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Hafez SH, Mohammed NA, A Alshehri A, Khalid Hussein M, Saad Abdullah Alwadei H, Eltaher Hamed Abdulrahman E, Ramadan Elrefaey S, Elhaj Alawad A, Elradhi Abdulrahman N, Saied Harfoush M. Exploring Public Knowledge, Attitudes, and Barriers to Using Genetic Services in Damanhur City and Beni-Suef City, Egypt: A Cross-Sectional Study. Cureus 2024; 16:e57171. [PMID: 38681307 PMCID: PMC11056030 DOI: 10.7759/cureus.57171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Advancements in genetic disorder management mark a transformative era in healthcare. This study aimed to assess knowledge, attitudes, and barriers to using genetic services among the Egyptian population. METHODS A cross-sectional study was used to achieve the aim of the study. A convenient sample was used to involve 385 residents of Damanhur City and Beni-Suef City to represent Upper and Lower Egypt. A validated questionnaire covering socio-demographic details, genetic knowledge, attitudes, and perceived barriers to using genetic services was used. RESULTS Regarding genetic knowledge, 70.9% of the participants reported an unsatisfactory level of knowledge about genetics. Furthermore, 67.6% expressed a negative attitude toward genetic services. Concerns about whether the test result is positive were the most common obstacle, cited by 64.94% of participants, followed by cost, which 60.78% of people found to be a major barrier. Significant associations emerge between socio-demographic factors and awareness levels. CONCLUSION The findings illuminate significant gaps in knowledge and attitude levels where less than a third of the participants had a satisfactory level of knowledge and about one-third had a positive attitude regarding genetic testing. Barriers such as concerns about treatment strategies, financial constraints, and conflict with personal beliefs emerge as critical obstacles. The identified associations between socio-demographic factors and awareness levels underscore the need for targeted interventions tailored to specific demographic groups. RECOMMENDATIONS This study recommends developing and implementing culturally sensitive awareness campaigns about genetics tailored to the specific demographic characteristics of the Egyptian population.
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Affiliation(s)
- Sameer H Hafez
- Community Health Nursing, Beni-Suef University, Beni-Suef, EGY
| | - Noha A Mohammed
- Community Health Nursing, Beni-Suef University, Beni-Suef, EGY
| | - Ahmad A Alshehri
- Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, Najran University, Najran, SAU
| | | | | | | | - Samah Ramadan Elrefaey
- Psychiatric and Mental Health Nursing, Faculty of Nursing, Benha University, Benha, EGY
- Community and Mental Health Nursing, Faculty of Nursing, Najran University, Najran, SAU
| | | | | | - Mohamed Saied Harfoush
- Community Health Nursing, Faculty of Nursing, Damanhour University, Damanhour, EGY
- Nursing, Buraydah College for Applied Medical Sciences, Buraydah, SAU
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Bilenduke E, Dwyer AJ, Staples ES, Kilbourn K, Valverde PA, Fernández ME, Risendal BC. A practical method for integrating community priorities in planning and implementing cancer control programs. Cancer Causes Control 2023; 34:113-123. [PMID: 37069456 PMCID: PMC10110487 DOI: 10.1007/s10552-023-01688-w] [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: 11/07/2022] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE Community engagement is essential in effective public health programs. This paper illustrates the methods used to engage community in the development of a multi-level implementation intervention to address cancer disparities related to hereditary cancer syndromes. METHODS Implementation Mapping (IM), was used to guide the co-creation of an intervention. Key partners were recruited to a 13-member statewide community advisory board (CAB) representing healthcare and community-based organizations. As part of a needs assessment, a 3-round modified Delphi method with the CAB was used to identify implementation outcomes to use in later steps of IM. An anonymous online survey of a validated community engagement measure assessed CAB members' satisfaction with the process. RESULTS Using a modified Delphi method as part of the needs assessment of IM, the CAB identified three broad categories of strategies: Changing infrastructure using patient navigation; training and educating patients, navigators and providers; and supporting clinicians in case identification and management. Self-reported satisfaction with the IM and Delphi process was high. CONCLUSIONS Implementation Mapping facilitated the use of available evidence, new data, and community engagement to identify strategies to improve the delivery of programs to reduce hereditary cancer disparities. The modified Delphi method was easy to administer in a virtual environment and may be a useful for others in community-engaged research.
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Affiliation(s)
- Emily Bilenduke
- Department of Psychology, University of Colorado Denver, Denver, CO, USA.
| | - Andrea J Dwyer
- Department of Community and Behavioral Health, School of Public Health, University of Colorado, Aurora, CO, USA
| | - Elsa S Staples
- Department of Community and Behavioral Health, School of Public Health, University of Colorado, Aurora, CO, USA
| | - Kristin Kilbourn
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Patricia A Valverde
- Department of Community and Behavioral Health, School of Public Health, University of Colorado, Aurora, CO, USA
| | - Maria E Fernández
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Betsy C Risendal
- Department of Community and Behavioral Health, School of Public Health, University of Colorado, Aurora, CO, USA
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Mapoko BSE, Ndi KC, Tabola L, Mouaye V, Douanla P, Nsangou N, Nkeng G, Vanvolkenburgh C, Dzekem B, Huo D, Ndom P, Olopade O. Feasibility of cancer genetic counselling and screening in Cameroon: perceived benefits and barriers. Ecancermedicalscience 2023; 17:1588. [PMID: 37799957 PMCID: PMC10550300 DOI: 10.3332/ecancer.2023.1588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Indexed: 10/07/2023] Open
Abstract
Because there was no genetic testing service in Cameroon, we assessed the acceptance, perceived benefits and barriers and willingness to pay for genetic cancer screening in Cameroon amongst patients with cancers. We carried out a hospital-based, cross-sectional study on adult cancer patients at the Yaoundé General Hospital and the non-Governmental Organisation Solidarity Chemotherapy between February 1, 2021, and December 31, 2021. This was a convenience sampling that included all consenting patients. Qualitative and quantitative data were analysed by Epi info version 7 and SPSS version 20. Our study included 160 (87.5% females) cancer patients, whose ages ranged from 20 to 82 years, with a mean of 49.9 ± 13.0 years. Only 11.9% had undergone some form of genetic counselling or information sessions, and most found this to be helpful in terms of increased knowledge and prevention strategies (13, 68.4%). Almost all participants (156, 97.5%) stated they will like their relatives to undergo genetic counselling. Of these, 151 (94.4%) expressed their desire for their relatives to discuss their cancer risk with a specialist. Perceived benefits of genetic testing included cancer prevention (108, 67.5%) and motivation of self-examination (81, 50.6%). Prominent possible barriers included the cost (129, 80.6%), unavailability of equipment (49, 30.6%) and anticipated anxiety (40, 25.0%). However, a majority of the participants (156, 97.5%) were willing to test for genetic mutations. One hundred and thirty-five (84.4%) participants were willing to pay for genetic testing, with the majority of them (71.8%) ready to pay between $16.7 and $100. Almost all of the participants expressed their willingness to receive cancer genetic counselling and testing but the cost became the main barrier. This pilot study will serve as a guide to the processes of establishing a cancer risk assessment clinic in Cameroon.
