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Lanjouw L, Mourits MJE, Bart J, Ter Elst A, Berger LPV, van der Hout AH, Alam N, de Bock GH. BRCA1/2 testing rates in epithelial ovarian cancer: a focus on the untested patients. Int J Gynecol Cancer 2023; 33:1260-1269. [PMID: 37137525 PMCID: PMC10423510 DOI: 10.1136/ijgc-2023-004307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/07/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Since 2015, Dutch guidelines have recommended BRCA1/2 pathogenic variant testing for all patients with epithelial ovarian cancer. Recently, recommendations shifted from germline testing to the tumor-first approach, in which tumor tissue is tested first, and subsequent germline testing is performed only in those with BRCA1/2 tumor pathogenic variants or a positive family history. Data on testing rates and on characteristics of patients missing out on testing remain scarce. OBJECTIVE To evaluate BRCA1/2 testing rates in patients with epithelial ovarian cancer and compare testing rates of germline testing (performed from 2015 until mid-2018) versus tumor-first testing (implemented mid-2018). METHODS A consecutive series of 250 patients diagnosed with epithelial ovarian cancer between 2016 and 2019 was included from the OncoLifeS data-biobank of the University Medical Center Groningen, the Netherlands. Testing rates were analyzed for the overall study population and for germline testing (period I) and tumor-first testing (period II) separately. Characteristics of tested and untested patients were compared and predictors for receiving testing were assessed with multivariable logistic regression. RESULTS Median age was 67.0 years (IQR 59.0-73.0) and 173 (69.2%) patients were diagnosed with high-grade serous carcinoma. Overall, 201 (80.4%) patients were tested. In period I, 137/171 (80.1%) patients were tested and in period II this was 64/79 (81.0%). Patients with non-high-grade serous carcinoma were significantly less likely to receive BRCA1/2 testing than patients with high-grade serous carcinoma (OR=0.23, 95% CI 0.11 to 0.46, p<0.001). CONCLUSIONS The results show that BRCA1/2 testing rates are suboptimal and suggest that clinicians may not be choosing to test patients with epithelial ovarian cancer with non-high-grade serous ovarian carcinoma, although guidelines recommend BRCA1/2 testing in all patients with epithelial ovarian cancer. Suboptimal testing rates limit optimization of care for patients with epithelial ovarian cancer and counseling of potentially affected relatives.
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Affiliation(s)
- Lieke Lanjouw
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Marian J E Mourits
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Joost Bart
- Department of Pathology and Medical Biology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Arja Ter Elst
- Department of Pathology and Medical Biology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Lieke P V Berger
- Department of Genetics, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Annemieke H van der Hout
- Department of Genetics, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Naufil Alam
- AstraZeneca Pharmaceuticals LP, Cambridge, UK
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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2
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Witjes VM, Ligtenberg MJL, Vos JR, Braspenning JCC, Ausems MGEM, Mourits MJE, de Hullu JA, Adang EMM, Hoogerbrugge N. The most efficient and effective BRCA1/2 testing strategy in epithelial ovarian cancer: Tumor-First or Germline-First? Gynecol Oncol 2023; 174:121-128. [PMID: 37182432 DOI: 10.1016/j.ygyno.2023.04.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/13/2023] [Accepted: 04/29/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVE Genetic testing in epithelial ovarian cancer (OC) is essential to identify a hereditary cause like a germline BRCA1/2 pathogenic variant (PV). An efficient strategy for genetic testing in OC is highly desired. We evaluated costs and effects of two strategies; (i) Tumor-First strategy, using a tumor DNA test as prescreen to germline testing, and (ii) Germline-First strategy, referring all patients to the clinical geneticist for germline testing. METHODS Tumor-First and Germline-First were compared in two scenarios; using real-world uptake of testing and setting implementation to 100%. Decision analytic models were built to analyze genetic testing costs (including counseling) per OC patient and per family as well as BRCA1/2 detection probabilities. With a Markov model, the life years gained among female relatives with a germline BRCA1/2 PV was investigated. RESULTS Focusing on real-world uptake, with the Tumor-First strategy more OC patients and relatives with a germline BRCA1/2 PV are detected (70% versus 49%), at lower genetic testing costs (€1898 versus €2502 per patient, and €2511 versus €2930 per family). Thereby, female relatives with a germline BRCA1/2 PV can live on average 0.54 life years longer with Tumor-First compared to Germline-First. Focusing on 100% uptake, the genetic testing costs per OC patient are substantially lower in the Tumor-First strategy (€2257 versus €4986). CONCLUSIONS The Tumor-First strategy in OC patients is more effective in identifying germline BRCA1/2 PV at lower genetic testing costs per patient and per family. Optimal implementation of Tumor-First can further improve detection of heredity in OC patients.
