinical policy. Fam Cancer 2024; 23:133-140. [PMID: 38662262 DOI: 10.1007/s10689-024-00376-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 04/26/2024]
Abstract
Hereditary Cancer makes up around 5-10% of all cancers. It is important to diagnose hereditary cancer in a timely fashion, as not only do patients require long-term care from a young age, but their relatives also require management. The main approach to capture at-risk relatives is cascade testing. It involves genetic testing of relatives of the first detected carrier of a pathogenic variant in a family i.e. the proband. The current standard of care for cascade testing is a patient-mediated approach. Probands are then advised to inform and encourage family members to undergo genetic testing. In Singapore, cascade testing is inefficient, around 10-15%, lower than the 30% global average. Here, we describe the cascade testing process and its effort to increase testing in Singapore. Precision Health Research, Singapore (PRECISE), was set up to coordinate Singapore's National Precision Medicine strategy and has awarded five clinical implementation pilots, with one of them seeking to identify strategies for how cascade testing for hereditary cancer can be increased in a safe and cost-efficient manner. Achieving this will be done through addressing barriers such as cost, manpower shortages, exploring a digital channel for contacting at-risk relatives, and getting a deeper insight into why genetic testing gets declined. If successful, it will likely result in care pathways that are a cost-effective public health intervention for identifying individuals at risk. Surveillance and management of those unaffected at-risk individuals, if caught early, will result in improved patient outcomes, and further reduce the healthcare burden for the economy.
Collapse
Affiliation(s)
- Rebecca Caeser
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, 169610, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Jianbang Chiang
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, 169610, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Ee Shien Tan
- Duke-National University of Singapore (NUS) Medical School, National University of Singapore, Singapore, Singapore
- Genetics Service, Department of Pediatrics, Kadang Kerbau (KK) Women's and Children's Hospital, Singapore, Singapore
| | - E Shyong Tai
- Duke-National University of Singapore (NUS) Medical School, National University of Singapore, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Precision Health Research, Singapore, Singapore
| | - Joanne Ngeow
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, 169610, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 308232, Singapore.
| |
Collapse
|
2
|
Fellner A, Goldberg Y, Basel-Salmon L. Ordering genetic testing by neurologists: points to consider. J Neurol 2023:10.1007/s00415-023-11758-3. [PMID: 37154893 DOI: 10.1007/s00415-023-11758-3] [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: 04/11/2023] [Revised: 04/28/2023] [Accepted: 04/29/2023] [Indexed: 05/10/2023]
Abstract
A significant challenge limiting the comprehensive utilization of genomic medicine is the lack of timely access to genetics specialists. Although neurologists see patients for whom genetic testing should be considered, the knowledge regarding the choice of the optimal genetic test for each case and the management of the test results are out of the scope of their everyday practice. In this review, we provide a step-by-step guide for non-geneticist physicians through the decision-making process when ordering diagnostic genetic testing for monogenic neurological diseases and when dealing with their results.
Collapse
Affiliation(s)
- Avi Fellner
- The Neurogenetics Clinic, Raphael Recanati Genetics Institute, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.