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Affiliation(s)
- Berthe Sabine Esson Mapoko
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé 99322, Cameroon
- National Cancer Control Committee, Yaoundé 99322, Cameroon
| | - Kenn Chi Ndi
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé 99322, Cameroon
| | - Lionel Tabola
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé 99322, Cameroon
| | - Vanessa Mouaye
- National Cancer Control Committee, Yaoundé 99322, Cameroon
| | - Pelagie Douanla
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé 99322, Cameroon
| | - Nasser Nsangou
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé 99322, Cameroon
| | - Glenda Nkeng
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé 99322, Cameroon
| | - Carmen Vanvolkenburgh
- Center for Global Health, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Bonaventure Dzekem
- Center for Global Health, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Dezheng Huo
- Center for Global Health, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Paul Ndom
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé 99322, Cameroon
- National Cancer Control Committee, Yaoundé 99322, Cameroon
| | - Olufunmilayo Olopade
- Center for Global Health, University of Chicago Medical Center, Chicago, IL 60637, USA
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Adejumo PO, Aniagwu TIG, Awolude OA, Adedokun B, Kochheiser M, Sowunmi A, Popoola A, Ojengbede O, Huo D, Olopade OI. Cancer Genetic Services in a Low- to Middle-Income Country: Cross-Sectional Survey Assessing Willingness to Undergo and Pay for Germline Genetic Testing. JCO Glob Oncol 2023; 9:e2100140. [PMID: 36854077 PMCID: PMC10166413 DOI: 10.1200/go.21.00140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
PURPOSE Cancer genetic testing (CGT), a pathway to personalized medicine, is also being embraced in Nigeria. However, little is known about the influence of demographics and perceptions on individuals' willingness to access and pay for CGT. This study assessed patients' willingness to undergo CGT in southwest Nigeria as a catalyst for sustainable Cancer Risk Management Program. METHODS This was a cross-sectional study using semistructured questionnaire to interview 362 patients with cancer and 10 referred first-degree relatives between July 2018 and February 2020. Participants from three Nigerian teaching hospitals-University College Hospital, Ibadan, Lagos State University Teaching Hospital, Lagos, and Lagos University Teaching Hospital, Lagos, received genetic counseling and had subsequent CGT. Primary outcomes were willingness to undergo CGT in determining cancer risk and the willingness to pay for it. Ethical approval was from appropriate ethics committees of participating hospitals. Data were analyzed with SPSS version 22. Univariate comparison of categorical variables was performed by χ2 test, multivariate analysis by logistic regression. RESULTS The participants from University College Hospital (56.2%), Lagos State University Teaching Hospital (26.3%), and Lagos University Teaching Hospital (17.5%) were mostly female (98.4%). Mean age was 48.8 years ± 11.79. Three hundred twenty-two (86.6%) patients and first-degree relatives were willing to take the test, of whom 231 (71.1%) were willing to pay for it. more than half (53.6%) of the participants were willing to pay between N10,000 and N30,000, which is less than $100 US dollars. Sociodemographic variables and willingness to test showed no association (P > .05). Education and ethnicity were found to be associated with their willingness to pay for CGT (P ≤ .05). CONCLUSION Learning clinically relevant details toward cancer prevention informs health-related decisions in patients and relatives, a motivator for willingness to pay for genetic testing in low- and middle-income countries. Increased awareness may influence outcomes of cancer risk management.
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Affiliation(s)
- Prisca O Adejumo
- Department of Nursing, College of Medicine, University of Ibadan, Nigeria
| | - Toyin I G Aniagwu
- School of Occupational Health Nursing, University College Hospital, Ibadan, Nigeria
| | - Olutosin A Awolude
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Oyo, Nigeria
| | - Babatunde Adedokun
- Center for Clinical Cancer Genetics & Global Health, Department of Medicine, The University of Chicago, Chicago, IL
| | - Makayla Kochheiser
- Center for Clinical Cancer Genetics & Global Health, Department of Medicine, The University of Chicago, Chicago, IL
| | | | | | - Oladosu Ojengbede
- Center for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Dezheng Huo
- Department of Public Health Sciences, The University of Chicago, Chicago, IL
| | - Olufunmilayo I Olopade
- Center for Clinical Cancer Genetics & Global Health, Department of Medicine, The University of Chicago, Chicago, IL
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LILLEY CULLENM, DELILLE MINERVE, MIRZA KAMRANM, PARILLA MEGAN. Toward a More Just System of Care in Molecular Pathology. Milbank Q 2022; 100:1192-1242. [PMID: 36454130 PMCID: PMC9836258 DOI: 10.1111/1468-0009.12587] [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: 02/02/2022] [Revised: 05/09/2022] [Accepted: 06/23/2022] [Indexed: 12/02/2022] Open
Abstract
Policy Points American health care policy must be critically assessed to establish the role it plays in sustaining and alleviating the health disparities that currently exist in molecular genetic testing. It is critical to understand the economic and sociocultural influences that drive patients to undergo or forgo molecular testing, especially in marginalized patient populations. A multipronged solution with actions necessary from multiple stakeholders is required to reduce the cost of health care, rebalance regional disparities, encourage physician engagement, reduce data bias, and earn patients' trust. CONTEXT The health status of a population is greatly influenced by both biological processes and external factors. For years, minority and low socioeconomic patient populations have faced worse outcomes and poorer health in the United States. Experts have worked extensively to understand the issues and find solutions to alleviate this disproportionate burden of disease. As a result, there have been some improvements and successes, but wide gaps still exist. Diagnostic molecular genetic testing and so-called personalized medicine are just now being integrated into the current American health care system. The way in which these tests are integrated can either exacerbate or reduce health disparities. METHODS We provide case scenarios-loosely based on real-life patients-so that nonexperts can see the impacts of complex policy decisions and unintentional biases in technology without needing to understand all the intricacies. We use data to explain these findings from an extensive literature search examining both peer-reviewed and gray literature. FINDINGS Access to diagnostic molecular genetic testing is not equitable or sufficient, owing to at least five major factors: (1) cost to the patient, (2) location, (3) lack of provider buy-in, (4) data-set bias, and (5) lack of public trust. CONCLUSIONS Molecular genetic pathology can be made more equitable with the concerted efforts of multiple stakeholders. Confronting the five major factors identified here may help us usher in a new era of precision medicine without its discriminatory counterpart.