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Affiliation(s)
- Vera M Witjes
- Department of Human Genetics, Radboud university medical center, Nijmegen, the Netherlands; Research Institute for Medical Innovation, Radboud university medical center, Nijmegen, the Netherlands
| | - Marjolijn J L Ligtenberg
- Department of Human Genetics, Radboud university medical center, Nijmegen, the Netherlands; Research Institute for Medical Innovation, Radboud university medical center, Nijmegen, the Netherlands; Department of Pathology, Radboud university medical center, Nijmegen, the Netherlands
| | - Janet R Vos
- Department of Human Genetics, Radboud university medical center, Nijmegen, the Netherlands; Research Institute for Medical Innovation, Radboud university medical center, Nijmegen, the Netherlands
| | - Jozé C C Braspenning
- Research Institute for Medical Innovation, Radboud university medical center, Nijmegen, the Netherlands; Department of IQ Healthcare, Radboud university medical center, Nijmegen, the Netherlands
| | - Margreet G E M Ausems
- Department of Genetics, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marian J E Mourits
- Department of Gynecology, University Medical Center Groningen, Groningen, the Netherlands
| | - Joanne A de Hullu
- Research Institute for Medical Innovation, Radboud university medical center, Nijmegen, the Netherlands; Department of Obstetrics and Gynecology, Radboud university medical center, Nijmegen, the Netherlands
| | - Eddy M M Adang
- Research Institute for Medical Innovation, Radboud university medical center, Nijmegen, the Netherlands; Department for Health Evidence, Radboud university medical center, Nijmegen, the Netherlands
| | - Nicoline Hoogerbrugge
- Department of Human Genetics, Radboud university medical center, Nijmegen, the Netherlands; Research Institute for Medical Innovation, Radboud university medical center, Nijmegen, the Netherlands.
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Lee SS, Rajeev P, Finning S, Oh C, Pothuri B. Missed opportunities in the real-world genetic testing in BRCA gene variant carriers with cancers meeting NCCN criteria. Gynecol Oncol 2023; 170:32-37. [PMID: 36610379 DOI: 10.1016/j.ygyno.2022.12.015] [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: 10/30/2022] [Revised: 12/23/2022] [Accepted: 12/25/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The objective of this study was to determine the proportion of patients meeting the National Comprehensive Cancer Network (NCCN)'s BRCA genetic testing criteria prior to a diagnosis of a BRCA-related cancer. METHODS This was a cross-sectional study of patients with BRCA pathogenic variants and a diagnosis of a BRCA-related cancer. Patients were included if they had known dates of genetic testing and cancer diagnosis. NCCN criteria (version 2.2021) were applied to determine if patients met criteria for testing before a BRCA-related cancer diagnosis. The outcome of interest was the proportion of patients undergoing genetic testing following a diagnosis of a BRCA-related cancer who qualified for genetic testing based on NCCN criteria. Chi-square, Mann-Whitney U test, and logistic regression were performed with significance at p < 0.05. RESULTS Of 270 patients with a BRCA-related cancer, 229 (85%) underwent genetic testing after a cancer diagnosis. Most patients (97%) met at least one NCCN criteria for BRCA testing; 166 (73%) of patients who were tested following a BRCA-related cancer diagnosis also met the criteria for testing by family history. Publicly insured or uninsured patients were three times more likely to undergo BRCA testing after a diagnosis of cancer (odds ratio [OR] 3.03, 95% confidence interval [CI] 1.09-8.40). Patients with a family history of pathogenic variants were more likely to undergo testing before a cancer diagnosis (OR 0.10, 95% CI 0.05-0.23). CONCLUSION Most patients with BRCA-associated cancers undergo genetic testing after their cancer diagnosis. Increased education on genetic testing criteria and novel methods to improve testing are desperately needed.