| | - Yael Goldberg
- Raphael Recanati Genetics Institute, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Lina Basel-Salmon
- Raphael Recanati Genetics Institute, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Felsenstein Medical Research Center, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
3
|
Chiang J, Ngeow JYY. Challenges with mainstreaming genetic testing for metastatic prostate cancer treatment in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:111-113. [PMID: 38904487 DOI: 10.47102/annals-acadmedsg.202384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Affiliation(s)
- Jianbang Chiang
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Joanne Yuen Yie Ngeow
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| |
Collapse
|
4
|
Hutchcraft ML, Zhang S, Lin N, Gottschalk GL, Keck JW, Belcher EA, Sears C, Wang C, Liu K, Dietz LE, Pickarski JC, Wei S, Cardarelli R, DiPaola RS, Kolesar JM. Real-World Evaluation of a Population Germline Genetic Screening Initiative for Family Medicine Patients. J Pers Med 2022; 12:1297. [PMID: 36013246 PMCID: PMC9410316 DOI: 10.3390/jpm12081297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022] Open
Abstract
Hereditary factors contribute to disease development and drug pharmacokinetics. The risk of hereditary disease development can be attenuated or eliminated by early screening or risk reducing interventions. The purpose of this study was to assess the clinical utility of germline medical exome sequencing in patients recruited from a family medicine clinic and compare the mutation frequency of hereditary predisposition genes to established general population frequencies. At the University of Kentucky, 205 family medicine patients underwent sequencing in a Clinical Laboratory Improvement Amendments of 1988-compliant laboratory to identify clinically actionable genomic findings. The study identified pathogenic or likely pathogenic genetic variants-classified according to the American College of Medical Genetics and Genomics variant classification guidelines-and actionable pharmacogenomic variants, as defined by the Clinical Pharmacogenetics Implementation Consortium. Test results for patients with pharmacogenomic variants and pathogenic or likely pathogenic variants were returned to the participant and enrolling physician. Hereditary disease predisposition gene mutations in APOB, BRCA2, MUTYH, CACNA1S, DSC2, KCNQ1, LDLR, SCN5A, or SDHB were identified in 6.3% (13/205) of the patients. Nine of 13 (69.2%) underwent subsequent clinical interventions. Pharmacogenomic variants were identified in 76.1% (156/205) of patients and included 4.9% (10/205) who were prescribed a medication that had pharmacogenomic implications. Family physicians changed medications for 1.5% (3/205) of patients to prevent toxicity. In this pilot study, we found that with systemic support, germline genetic screening initiatives were feasible and clinically beneficial in a primary care setting.
Collapse
Affiliation(s)
- Megan Leigh Hutchcraft
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA
| | - Shulin Zhang
- Department of Pathology and Laboratory Medicine, University of Kentucky Chandler Medical Center, Lexington, KY 40536, USA
| | - Nan Lin
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY 40506, USA
| | - Ginny Lee Gottschalk
- Department of Family and Community Medicine, University of Kentucky Chandler Medical Center, Lexington, KY 40536, USA
| | - James W. Keck
- Department of Family and Community Medicine, University of Kentucky Chandler Medical Center, Lexington, KY 40536, USA
| | - Elizabeth A. Belcher
- Department of Clinical Research, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA
| | - Catherine Sears
- Department of Pathology and Laboratory Medicine, University of Kentucky Chandler Medical Center, Lexington, KY 40536, USA
| | - Chi Wang
- Shared Resource Facility, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA
- Division of Cancer Biostatistics, Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY 40506, USA
| | - Kun Liu
- Dr. Bing Zhang Department of Statistics, University of Kentucky, Lexington, KY 40536, USA
| | - Lauren E. Dietz
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY 40506, USA
| | | | - Sainan Wei
- Department of Pathology and Laboratory Medicine, University of Kentucky Chandler Medical Center, Lexington, KY 40536, USA
| | - Roberto Cardarelli
- Department of Family and Community Medicine, University of Kentucky Chandler Medical Center, Lexington, KY 40536, USA
| | - Robert S. DiPaola
- University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA
| | - Jill M. Kolesar
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY 40506, USA
| |
Collapse
|
5
|
Christian S, Tagoe J, Delday L, Bernier FP, Kohut R, Ferrier R. IMPACT webinars: Improving Patient Access to genetic Counselling and Testing using webinars-the Alberta experience with hypertrophic cardiomyopathy. J Community Genet 2022; 13:81-89. [PMID: 34766249 PMCID: PMC8582342 DOI: 10.1007/s12687-021-00564-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/03/2021] [Indexed: 11/20/2022] Open
Abstract
Growing demand for genetic counselling and testing has created a need for innovative service delivery models to provide quality care in an efficient manner. The goal of this study was to develop and evaluate a patient-facing webinar providing pre-test genetic counselling to individuals with hypertrophic cardiomyopathy. A patient-facing webinar was developed and implemented between April 2019 and January 2021. It was evaluated using the Alberta Quality Matrix for Health framework, which considers the patient experience across the domains of effectiveness, appropriateness, acceptability, accessibility, and efficiency. The webinar group showed comparable scores to controls with regard to self-perceived knowledge and decisional conflict. The majority of patients reported that the webinar met their expectations and was an acceptable replacement for a 1:1 genetic counselling appointment. Finally, the webinar reduced genetic counsellor time to an average of 24 min per patient. Providing pre-test genetic counselling to index hypertrophic cardiomyopathy patients via a group webinar has achieved a high quality of care, and optimized use of provider and space resources.