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Affiliation(s)
| | | | - KAMRAN M. MIRZA
- Loyola University Chicago, Strich School of Medicine
- Loyola Medical Center
| | - MEGAN PARILLA
- Loyola University Chicago, Strich School of Medicine
- Loyola Medical Center
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Moretz C, Byfield SD, Hatchell KE, Dalton J, Onglao PN, Hang L, Hansen P, Radford C, Nielsen SM, Heald B, Munro SB, Nussbaum RL, Esplin ED. Comparison of Germline Genetic Testing Before and After a Medical Policy Covering Universal Testing Among Patients With Colorectal Cancer. JAMA Netw Open 2022; 5:e2238167. [PMID: 36279135 PMCID: PMC9593236 DOI: 10.1001/jamanetworkopen.2022.38167] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE In 2020, some health insurance plans updated their medical policy to cover germline genetic testing for all patients diagnosed with colorectal cancer (CRC). Guidelines for universal tumor screening via microsatellite instability and/or immunohistochemistry (MSI/IHC) for mismatch repair protein expression for patients with CRC have been in place since 2009. OBJECTIVES To examine whether uptake of MSI/IHC screening and germline genetic testing in patients with CRC has improved under these policies and to identify actionable findings and management implications for patients referred for germline genetic testing. DESIGN, SETTING, AND PARTICIPANTS The multicenter, retrospective cohort study comprised 2 analyses of patients 18 years or older who were diagnosed with CRC between January 1, 2017, and December 31, 2020. The first analysis used an insurance claims data set to examine use of MSI/IHC screening and germline genetic testing for patients diagnosed with CRC between 2017 and 2020 and treated with systemic therapy. The second comprised patients with CRC who had germline genetic testing performed in 2020 that was billed under a universal testing policy. MAIN OUTCOMES AND MEASURES Patient demographic characteristics, clinical information, and use of MSI/IHC screening and germline genetic testing were analyzed. RESULTS For 9066 patients with newly diagnosed CRC (mean [SD] age, 64.2 [12.7] years; 4964 [54.8%] male), administrative claims data indicated that MSI/IHC was performed in 6645 eligible patients (73.3%) during the study period, with 2288 (25.2%) not receiving MSI/IHC despite being eligible for coverage. Analysis of a second cohort of 55 595 patients with CRC diagnosed in 2020 and covered by insurance found that only 1675 (3.0%) received germline genetic testing. In a subset of patients for whom germline genetic testing results were available, 1 in 6 patients had pathogenic or likely pathogenic variants, with most of these patients having variants with established clinical actionability. CONCLUSIONS AND RELEVANCE This nationwide cohort study found suboptimal rates of MSI/IHC screening and germline genetic testing uptake, resulting in clinically actionable genetic data being unavailable to patients diagnosed with CRC, despite universal eligibility. Effective strategies are required to address barriers to implementation of evidence-based universal testing policies that support precision treatment and optimal care management for patients with CRC.
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Affiliation(s)
| | | | | | - Joline Dalton
- Optum Labs, Minnetonka, Minnesota
- Variantyx Inc, Framingham, Massachusetts
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Association between Health Insurance Type and Genetic Testing and/or Counseling for Breast and Ovarian Cancer. J Pers Med 2022; 12:jpm12081263. [PMID: 36013212 PMCID: PMC9409681 DOI: 10.3390/jpm12081263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
Abstract
As genetic testing becomes increasingly incorporated into clinical practice to aid in both the diagnosis and risk assessment of genetic diseases, patients benefit from genetic counseling to support their understanding of test results either before and/or after genetic testing. Therefore, access to genetic testing and counseling is imperative for patient care. It is well established that health insurance coverage is a major determinant of access to health care in the United States as individuals without insurance are less likely to have a regular source of health care than their insured counterparts. Different health insurance plans and benefits also influence patients’ access to health care. Data on the association of health insurance and the uptake of genetic testing and/or counseling for cancer risk are limited. Using data from the National Health Interview Survey, we examined the uptake of genetic testing and/or counseling for breast/ovarian cancer risk by health insurance type. We found that only a small proportion of women undergo genetic testing and/or counseling for breast/ovarian cancer risk (2.3%), even among subgroups of women at risk due to family or personal history (6.5%). Women with health insurance were more likely to undergo genetic testing and/or counseling for breast/ovarian cancer risk, particularly those with military and private insurance plans, than those without health insurance after adjusting for various demographic, socioeconomic, and health risk covariates. Further investigations are needed to examine potential disparities in access and health inequities.