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Affiliation(s)
- Sarah S Lee
- New York University Langone Health, Department of Obstetrics and Gynecology, New York, NY, USA; New York University Langone Health, Department of Medicine, New York, NY, USA
| | - Pournami Rajeev
- New York University Grossman School of Medicine, New York, NY, USA
| | - Skyler Finning
- New York University Langone Health, Department of Obstetrics and Gynecology, New York, NY, USA
| | - Cheongeun Oh
- New York University Langone Health, Department of Population Health, New York, NY, USA
| | - Bhavana Pothuri
- New York University Langone Health, Department of Obstetrics and Gynecology, New York, NY, USA; New York University Langone Health, Department of Medicine, New York, NY, USA.
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Espinoza Moya ME, Guertin JR, Dorval M, Lapointe J, Bouchard K, Nabi H, Laberge M. Examining interprofessional collaboration in oncogenetic service delivery models for hereditary cancers: a scoping review protocol. BMJ Open 2022; 12:e066802. [PMID: 36523215 PMCID: PMC9748975 DOI: 10.1136/bmjopen-2022-066802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION In a context of limited genetic specialists, collaborative models have been proposed to ensure timely access to high quality oncogenetic services for individuals with inherited cancer susceptibility. Yet, extensive variability in the terminology used and lack of a clear understanding of how interprofessional collaboration is operationalised and evaluated currently constrains the development of a robust evidence base on the value of different approaches used to optimise access to these services. To fill in this knowledge gap, this scoping review aims to systematically unpack the nature and extent of collaboration proposed by these interventions, and synthesise the evidence available on their implementation, effectiveness and economic impact. METHODS AND ANALYSIS Following the Joanna Briggs Institute guidelines for scoping reviews, a comprehensive literature search will be conducted to identify peer-reviewed and grey literature on collaborative models used for adult patients with, or at increased risk of, hereditary breast, ovarian, colorectal and prostate cancers. An initial search was developed for Medline, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane and Web of Science on 13 June 2022 and will be complemented by searches in Google and relevant websites. Documents describing either the theory of change, planning, implementation and/or evaluation of these interventions will be considered for inclusion. Results will be summarised descriptively and used to compare relevant model characteristics and synthesise evidence available on their implementation, effectiveness and economic impact. This process is expected to guide the development of a definition and typology of collaborative models in oncogenetics that could help strengthen the knowledge base on these interventions. Moreover, because we will be mapping the existing evidence on collaborative models in oncogenetics, the proposed review will help us identify areas where additional research might be needed. ETHICS AND DISSEMINATION This research does not require ethics approval. Results from this review will be disseminated through peer-reviewed articles and conferences.
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Affiliation(s)
- Maria Eugenia Espinoza Moya
- Population Health and Optimal Health Practices Unit, Centre de Recherche du Centre hospitalier universitaire (CHU) de Québec-Université Laval, Quebec City, Quebec, Canada
- Département des opérations et systèmes de décision, Faculté des sciences de l'administration, Université Laval, Quebec City, Quebec, Canada
| | - Jason Robert Guertin
- Population Health and Optimal Health Practices Unit, Centre de Recherche du Centre hospitalier universitaire (CHU) de Québec-Université Laval, Quebec City, Quebec, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Michel Dorval
- Oncology Division, Centre de Recherche du CHU de Québec-Université Laval, Quebec City, Quebec, Canada
- Faculty of Pharmacy, Université Laval, Quebec City, Quebec, Canada
- CISSS, Chaudière-Appalaches Research Center, Lévis, Québec, Canada
| | - Julie Lapointe
- Oncology Division, Centre de Recherche du CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Karine Bouchard
- Département de cancérologie, CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Hermann Nabi
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- Oncology Division, Centre de Recherche du CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Maude Laberge
- Population Health and Optimal Health Practices Unit, Centre de Recherche du Centre hospitalier universitaire (CHU) de Québec-Université Laval, Quebec City, Quebec, Canada
- Département des opérations et systèmes de décision, Faculté des sciences de l'administration, Université Laval, Quebec City, Quebec, Canada
- Vitam, Centre de recherche en santé durable, Laval University, Quebec City, Quebec, Canada