Collapse
Affiliation(s)
- Susan Christian
- Medical Genetics Clinic, Alberta Health Services, Edmonton, AB, Canada.
- Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada.
| | - Julia Tagoe
- Lethbridge Outreach Genetics Service, Alberta Health Services, Lethbridge, AB, Canada
| | - Lenore Delday
- Unified Communications Services, Alberta Health Services, Calgary, AB, Canada
| | - Francois P Bernier
- Clinical and Metabolic Genetics, Alberta Health Services South, Calgary, AB, Canada
- Department of Medical Genetics, University of Calgary, Calgary, AB, Canada
| | - Ruth Kohut
- Clinical and Metabolic Genetics, Alberta Health Services South, Calgary, AB, Canada
| | - Raechel Ferrier
- Clinical and Metabolic Genetics, Alberta Health Services South, Calgary, AB, Canada
| |
Collapse
|
6
|
Briggs MS, Ulses C, VanEtten L, Mansfield C, Ganim A, Hand BN, Quatman-Yates CC. Predictive Factors for Patients' Failure to Show for Initial Outpatient Physical Therapist Evaluation. Phys Ther 2021; 101:6124132. [PMID: 33528021 DOI: 10.1093/ptj/pzab047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/19/2020] [Accepted: 12/31/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The objective of this study was to examine primary factors that may predict patients' failure to show at initial physical therapist evaluation in an orthopedic and sports outpatient setting. METHODS A retrospective analysis of patients' demographic data for physical therapist evaluations between January 2013 and April 2015 was performed. A binary logistic regression model was used to evaluate the odds of a no-show at evaluation. Demographic variables of age, employment status, days waited for the appointment, payer source, and distance traveled to the clinic were analyzed. Independent variables were considered significant if the 95% CIs of the odds ratios (ORs) did not include 1.0. RESULTS A total of 6971 patients were included in the final analysis, with 10% (n = 698) of the scheduled patients having a no-show event for their initial evaluation. The following factors increased the odds of patients having a no-show event: days to appointment (OR = 1.058; 95% CI = 1.042-1.074), unemployment status (OR = 1.96; 95% CI = 1.41-2.73), unknown employment status (OR = 3.22; 95% CI = 1.12-8.69), Medicaid insurance (OR = 4.87; 95% CI = 3.43-6.93), Medicare insurance (OR = 2.22; 95% CI = 1.10-4.49), unknown payer source (OR = 262.84; 95% CI = 188.72-366.08), and distance traveled 8 or more kilometers (OR = 1.31; 95% CI = 1.01-1.70). Female sex (OR = 0.73; 95% CI = 0.57-0.95) and age 40 years or older (OR = 0.44; 95% CI = 0.33-0.60) decreased the odds of a no-show event. CONCLUSIONS Results from this study indicate there may be some demographic factors that are predictive of patients failing to attend their first physical therapist visit. IMPACT Understanding the predictive factors and identifying potential opportunities for improvements in scheduling processes might help decrease the number of patients failing to show for their initial physical therapy appointment, with the ultimate goal of positively influencing patient outcomes.