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8
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McHugh JK, Offiah G, Daly S, El Beltagi N, Barry MK, O'Reilly S, McVeigh TP. Postgraduate training in Cancer Genetics-a cross-specialty survey exploring experience of clinicians in Ireland. Ir J Med Sci 2022; 191:1427-1434. [PMID: 34195919 PMCID: PMC8244677 DOI: 10.1007/s11845-021-02637-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/01/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND As genomic profiling of constitutional and tumour-derived DNA becomes increasingly critical in cancer risk estimation, prognostication and treatment, there is a growing need for clinicians involved in cancer care to up-skill in Cancer Genetics. In the Republic of Ireland (ROI), this is particularly crucial, given a paucity of vocationally trained Clinical Geneticists per capita compared to other European countries. AIMS We aimed to assess the self-reported confidence of postgraduate medical/surgical trainees in ROI in requesting, interpreting, and managing genomic data in patients with cancer, and to assess their selfreported experience, and demand for future training in this area. METHODS A cross-sectional survey of postgraduate trainees in four specialties (Medical and Radiation Oncology, Surgery, and Obstetrics and Gynaecology (O&G)), training in ROI, was undertaken. A bespoke electronic questionnaire was designed to capture data regarding preceding experience, and confidence across several hypothetical clinical scenarios involving genomic testing. The survey was circulated to eligible participants by training programme administrators, after relevant institutional ethical approval. Data was collected anonymously. RESULTS The study cohort included 62 respondents. A paucity of cancer genetics training at every level was demonstrated, with "hardly any" or "none at all" reported by 47(76%), 62(100%), and 50(81%) during undergraduate, core specialty, and higher specialist training, respectively. A relative lack of confidence in all clinical scenarios was apparent, particularly among Surgery/O&G trainees. Most respondents would value more training in Cancer Genetics. CONCLUSIONS This study demonstrates an unmet need in dedicated Cancer Genetics training for postgraduate specialty trainees in ROI.
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Affiliation(s)
- Jana K McHugh
- Institute of Cancer Research, London, UK.
- Royal Marsden NHS Foundation Trust, London, UK.
| | - Gozie Offiah
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sean Daly
- Rotunda Hospital, Parnell Square E, Rotunda, Dublin 1, D01 P5W9, Dublin, Ireland
| | | | | | | | - Terri P McVeigh
- Institute of Cancer Research, London, UK
- Royal Marsden NHS Foundation Trust, London, UK
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Hebert D, Pacheco F, WintonLi L, Taj A. Demographic Barriers for Genetic Testing in High-Risk Breast Cancer Patients in the Northern Michigan Area. Cureus 2022; 14:e22966. [PMID: 35411261 PMCID: PMC8989629 DOI: 10.7759/cureus.22966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction: The National Comprehensive Cancer Network (NCCN) has outlined guidelines for criteria regarding genetic testing for high-penetrance breast and/or ovarian cancer susceptibility genes. Due to the lack of availability of genetic counseling services in Northern Michigan prior to COVID-19, the utilization of genetic testing falls well below recommended guidelines. Methods: Patients diagnosed with breast cancer in 2019 were randomly selected from Ascension Michigan's Northern Ministries Tumor Registry. A retrospective chart review was conducted. For patients who met NCCN criteria, their medical records were used to determine if genetic testing was recommended and if genetic testing was completed. Univariate (Crosstabs and t-tests) and multivariate tests with logistic regression were used to identify significant associations between the variables of interest. Results: One hundred and two (102) patient charts were reviewed in this group; 55 (52.4%) were eligible by the NCCN guidelines for genetic testing. From this eligible subset of patients, only 29 were offered genetic testing, and only 21 were tested. The mean age of the patients offered genetic counseling was 56.2 years compared and 67.6 years in the group not offered counseling (p < 0.001). The patient's insurance type was an independent factor for obtaining genetic testing, specifically, the subgroup who had Medicare (OR = 0.73, CI = 0.01-0.54; p = 0.02). Patients insured through Medicare were less likely to obtain genetic testing after referral to a genetic counselor (p = 0.01). Conclusion: Genetic counseling for high-risk breast cancer patients is below average in Northern Michigan, likely related to lack of physician referral, poor availability of counseling services, low socioeconomic status as well as a lower level of concern in older ages.
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Shah SM, Demidova EV, Lesh RW, Hall MJ, Daly MB, Meyer JE, Edelman MJ, Arora S. Therapeutic implications of germline vulnerabilities in DNA repair for precision oncology. Cancer Treat Rev 2022; 104:102337. [PMID: 35051883 PMCID: PMC9016579 DOI: 10.1016/j.ctrv.2021.102337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 12/12/2022]
Abstract
DNA repair vulnerabilities are present in a significant proportion of cancers. Specifically, germline alterations in DNA repair not only increase cancer risk but are associated with treatment response and clinical outcomes. The therapeutic landscape of cancer has rapidly evolved with the FDA approval of therapies that specifically target DNA repair vulnerabilities. The clinical success of synthetic lethality between BRCA deficiency and poly(ADP-ribose) polymerase (PARP) inhibition has been truly revolutionary. Defective mismatch repair has been validated as a predictor of response to immune checkpoint blockade associated with durable responses and long-term benefit in many cancer patients. Advances in next generation sequencing technologies and their decreasing cost have supported increased genetic profiling of tumors coupled with germline testing of cancer risk genes in patients. The clinical adoption of panel testing for germline assessment in high-risk individuals has generated a plethora of genetic data, particularly on DNA repair genes. Here, we highlight the therapeutic relevance of germline aberrations in DNA repair to identify patients eligible for precision treatments such as PARP inhibitors (PARPis), immune checkpoint blockade, chemotherapy, radiation therapy and combined treatment. We also discuss emerging mechanisms that regulate DNA repair.
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Affiliation(s)
- Shreya M Shah
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, United States; Science Scholars Program, Temple University, Philadelphia, PA, United States
| | - Elena V Demidova
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, United States; Kazan Federal University, Kazan, Russian Federation
| | - Randy W Lesh
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, United States; Geisinger Commonwealth School of Medicine, Scranton, PA, United States
| | - Michael J Hall
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, United States; Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Mary B Daly
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, United States; Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Joshua E Meyer
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States; Molecular Therapeutics Program, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Martin J Edelman
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States.
| | - Sanjeevani Arora
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, United States; Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States.