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Bokkers K, Frederix GWJ, Velthuizen ME, van der Aa M, Gerestein CG, van Dorst EBL, Lange JG, Louwers JA, Koole W, Zweemer RP, Ausems MGEM. Mainstream germline genetic testing for patients with epithelial ovarian cancer leads to higher testing rates and a reduction in genetics-related healthcare costs from a healthcare payer perspective. Gynecol Oncol 2022; 167:115-122. [PMID: 36031452 DOI: 10.1016/j.ygyno.2022.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/26/2022] [Accepted: 08/11/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Germline genetic testing is increasingly offered to patients with epithelial ovarian cancer by non-genetic healthcare professionals, so called mainstream genetic testing. The aim of this study was to evaluate the effect of implementing a mainstream genetic testing pathway on the percentage of newly diagnosed patients with epithelial ovarian cancer to whom genetic testing was offered and the genetics-related healthcare costs. METHODS The possible care pathways for genetic counseling and testing and their associated costs were mapped. Patient files from all newly diagnosed patients with epithelial ovarian cancer before (March 2016 - September 2017) and after (April 2018 - December 2019) implementing our mainstream genetic testing pathway were analyzed. Based on this analysis, the percentage of newly diagnosed patients to whom genetic testing was offered was assessed and genetics-related healthcare costs were calculated using a healthcare payer perspective based on a Diagnosis-Related Group financing approach. RESULTS Within six months after diagnosis, genetic testing was offered to 56% of patients before and to 70% of patients after implementation of our mainstream genetic testing pathway (p = 0.005). Genetics-related healthcare costs decreased from €3.511,29 per patient before implementation to €2.418,41 per patient after implementation of our mainstream genetic testing pathway (31% reduction, p = 0.000). CONCLUSION This study shows that mainstream genetic testing leads to a significantly higher proportion of newly diagnosed patients with epithelial ovarian cancer being offered germline genetic testing. In addition, it significantly reduces genetics-related healthcare costs per patient.
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Affiliation(s)
- K Bokkers
- Division Laboratories, Pharmacy and Biomedical Genetics, Dept. of Genetics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - G W J Frederix
- Division Laboratories, Pharmacy and Biomedical Genetics, Dept. of Genetics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CX Utrecht, the Netherlands
| | - M E Velthuizen
- Division Laboratories, Pharmacy and Biomedical Genetics, Dept. of Genetics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - M van der Aa
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands
| | - C G Gerestein
- Department of Gynecological Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Department of Gynecology, Meander Medical Center, Maatweg 3, 3813 TZ Amersfoort, the Netherlands
| | - E B L van Dorst
- Department of Gynecological Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - J G Lange
- Department of Gynecology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, the Netherlands
| | - J A Louwers
- Department of Gynecology, Diakonessenhuis, Bosboomstraat 1, 3582 KE Utrecht, the Netherlands
| | - W Koole
- Division Laboratories, Pharmacy and Biomedical Genetics, Dept. of Genetics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - R P Zweemer
- Department of Gynecological Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - M G E M Ausems
- Division Laboratories, Pharmacy and Biomedical Genetics, Dept. of Genetics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
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Rahman B, McEwen A, Phillips JL, Tucker K, Goldstein D, Jacobs C. Genetic and genomic learning needs of oncologists and oncology nurses in the era of precision medicine: a scoping review. Per Med 2022; 19:139-153. [PMID: 35060769 DOI: 10.2217/pme-2021-0096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Genetic and genomic data are increasingly guiding clinical care for cancer patients. To meet the growing demand for precision medicine, patient-facing oncology staff will be a part of leading the provision of genomic testing. A scoping review was undertaken to identify the range of genetic and genomic learning needs of oncologists and oncology nurses. Learning needs were reported relating to interpretation of genomic data, clinical decision-making, patient communication and counseling, and fundamentals of genetics and genomics. There was a lack of empirical research specific to oncology nurses and their learning needs in tumor sequencing. Our findings suggest that oncologists and oncology nurses need tailored support, education and training to improve their confidence and skills in adopting genomic testing into clinical practice.