Collapse
Affiliation(s)
- Matthew S Briggs
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christine Ulses
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Lucas VanEtten
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Cody Mansfield
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,School of Health & Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Anthony Ganim
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brittany N Hand
- School of Health & Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Catherine C Quatman-Yates
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,School of Health & Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
7
|
Ebrahimzadeh JE, Long JM, Wang L, Nathanson JT, Siddique SM, Rustgi AK, Goldberg DS, Katona BW. Associations of sociodemographic and clinical factors with gastrointestinal cancer risk assessment appointment completion. J Genet Couns 2020; 29:616-624. [PMID: 32227561 PMCID: PMC7415544 DOI: 10.1002/jgc4.1254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/19/2020] [Accepted: 02/22/2020] [Indexed: 12/18/2022]
Abstract
Cancer risk assessment services are important for patient care; effective use requires appropriate provider referral, accurate scheduling processes, and completed attendance at booked appointments. Sociodemographic and clinical factors associated with gastrointestinal cancer (GIC)-specific risk assessment appointments remain unstudied; therefore, we aimed to identify factors associated with appointment completion in a GIC risk assessment program at a tertiary academic center. Retrospective chart review was conducted on all patients scheduled for an appointment in the Gastrointestinal Cancer Risk Evaluation Program (GI-CREP) between January 2016 and December 2017. Data collected included demographic and clinical factors. Chi-square and Wilcoxon's rank-sum tests compared variables among patients based on the study outcome of whether a GI-CREP appointment was completed; marginal standardization was used to predict the standardized percentage of patients that had appointment completion. A total of 676 patients had a scheduled GI-CREP appointment; 32 individuals were excluded due to incomplete information or scheduling error, resulting in 644 patients available for final analysis. Our study population was predominantly female (61%), White (77%), and married (64%), had private healthcare insurance (76%), and lacked a personal history of cancer (60%). Referrals internal to the healthcare system were most common (77%), with gastroenterologists as the most frequent referring provider (42%). Seventy-five percent of scheduled individuals had appointment completion, while 25% of individuals did not. Independent predictors for an incomplete GI-CREP appointment included Medicaid insurance (OR 2.45, 95% CI 1.21-4.28, p = .01), self-identified Black race (OR 1.97, 95% CI: 1.20-3.25, p = .008), and personal history of cancer (OR 1.60, 95% CI 1.11-2.31, p = .01). These data highlight existing disparities in GIC risk assessment appointment completion associated with race, health insurance coverage, and medical status. Further studies of these areas are necessary to ensure equitable access to important GIC risk assessment services.
Collapse
Affiliation(s)
- Jessica E. Ebrahimzadeh
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jessica M. Long
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Louise Wang
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - John T. Nathanson
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Shazia Mehmood Siddique
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Anil K. Rustgi
- Division of Digestive and Liver Diseases, Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - David S. Goldberg
- Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, Miami, FL
| | - Bryson W. Katona
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| |
Collapse
|
8
|
Marbouh D, Khaleel I, Al Shanqiti K, Al Tamimi M, Simsekler MCE, Ellahham S, Alibazoglu D, Alibazoglu H. Evaluating the Impact of Patient No-Shows on Service Quality. Risk Manag Healthc Policy 2020; 13:509-517. [PMID: 32581613 PMCID: PMC7280239 DOI: 10.2147/rmhp.s232114] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 03/23/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Patient no-shows are long-standing issues affecting resource utilization and posing risks to the quality of healthcare services. They also lead to loss of anticipated revenue, particularly in services where resources are expensive and in great demand. Methods In order to address common reasons why patients miss appointments, this study reviews the current literature and investigates various tools and methods that have been implemented to mitigate such issues. Further, a case study is conducted to identify the rate of no-shows and underlying causes at a radiology department in one of the leading hospitals in the MENA region. Results Our results show that the no-shows are high due to multiple factors, such as patient behavior, patients’ financial situation, environmental factors and scheduling policy. Conclusion In conclusion, we generate a list of recommendations that can help in reducing the rate of patient no-shows, such as patient education, application of dynamic scheduling policies and effective appointment reminder systems to patients.