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Morgan KM, Hamilton JG, Symecko H, Kamara D, Jenkins C, Lester J, Spielman K, Pace LE, Gabriel C, Levin JD, Tejada PR, Braswell A, Marcell V, Wildman T, Devolder B, Baum RC, Block JN, Fesko Y, Boehler K, Howell V, Heitler J, Robson ME, Nathanson KL, Tung N, Karlan BY, Domchek SM, Garber JE, Offit K. Targeted BRCA1/2 population screening among Ashkenazi Jewish individuals using a web-enabled medical model: An observational cohort study. Genet Med 2021; 24:564-575. [PMID: 34906490 DOI: 10.1016/j.gim.2021.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/22/2021] [Indexed: 01/09/2023] Open
Abstract
PURPOSE This study aimed to evaluate uptake and follow-up using internet-assisted population genetic testing (GT) for BRCA1/2 Ashkenazi Jewish founder pathogenic variants (AJPVs). METHODS Across 4 cities in the United States, from December 2017 to March 2020, individuals aged ≥25 years with ≥1 Ashkenazi Jewish grandparent were offered enrollment. Participants consented and enrolled online with chatbot and video education, underwent BRCA1/2 AJPV GT, and chose to receive results from their primary care provider (PCP) or study staff. Surveys were conducted at baseline, at 12 weeks, and annually for 5 years. RESULTS A total of 5193 participants enrolled and 4109 (79.1%) were tested (median age = 54, female = 77.1%). Upon enrollment, 35.1% of participants selected a PCP to disclose results, and 40.5% of PCPs agreed. Of those tested, 138 (3.4%) were AJPV heterozygotes of whom 21 (15.2%) had no significant family history of cancer, whereas 86 (62.3%) had a known familial pathogenic variant. At 12 weeks, 85.5% of participants with AJPVs planned increased cancer screening; only 3.7% with negative results and a significant family history reported further testing. CONCLUSION Although continued follow-up is needed, internet-enabled outreach can expand access to targeted GT using a medical model. Observed challenges for population genetic screening efforts include recruitment barriers, improving PCP engagement, and increasing uptake of additional testing when indicated.
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Affiliation(s)
| | | | - Heather Symecko
- Department of Medicine and Basser Center for BRCA, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Daniella Kamara
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Colby Jenkins
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA
| | - Jenny Lester
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Kelsey Spielman
- Department of Medicine and Basser Center for BRCA, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lydia E Pace
- Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | | | | | | | - Anthony Braswell
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | | | | | | | | | | | | | | | | | | | - Mark E Robson
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Katherine L Nathanson
- Department of Medicine and Basser Center for BRCA, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nadine Tung
- Beth Israel Deaconess Medical Center, Boston, MA
| | - Beth Y Karlan
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Susan M Domchek
- Department of Medicine and Basser Center for BRCA, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Kenneth Offit
- Memorial Sloan Kettering Cancer Center, New York, NY.
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12
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McKay GE, Zakas AL, Osman F, Parkes A. Factors Affecting Genetic Consultation in Adolescent and Young Adult Patients With Sarcoma. J Natl Compr Canc Netw 2021; 19:1-8. [PMID: 34666309 DOI: 10.6004/jnccn.2021.7034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/03/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Given a link between sarcomas and hereditary cancer predisposition syndromes, including Li-Fraumeni syndrome, the consideration for genetic counseling is recommended for all adolescent and young adult (AYA) patients diagnosed with sarcoma. The aim of this study was to evaluate factors influencing genetic consultations in AYA patients with sarcoma at the University of Wisconsin (UW). METHODS A retrospective chart review was performed on AYA patients diagnosed with sarcoma between the ages of 15 and 39 years who were seen at least once between 2015 to 2019 at UW. Our chart review identified discussions regarding genetics, referrals to genetics, genetic consultations, and results of genetic testing. Variables hypothesized to affect patient referrals for genetic consultation were identified a priori. Descriptive statistical methods and a univariate analysis were used to identify patient characteristics associated with genetic counseling referral. RESULTS We identified 87 AYA patients with sarcoma. Only 19 (22%) of these patients had documentation of a discussion about genetics, 15 (17%) of whom were subsequently referred for genetic consultation. Of these 15 patients, 9 (60%) were seen in consultation. All 9 patients seen by genetics underwent genetic testing, with 4 (44%) of these patients having identified heritable cancer predisposition syndromes. Likelihood for genetics referral was linked most strongly to documented genetics discussion with an oncology provider (P<.001). CONCLUSIONS Despite the recommendation for consideration for genetic counseling in AYA patients with sarcoma, <25% of such patients in our study had a documented discussion about genetics. Supporting this need, all referred patients met criteria for genetic testing, and 44% of tested patients were found to have a heritable cancer predisposition syndrome. These data support the initial conversation by a provider as critical to genetic referral and suggest the need for more specific national recommendations for the genetic evaluation of all AYA patients with sarcoma.
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Affiliation(s)
- Grace E McKay
- 1Section of Hematology/Oncology, Department of Medicine, and
| | - Anna L Zakas
- 2Section of Oncology Genetics, Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Fauzia Osman
- 1Section of Hematology/Oncology, Department of Medicine, and
| | - Amanda Parkes
- 1Section of Hematology/Oncology, Department of Medicine, and
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13
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Young JL, Mak J, Stanley T, Bass M, Cho MK, Tabor HK. Genetic counseling and testing for Asian Americans: a systematic review. Genet Med 2021; 23:1424-1437. [PMID: 33972720 DOI: 10.1038/s41436-021-01169-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Asian Americans have been understudied in the literature on genetic and genomic services. The current study systematically identified, evaluated, and summarized findings from relevant qualitative and quantitative studies on genetic health care for Asian Americans. METHODS A search of five databases (1990 to 2018) returned 8,522 unique records. After removing duplicates, abstract/title screening, and full text review, 47 studies met inclusion criteria. Data from quantitative studies were converted into "qualitized data" and pooled together with thematic data from qualitative studies to produce a set of integrated findings. RESULTS Synthesis of results revealed that (1) Asian Americans are under-referred but have high uptake for genetic services, (2) linguistic/communication challenges were common and Asian Americans expected more directive genetic counseling, and (3) Asian Americans' family members were involved in testing decisions, but communication of results and risk information to family members was lower than other racial groups. CONCLUSION This study identified multiple barriers to genetic counseling, testing, and care for Asian Americans, as well as gaps in the research literature. By focusing on these barriers and filling these gaps, clinical genetic approaches can be tailored to meet the needs of diverse patient groups, particularly those of Asian descent.