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Affiliation(s)
- Belinda Rahman
- Graduate School of Health, University of Technology Sydney, NSW, Australia
| | - Alison McEwen
- Graduate School of Health, University of Technology Sydney, NSW, Australia
| | - Jane L Phillips
- School of Nursing, Faculty of Health, Queensland University of Technology, QLD, Australia.,IMPACCT, University of Technology Sydney, NSW, Australia
| | - Katherine Tucker
- Hereditary Cancer Centre, Prince of Wales Hospital, NSW, Australia.,Prince of Wales Clinical School, University of New South Wales, NSW, Australia
| | - David Goldstein
- Prince of Wales Clinical School, University of New South Wales, NSW, Australia
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, NSW, Australia
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Positive experiences of healthcare professionals with a mainstreaming approach of germline genetic testing for women with ovarian cancer. Fam Cancer 2021; 21:295-304. [PMID: 34617209 PMCID: PMC9203381 DOI: 10.1007/s10689-021-00277-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/28/2021] [Indexed: 12/24/2022]
Abstract
According to current guidelines, all women with epithelial ovarian cancer are eligible for genetic testing for BRCA germline pathogenic variants. Unfortunately, not all affected women are tested. We evaluated the acceptability and feasibility for non-genetic healthcare professionals to incorporate germline genetic testing into their daily practice. We developed and implemented a mainstreaming pathway, including a training module, in collaboration with various healthcare professionals and patient organizations. Healthcare professionals from 4 different hospitals were invited to participate. After completing the training module, gynecologic oncologists, gynecologists with a subspecialty training in oncology, and nurse specialists discussed and ordered genetic testing themselves. They received a questionnaire before completing the training module and 6 months after working according to the new pathway. We assessed healthcare professionals’ attitudes, perceived knowledge, and self-efficacy, along with the feasibility of this new mainstream workflow in clinical practice, and evaluated the use and content of the training module. The participation rate for completing the training module was 90% (N = 19/21). At baseline and after 6 months, healthcare professionals had a positive attitude, high perceived knowledge and high self-efficacy toward discussing and ordering genetic testing. Knowledge had increased significantly after 6 months. The training module was rated with an average of 8.1 out of 10 and was considered useful. The majority of healthcare professionals (9/15) was able to discuss a genetic test in five to 10 min. After completion of a training module, non-genetic healthcare professionals feel motivated and competent to discuss and order genetic testing themselves.
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BRCA1/2 Molecular Assay for Ovarian Cancer Patients: A Survey through Italian Departments of Oncology and Molecular and Genomic Diagnostic Laboratories. Diagnostics (Basel) 2019; 9:diagnostics9040146. [PMID: 31600986 PMCID: PMC6963957 DOI: 10.3390/diagnostics9040146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/04/2019] [Accepted: 10/04/2019] [Indexed: 12/15/2022] Open
Abstract
In Italy, 5200 new ovarian cancers were diagnosed in 2018, highlighting an increasing need to test women for BRCA1/2. The number of labs offering this test is continuously increasing. The aim of this study was to show the results coming from the intersociety survey coordinated by four different Clinical and Laboratory Italian Scientific Societies (AIOM, SIAPEC-IAP, SIBIOC, and SIGU). A multidisciplinary team belonging to the four scientific societies drew up two different questionnaires: One was targeted toward all Italian Departments of Medical Oncology, and the second toward laboratories of clinical molecular biology. This survey was implemented from September 2017 to March 2018. Seventy-seven out of 305 (25%) Departments of Medical Oncology filled our survey form. Indeed, 59 molecular laboratories were invited. A total of 41 laboratories (70%) filled in the questionnaire. From 2014 to 2017, 16 new molecular laboratories were activated. A total of 12,559 tests were performed in the year 2016, with a mean of 339 tests and a median of 254 tests per laboratory, showing a glimpse of an extreme low number of tests performed per year by some laboratories. In terms of the type and number of professionals involved in the pre- and post-test counseling, results among the onco-genetic team were heterogeneous. Our data show that the number of laboratories providing BRCA1/2 germline assays is significantly increased with further implementation of the somatic test coming soon. The harmonization of the complete laboratory diagnostic path should be encouraged, particularly in order to reduce the gap between laboratories with high and low throughput.