Collapse
Affiliation(s)
- Dounia Marbouh
- Research Center of Digital Supply Chain and Operations, Department of Industrial and Systems Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Iman Khaleel
- Research Center of Digital Supply Chain and Operations, Department of Industrial and Systems Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Khawla Al Shanqiti
- Research Center of Digital Supply Chain and Operations, Department of Industrial and Systems Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Maryam Al Tamimi
- Research Center of Digital Supply Chain and Operations, Department of Industrial and Systems Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Mecit Can Emre Simsekler
- Research Center of Digital Supply Chain and Operations, Department of Industrial and Systems Engineering, Khalifa University, Abu Dhabi, United Arab Emirates.,School of Management, University College London, London, UK
| | - Samer Ellahham
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Deniz Alibazoglu
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Haluk Alibazoglu
- Imaging Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| |
Collapse
|
9
|
Chin XW, Ang ZLT, Tan RYC, Courtney E, Shaw T, Chen Y, Li S, Ngeow JYY. Use of telephone intake for family history taking at a cancer genetics service in Asia. J Genet Couns 2020; 29:1192-1199. [DOI: 10.1002/jgc4.1286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/30/2020] [Accepted: 04/04/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Xin Wei Chin
- Cancer Genetics Service Division of Medical Oncology National Cancer Centre Singapore City Singapore
| | - Zoe L. T. Ang
- Cancer Genetics Service Division of Medical Oncology National Cancer Centre Singapore City Singapore
| | - Ryan Y. C. Tan
- Cancer Genetics Service Division of Medical Oncology National Cancer Centre Singapore City Singapore
| | - Eliza Courtney
- Cancer Genetics Service Division of Medical Oncology National Cancer Centre Singapore City Singapore
| | - Tarryn Shaw
- Cancer Genetics Service Division of Medical Oncology National Cancer Centre Singapore City Singapore
| | - Yanni Chen
- Cancer Genetics Service Division of Medical Oncology National Cancer Centre Singapore City Singapore
| | - Shao‐Tzu Li
- Cancer Genetics Service Division of Medical Oncology National Cancer Centre Singapore City Singapore
| | - Joanne Yuen Yie Ngeow
- Cancer Genetics Service Division of Medical Oncology National Cancer Centre Singapore City Singapore
- Lee Kong Chian School of Medicine Nanyang Technological University Singapore City Singapore
| |
Collapse
|
10
|
Greenberg SE, Boothe E, Delaney CL, Noss R, Cohen SA. Genetic Counseling Service Delivery Models in the United States: Assessment of changes in use from 2010 to 2017. J Genet Couns 2020; 29:1126-1141. [DOI: 10.1002/jgc4.1265] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 02/21/2020] [Accepted: 02/22/2020] [Indexed: 12/12/2022]
Affiliation(s)
| | - Emily Boothe
- University of Mississippi Medical Center Jackson MS USA
| | | | | | | |
Collapse
|
11
|
Chiang J, Yuen J, Shaw T, Goh HX, Li ST, Courtney E, Ngeow J. Predictive Testing for Tumor Predisposition Syndromes in Pediatric Relatives: An Asian Experience. Front Pediatr 2020; 8:568528. [PMID: 33194895 PMCID: PMC7661469 DOI: 10.3389/fped.2020.568528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/08/2020] [Indexed: 11/17/2022] Open
Abstract
Approximately 10% of pediatric cancer patients possess germline pathogenic/likely pathogenic variants (PV/LPV) in known tumor predisposition genes. Predictive testing is the optimal approach to identify asymptomatic at-risk relatives to guide gene-directed surveillance for early cancer detection and/or risk-reducing strategies. However, the uptake rate for predictive testing remains low in Asian countries. We aim to evaluate the uptake rate of predictive testing in a pediatric population (aged under 21-years-old) in a multi-ethnic Asian cancer center. Our retrospective analysis included families with PV/LPVs identified in genes associated with pediatric tumor predisposition. Of the 83 pediatric first-degree relatives (FDRs) from 49 unrelated families, 20 FDRs (24.1%) originating from 13 families (26.6%) underwent predictive testing. Genes tested in pediatric FDRs were APC, RB1, SBDS, SDHA, SDHB, SDHD, and TP53. All pediatric FDRs of probands with PV/LPVs in RB1 and biallelic PVs in SBDS underwent predictive testing, while <45% of pediatric FDRs had predictive testing for familial PV/LPVs identified in the APC, SDHA, SDHB, SDHD, and TP53 genes. Amongst the 13 families who underwent pre-test counseling, 80% of pediatric FDRs in these families proceeded with predictive testing. Malay pediatric FDRs and siblings of probands were more likely to undergo predictive testing. We conclude that the predictive testing rate in pediatric FDRs is higher than that of adult FDRs in Asia, but still below the global average. We postulate factors that may influence predictive testing uptake in pediatric FDRs includes a lack of genetics awareness, concerns regarding insurance, and genetic discrimination.