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Affiliation(s)
- Jennifer L Young
- Stanford Center for Biomedical Ethics, Stanford University, CA, USA.
| | - Julie Mak
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, CA, USA
| | - Talia Stanley
- Stanford Center for Biomedical Ethics, Stanford University, CA, USA
| | - Michelle Bass
- Countway Library of Medicine, Harvard Medical School, MA, USA
| | - Mildred K Cho
- Department of Pediatrics, Stanford University, CA, USA
- Department of Medicine, Stanford University, CA, USA
| | - Holly K Tabor
- Department of Medicine, Stanford University, CA, USA
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14
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Wang A, Everett JN, Chun J, Cen C, Simeone DM, Schnabel F. Impact of changing guidelines on genetic testing and surveillance recommendations in a contemporary cohort of breast cancer survivors with family history of pancreatic cancer. Sci Rep 2021; 11:12491. [PMID: 34127761 PMCID: PMC8203798 DOI: 10.1038/s41598-021-91971-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/27/2021] [Indexed: 01/06/2023] Open
Abstract
Changing practice guidelines and recommendations have important implications for cancer survivors. This study investigated genetic testing patterns and outcomes and reported family history of pancreatic cancer (FHPC) in a large registry population of breast cancer (BC) patients. Variables including clinical and demographic characteristics, FHPC in a first or second-degree relative, and genetic testing outcomes were analyzed for BC patients diagnosed between 2010 and 2018 in the NYU Langone Health Breast Cancer Database. Among 3334 BC patients, 232 (7%) had a positive FHPC. BC patients with FHPC were 1.68 times more likely to have undergone genetic testing (p < 0.001), but 33% had testing for BRCA1/2 only and 44% had no genetic testing. Pathogenic germline variants (PGV) were identified in 15/129 (11.6%) BC patients with FHPC, and in 145/1315 (11.0%) BC patients without FHPC. Across both groups, updates in genetic testing criteria and recommendations could impact up to 80% of this cohort. Within a contemporary cohort of BC patients, 7% had a positive FHPC. The majority of these patients (56%) had no genetic testing, or incomplete testing by current standards, suggesting under-diagnosis of PC risk. This study supports recommendations for survivorship care that incorporate ongoing genetic risk assessment and counseling.
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Affiliation(s)
- Annie Wang
- Department of Surgery, New York University Langone Health, New York, NY, USA
| | - Jessica N Everett
- Department of Medicine, New York University Langone Health, New York, NY, USA
- Perlmutter Cancer Center, New York University Langone Health, 160 East 34th St., New York, NY, 10016, USA
| | - Jennifer Chun
- Perlmutter Cancer Center, New York University Langone Health, 160 East 34th St., New York, NY, 10016, USA
| | - Cindy Cen
- Department of Surgery, New York University Langone Health, New York, NY, USA
| | - Diane M Simeone
- Department of Surgery, New York University Langone Health, New York, NY, USA.
- Department of Pathology, New York University Langone Health, New York, NY, USA.
- Perlmutter Cancer Center, New York University Langone Health, 160 East 34th St., New York, NY, 10016, USA.
| | - Freya Schnabel
- Department of Surgery, New York University Langone Health, New York, NY, USA.
- Perlmutter Cancer Center, New York University Langone Health, 160 East 34th St., New York, NY, 10016, USA.
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15
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Hinshaw JC, Zhao LP, Brimm JE, Payne TH, Hisama FM. Value of a genetics clinic evaluation in identifying women at risk for hereditary breast-ovarian cancer syndrome. J Genet Couns 2021; 30:1591-1597. [PMID: 33881185 DOI: 10.1002/jgc4.1425] [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: 07/20/2020] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 11/08/2022]
Abstract
Our work evaluates the contributions of a genetics clinic visit in assessing patients' risk of hereditary cancers and in meeting National Cancer Comprehensive Network (NCCN) criteria for genetic testing. We reviewed the electronic health records (EHR) of 56 women seen for medical care in our healthcare system who were subsequently seen in the Adult Genetics Clinic. We searched for all personal or family cancer history available in either free-text or structured form within the EHR prior to the genetics visit. For each patient, we then compared the aggregate data with the pedigree information obtained at the Genetics Clinic visit for first-, second-, and third-degree relatives. During the genetics clinic visit, the number of relatives with cancer diagnoses doubled from 121 to 235, and for 17 of 56 (30%) of patients, family histories changed one or more NCCN criteria. For 39/56 (70%) of patients, the family history in the EHR was not changed during the genetics clinic visit. Of 56 women referred to the genetics clinic, 45 (80%) met NCCN guidelines for testing, 40 women underwent genetic testing, and 9 of 40 (23%) tested were positive for a Likely Pathogenic or Pathogenic (LP/P) variant. This study of 56 women quantitatively demonstrates the value of a genetics clinic visit by improved identification of key family history components.