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Hoskins P, Eccleston A, Hurry M, Dyer M. Targeted surgical prevention of epithelial ovarian cancer is cost effective and saves money in BRCA mutation carrying family members of women with epithelial ovarian cancer. A Canadian model. Gynecol Oncol 2019; 153:87-91. [PMID: 30704745 DOI: 10.1016/j.ygyno.2019.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/18/2019] [Accepted: 01/20/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Survival but not cure rates have improved for epithelial ovarian cancer (EOC), demonstrating the need for effective prevention. Targeted prevention in BRCA carriers by risk reducing surgery (RRS) prevents 80% of cases but incurs additional up-front costs, compensated for by the potential for long term savings from treatment avoidance. Does prevention represent value for money? In the absence of long-term data from prospective trials, determining the cost effectiveness of a prevention strategy requires economic modelling. METHODS A patient level simulation was developed comparing outcomes between two groups, using Canadian data. Group 1: no mutation testing with treatment if EOC developed. Group 2: cascade testing (index patient BRCA tested and the first and second-degree relatives tested if index patient or first-degree relative respectively were positive) with RRS in carriers. End points were Incremental Cost-Effectiveness Ratio (ICER) and budget impact. RESULTS 2786 women with EOC (1 year incidence) had 766 first and 207 second-degree female relatives. BRCA mutations were present in 390 index cases, 366 first and 49 second-degree relatives. With 100% RRS uptake, 59 EOC were prevented and testing dominated no testing (more effective and less costly; ICER -$8919). The total cost saving over 50 years was $2,904,486 (cost saving of $9,660,381 in treatment costs versus increased cost from cascade testing/RRS of $6,755,895). At a threshold of $100,000 per QALY, prevention was cost effective in all modelled scenarios. CONCLUSIONS Targeted prevention in BRCA mutation carriers not only prevents EOC but is cost-effective compared to treating EOC if it develops.
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Affiliation(s)
- Paul Hoskins
- BC Cancer, Department of Medical Oncology, Vancouver, Canada.
| | | | - Manjusha Hurry
- AstraZeneca, Health Economics, Mississauga, Ontario, Canada
| | - Matthew Dyer
- AstraZeneca, Health Economics, Cambridge, United Kingdom
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Cohen SA, Bradbury A, Henderson V, Hoskins K, Bednar E, Arun BK. Genetic Counseling and Testing in a Community Setting: Quality, Access, and Efficiency. Am Soc Clin Oncol Educ Book 2019; 39:e34-e44. [PMID: 31099680 DOI: 10.1200/edbk_238937] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
There is an increasing need for genetic counseling and testing for individuals diagnosed with cancer, as treatment may be affected by the results. In addition, the identification of individuals before a diagnosis of cancer allows for optimal surveillance and early detection and prevention of cancer. With the recognition that as much as 10% of all cancers are hereditary, there is a growing need to improve access to genetic counseling and genetic testing, both before and at the time of diagnosis. This article focuses on models of identifying at-risk patients, including underserved communities; providing genetic counseling and testing in community practices; using telehealth; and collaborating with nongenetics health care providers and technological solutions to maximize efficiency and access.
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Affiliation(s)
- Stephanie A Cohen
- 1 Cancer Genetics Risk Assessment Program, Ascension St. Vincent, Indianapolis, IN
| | - Angela Bradbury
- 2 Department of Medicine, Division of Hematology-Oncology, Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA
| | | | - Kent Hoskins
- 3 The University of Illinois at Chicago, Chicago, IL
| | - Erica Bednar
- 4 The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Banu K Arun
- 4 The University of Texas MD Anderson Cancer Center, Houston, TX
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Reed NS, Symonds RP. Ovarian Cancer. Clin Oncol (R Coll Radiol) 2018; 30:461-462. [PMID: 29935926 DOI: 10.1016/j.clon.2018.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 12/18/2022]
Affiliation(s)
- N S Reed
- Department of Clinical Oncology, Beatson Oncology Centre, Glasgow, UK.
| | - R P Symonds
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
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