Collapse
Affiliation(s)
- Jianbang Chiang
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Center Singapore, Singapore, Singapore
| | - Jeanette Yuen
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Center Singapore, Singapore, Singapore
| | - Tarryn Shaw
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Center Singapore, Singapore, Singapore
| | - Hui Xuan Goh
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Center Singapore, Singapore, Singapore
| | - Shao-Tzu Li
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Center Singapore, Singapore, Singapore
| | - Eliza Courtney
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Center Singapore, Singapore, Singapore
| | - Joanne Ngeow
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Center Singapore, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| |
Collapse
|
12
|
Shaw T, Ishak D, Lie D, Menon S, Courtney E, Li ST, Ngeow J. The influence of Malay cultural beliefs on breast cancer screening and genetic testing: A focus group study. Psychooncology 2018; 27:2855-2861. [PMID: 30264524 DOI: 10.1002/pon.4902] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/30/2018] [Accepted: 09/24/2018] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Malays comprise an Asian cultural group reported to have low breast cancer screening uptake rates and poor cancer outcomes. Little is known about Malay cultural factors influencing beliefs and practice of cancer screening and genetic testing. Our study aims to explore health beliefs of Malay women around breast cancer screening and genetic testing. METHODS We conducted focus groups among healthy English-speaking Malay women in Singapore, aged 40 to 69 years, using a structured guide developed through literature review, expertise input and participant refinement. Thematic analysis was conducted to extract dominant themes representing key motivators and barriers to screening and genetic testing. We used grounded theory to interpret results and derive a framework of understanding, with implications for improving uptake of services. RESULTS Five focus groups (four to six participants per group) comprising 27 women were conducted to theme saturation. Major themes were (a) spiritual and religious beliefs act as barriers towards uptake of screening and genetic testing; (b) preference for traditional medicine competes with Western medicine recommendations; (c) family and community influence health-related decisions, complexed by differences in intergenerational beliefs creating contrasting attitudes towards screening and prevention. CONCLUSIONS Decisions to participate in breast cancer screening and genetic testing are influenced by cultural, traditional, spiritual/religious, and intergenerational beliefs. Strategies to increase uptake should include acknowledgement and integration of these beliefs into counseling and education and collaboration with key influential Malay stakeholders and leaders.
Collapse
Affiliation(s)
- Tarryn Shaw
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre, Singapore
| | - Diana Ishak
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre, Singapore
| | - Désirée Lie
- Office of Clinical Sciences, Duke-NUS Medical School, Singapore
| | - Sapna Menon
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre, Singapore
| | - Eliza Courtney
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre, Singapore
| | - Shao-Tzu Li
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre, Singapore
| | - Joanne Ngeow
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore.,Institute of Molecular and Cell Biology, Agency for Science Technology and Research (A*Star), Singapore
| |
Collapse
|