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Affiliation(s)
- Jesse C Hinshaw
- University of Washington School of Medicine, Seattle, WA, USA
| | - Lue-Ping Zhao
- Fred Hutchinson Cancer Research Institute, Seattle, WA, USA
| | - John E Brimm
- University of Washington School of Medicine, Seattle, WA, USA
| | - Thomas H Payne
- Department of Medicine (General Internal Medicine), University of Washington School of Medicine, Seattle, WA, USA.,Brotman Baty Institute for Precision Medicine, University of Washington, Seattle, WA, USA
| | - Fuki M Hisama
- Brotman Baty Institute for Precision Medicine, University of Washington, Seattle, WA, USA.,Department of Medicine (Medical Genetics), University of Washington School of Medicine, Seattle, WA, USA
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16
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Payne TH, Zhao LP, Le C, Wilcox P, Yi T, Hinshaw J, Hussey D, Kostrinsky-Thomas A, Hale M, Brimm J, Hisama FM. Electronic health records contain dispersed risk factor information that could be used to prevent breast and ovarian cancer. J Am Med Inform Assoc 2021; 27:1443-1449. [PMID: 32940694 PMCID: PMC7526466 DOI: 10.1093/jamia/ocaa152] [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: 05/08/2020] [Revised: 06/11/2020] [Accepted: 06/23/2020] [Indexed: 12/20/2022] Open
Abstract
Objective The genetic testing for hereditary breast cancer that is most helpful in high-risk women is underused. Our objective was to quantify the risk factors for heritable breast and ovarian cancer contained in the electronic health record (EHR), to determine how many women meet national guidelines for referral to a cancer genetics professional but have no record of a referral. Methods and Materials We reviewed EHR records of a random sample of women to determine the presence and location of risk-factor information meeting National Comprehensive Cancer Network (NCCN) guidelines for a further genetic risk evaluation for breast and/or ovarian cancer, and determine whether the women were referred for such an evaluation. Results A thorough review of the EHR records of 299 women revealed that 24 (8%) met the NCCN criteria for referral for a further genetic risk evaluation; of these, 12 (50%) had no referral to a medical genetics clinic. Conclusions Half of the women whose EHR records contain risk-factor information meeting the criteria for further genetic risk evaluation for heritable forms of breast and ovarian cancer were not referred.
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Affiliation(s)
- Thomas H Payne
- University of Washington School of Medicine, Seattle, Washington, USA.,Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Lue Ping Zhao
- Fred Hutchison Cancer Research Center, Seattle, Washington, USA
| | - Calvin Le
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Peter Wilcox
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Troy Yi
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Jesse Hinshaw
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Duncan Hussey
- University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Malika Hale
- University of Washington School of Medicine, Seattle, Washington, USA
| | - John Brimm
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Fuki M Hisama
- University of Washington School of Medicine, Seattle, Washington, USA.,Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
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17
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Raspa M, Moultrie R, Toth D, Haque SN. Barriers and Facilitators to Genetic Service Delivery Models: Scoping Review. Interact J Med Res 2021; 10:e23523. [PMID: 33629958 PMCID: PMC7952239 DOI: 10.2196/23523] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/28/2020] [Accepted: 01/16/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Advances in diagnostics testing and treatment of genetic conditions have led to increased demand for genetic services in the United States. At the same time, there is a shortage of genetic services professionals. Thus, understanding the models of service delivery currently in use can help increase access and improve outcomes for individuals identified with genetic conditions. OBJECTIVE This review aims to provide an overview of barriers and facilitators to genetic service delivery models to inform future service delivery. METHODS We conducted a scoping literature review of the evidence to more fully understand barriers and facilitators around the provision of genetic services. RESULTS There were a number of challenges identified, including the limited number of genetics specialists, wait time for appointments, delivery of services by nongenetics providers, reimbursement, and licensure. The ways to address these challenges include the use of health information technology such as telehealth, group genetic counseling, provider-to-provider education, partnership models, and training; expanding genetic provider types; and embedding genetic counselors in clinical settings. CONCLUSIONS The literature review highlighted the need to expand access to genetic services. Ways to expand services include telehealth, technical assistance, and changing staffing models. In addition, using technology to improve knowledge among related professionals can help expand access.
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Affiliation(s)
- Melissa Raspa
- RTI International, Research Triangle Park, NC, United States
| | | | - Danielle Toth
- RTI International, Research Triangle Park, NC, United States
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18
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Grindedal EM, Jørgensen K, Olsson P, Gravdehaug B, Lurås H, Schlichting E, Vamre T, Wangensteen T, Heramb C, Mæhle L. Mainstreamed genetic testing of breast cancer patients in two hospitals in South Eastern Norway. Fam Cancer 2021; 19:133-142. [PMID: 32002722 PMCID: PMC7101297 DOI: 10.1007/s10689-020-00160-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Studies have shown that a significant number of eligible breast cancer patients are not offered genetic testing or referral to genetic counseling. To increase access to genetic testing in South Eastern Norway, testing has since 2014 been offered directly to breast cancer patients by surgeons and oncologists. This practice is termed “mainstreamed genetic testing”. The aim of this study was to investigate to what extent patients in South Eastern Norway are offered testing. Three hundred and sixty one patients diagnosed in 2016 and 2017 at one regional and one university hospital in South Eastern Norway were included. Data on whether the patients fulfilled the criteria, whether they had been offered testing and if they were tested were collected. In total, 26.6% (96/361) fulfilled the criteria for testing. Seventy five percent (69/92) of these were offered testing, and 71.7% (66/92) were tested. At the university hospital, 90.2% (37/41) of eligible patients were offered testing, and at the regional hospital 62.7% (32/51). Fifty two percent (12/23) of eligible patient not offered testing were younger than 50 years at time of diagnosis. As many as 95.4% (125/131) of all patients who were offered testing, wanted to be tested. The majority of patients who fulfilled the criteria were offered testing, supporting the practice of mainstreamed genetic testing. There were nevertheless differences in rates of testing between the hospitals that affected all groups of patients, indicating that genetic testing may not be equally accessible to all patients. We suggest that efforts should be made to increase awareness and improve routines for genetic testing of breast cancer patients in Norway.
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Affiliation(s)
| | - Kjersti Jørgensen
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Pernilla Olsson
- Department of Surgery, Section of Breast and Endocrine Surgery, Innlandet Hospital, Hamar, Norway
| | - Berit Gravdehaug
- Department of Breast and Endocrine Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Hilde Lurås
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ellen Schlichting
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Oncology, Section of Breast- and Endocrine Surgery, Oslo University Hospital, Oslo, Norway
| | - Tone Vamre
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | | | - Cecilie Heramb
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Lovise Mæhle
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
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19
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Scheinberg T, Goodwin A, Ip E, Linton A, Mak B, Smith DP, Stockler MR, Strach MC, Tran B, Young AL, Zhang AY, Mahon KL, Horvath LG. Evaluation of a Mainstream Model of Genetic Testing for Men With Prostate Cancer. JCO Oncol Pract 2020; 17:e204-e216. [PMID: 32970524 DOI: 10.1200/op.20.00399] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To identify the approximately 12% with inherited cancer predisposition, all men with metastatic prostate cancer (mPC) should be offered germline genetic testing. This guides treatment choices and impacts cancer prevention in the family. Limited genetic services globally present a barrier to testing. This study tested a potential solution, "mainstreaming," where counseling and testing are performed by the patient's oncologist. PATIENTS AND METHODS Men with mPC at three Australian sites were offered germline genetic testing at their medical oncology appointment. Panel testing (ATM, BRCA1, BRCA2, BRIP1, CHEK2, EPCAM, FANCA, HOXB13, MLH1, MSH2, MSH6, NBN, PALB2, PMS2, RAD51D, and TP53) was performed on saliva/blood (Invitae, San Francisco, CA). Primary outcomes were clinician and patient satisfaction. Secondary outcomes included mutation rates and resource allocation. RESULTS Of 66 men offered testing, 63 (95%) accepted. Four pathogenic variants were identified (two BRCA2, one NBN, and one MSH6). Fifty patients and nine clinicians completed questionnaires. Satisfaction was high. All patients were pleased to have had testing overall, 98% (46 of 47) to have had testing at their usual oncology appointment, and all to receive results from their usual specialist, rather than a separate genetics appointment. A total of 88% (7 of 8) of clinicians felt confident, and all were satisfied with mainstreaming. Mainstreaming was resource efficient, requiring 87% fewer genetic consultations than traditional genetic counseling. CONCLUSION This study demonstrates that mainstreaming of men with mPC is feasible, resource efficient, and satisfactory for clinicians and patients. Widespread implementation as standard of care would facilitate timely access to genetic testing for men with mPC.
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Affiliation(s)
- Tahlia Scheinberg
- Medical Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.,Clinical Prostate Cancer Group, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Annabel Goodwin
- Medical Oncology, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,Cancer Genetics, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Emilia Ip
- Cancer Genetics, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Cancer Genetics, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Anthony Linton
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,Medical Oncology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Blossom Mak
- Medical Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.,Clinical Prostate Cancer Group, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - David P Smith
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,Cancer Research Division, Cancer Council NSW, New South Wales, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Martin R Stockler
- Medical Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,Medical Oncology, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,Medical Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Madeleine C Strach
- Medical Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Ben Tran
- Medical Oncology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.,Division of Systems Biology and Personalised Medicine, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Medical Oncology, Epworth Freemasons, East Melbourne, Victoria, Australia
| | - Alison L Young
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,Sydney Catalyst Translational Research Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Alison Y Zhang
- Medical Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,Medical Oncology, Macquarie University Hospital, Macquarie University, New South Wales, Australia
| | - Kate L Mahon
- Medical Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.,Clinical Prostate Cancer Group, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,Medical Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Lisa G Horvath
- Medical Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.,Clinical Prostate Cancer Group, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,Medical Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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20
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Reid S, Spalluto LB, Pal T. Strategies to enhance identification of hereditary breast cancer gene carriers. Expert Rev Mol Diagn 2020; 20:861-865. [PMID: 32856489 PMCID: PMC7606636 DOI: 10.1080/14737159.2020.1816829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Sonya Reid
- Vanderbilt University Medical Center, Nashville TN, USA
| | - Lucy B. Spalluto
- Vanderbilt University Medical Center, Nashville TN, USA,Veterans Health Administration – Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, USA
| | - Tuya Pal
- Vanderbilt University Medical Center, Nashville TN, USA
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21
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Thapa S, Leppin A, Kristensen R, Just Bonde M, Aro AR. Implementation of interventions targeting the uptake of genetic testing services for breast cancer risk: protocol for a systematic review. BMJ Open 2020; 10:e031727. [PMID: 32595144 PMCID: PMC7322324 DOI: 10.1136/bmjopen-2019-031727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The timely identification of breast cancer-related pathogenic variants can help to identify the risk of potential disease development and determine healthcare choices. However, the uptake rate of genetic testing services for breast cancer risk remains low in many countries. Interventions targeting the uptake of these services among individuals potentially at risk for inherited breast cancer are often complex and have multiple components, and are therefore difficult to implement, replicate and disseminate to new contexts. Our aim is to systematically review studies targeting the uptake of genetic testing services for breast cancer risk and critically assess the quality of implementation outcomes and the reporting of intervention descriptions. METHODS AND ANALYSIS PubMed, CINAHL, PsycINFO, Embase, Cochrane Library and all Campbell Coordinating Group databases will be searched for intervention studies that target individuals' participation in breast cancer genetic testing programmes. Papers published in English within the time period from January 2005 until October 2019 will be considered for inclusion. Titles, abstracts and full papers will be screened for eligibility by two pairs of reviewers independently. For data analysis and synthesis, study-level and intervention-level characteristics will be abstracted. We will present all implementation outcomes that are mentioned in each of the studies and register the number of studies that do not at all look at or report implementation outcomes. The quality of implementation will be checked using a 5-point rubric item, and the quality and completeness of reporting of intervention description will be evaluated using the 12-item Template for Intervention Description and Replication (TIDieR). ETHICS AND DISSEMINATION Ethical approval is not required to conduct this review. Review findings will be disseminated to academic and non-specialist audiences via peer-reviewed academic journals and presented at appropriate conferences, workshops and meetings to policymakers, practitioners and organisations that work with our population of interest. PROSPERO REGISTRATION NUMBER CRD42018105732.
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Affiliation(s)
- Subash Thapa
- Research Unit of General Practice, University of Southern Denmark, J.B. Winsløws Vej 9, 5000 Odense, Denmark
| | - Anja Leppin
- Unit for Health Promotion Research, University of Southern Denmark, Niels Bohrs Vej 9-10, 6700 Esbjerg, Denmark
| | - Rikke Kristensen
- Unit for Health Promotion Research, University of Southern Denmark, Niels Bohrs Vej 9-10, 6700 Esbjerg, Denmark
| | - Mette Just Bonde
- Unit for Health Promotion Research, University of Southern Denmark, Niels Bohrs Vej 9-10, 6700 Esbjerg, Denmark
| | - Arja R Aro
- Unit for Health Promotion Research, University of Southern Denmark, Niels Bohrs Vej 9-10, 6700 Esbjerg, Denmark
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