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Ring KL, Duska LR. How far is too far? Cancer prevention and clinical trial enrollment in geographically underserved patient populations. Gynecol Oncol 2024; 184:8-15. [PMID: 38271774 DOI: 10.1016/j.ygyno.2024.01.008] [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: 10/31/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 01/27/2024]
Abstract
Despite dedicated efforts to improve equitable access to cancer care in the United States, disparities in cancer outcomes persist, and geographically underserved patients remain at an increased risk of cancer with lower rates of survival. The critical evaluation of cancer prevention inequities and clinical trial access presents the opportunity to outline novel strategies to incrementally improve bookended access to gynecologic cancer care for geographically underserved patients. Cancer prevention strategies that can be addressed in the rural patient population mirror priorities in the Healthy People 2030 objectives and include increased identification of high risk individuals who may benefit from increased cancer screening and risk reduction, increasing the proportion of people who discuss interventions to prevent cancer, such as HPV vaccination, with their provider, and increasing the proportion of adults who complete evidence based cancer screening. Barriers to accrual to clinical trials for rural patients overlap significantly with the same barriers to obtaining health care in general. These barriers include: lack of facilities and specialized providers; lack of robust health infrastructure; inability to travel; and financial barriers. In this review, we will discuss current knowledge and opportunities to improve cancer prevention initiatives and clinical trial enrollment in geographically underserved populations with a focus on rurality.
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Affiliation(s)
- Kari L Ring
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22908, United States of America.
| | - Linda R Duska
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22908, United States of America
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Zhong L, Bather JR, Daly BM, Kohlmann WK, Goodman MS, Rothwell E, Kaphingst KA. Investigation of interest in and timing preference for cancer predisposition testing and expanded carrier screening among women of reproductive age. PEC INNOVATION 2023; 2:100128. [PMID: 37214524 PMCID: PMC10194195 DOI: 10.1016/j.pecinn.2023.100128] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 05/24/2023]
Abstract
Objective To examine cognitive, relational, and social predictors of interest in and timing preference for cancer predisposition testing (CPT) and expanded carrier screening (ECS) offered in routine gynecologic care for women of reproductive age. Methods Women between 20 and 35 years old who were currently pregnant or had a prior pregnancy (N = 351) completed an online survey. Bivariate and multivariable analyses were used to identify significant predictors of women's interest in and timing preference for CPT and ECS. Results Most respondents reported high interest in CPT and ECS and preferred to have them when planning for a pregnancy. Perceived importance of genetic information and negative attitude towards uncertainty predicted interest in CPT and ECS in multivariable models. Genetic knowledge predicted preference for CPT or ECS when planning for a pregnancy. Conclusion Educational and decision support tools should be developed to enhance women's knowledge and awareness of CPT and ECS and to provide them with strategies to manage uncertainty. Innovation We examined women's timing preference for CPT and ECS and the impact of partner support and trust with gynecologist. A context-specific attitudes toward uncertainty scale was used to investigate women's particular perceptions of uncertainty in genetic testing.
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Affiliation(s)
- Lingzi Zhong
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
- Department of Communication, University of Utah, Salt Lake City, UT, United States
| | - Jemar R. Bather
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Brianne M. Daly
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Wendy K. Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Melody S. Goodman
- Department of Biostatistics, New York University School of Global Public Health, New York City, NY, United States
| | - Erin Rothwell
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Kimberly A. Kaphingst
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
- Department of Communication, University of Utah, Salt Lake City, UT, United States
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3
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Jordano JO, Gallion T, Cevan C, Carew B, Lloyd MC, Weaver EO, Miller RF, Dudek M. How the other half screens: A model for partnerships between student-run free clinics and genetic counseling programs to address disparities in hereditary cancer evaluation. J Genet Couns 2023. [PMID: 37960965 DOI: 10.1002/jgc4.1835] [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: 05/18/2023] [Revised: 10/19/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023]
Abstract
Genetic medicine is considered a major part of the future of preventative care, offering evidence-based, effective interventions to improve health outcomes and reduce morbidity and mortality, especially regarding hereditary cancer screening. Identification of individuals who would benefit from screening is key to improving their cancer-related healthcare outcomes. However, patients without insurance, of historically underserved races, of lower socioeconomic status, and in rural communities have lower access to such care. Barriers to access lead to populations having higher rates of undetected hereditary cancer, and consequently more severe forms of cancer. With an already-established reach, student-run free clinics can work with genetic counseling training programs to incorporate genetic medicine into their workflow. Such partnerships will (1) make genetic care more accessible with goals of improving patient morbidity, mortality, and health outcomes, (2) offer robust educational experiences for genetic counseling learners, particularly in understanding social determinants of health and barriers to care, and (3) actively combat the growing racial and geographic gaps in genetic care. Our study presents how one student-run free clinic implemented genetic counseling into its primary care workflow to improve access to genetics services. We present two examples of how genetic counseling improved patients' medical care. We also identify obstacles encountered during this program's development, as well as solutions-those we incorporated and possible considerations for other clinics. With the hope that other clinics can use this paper to design similar partnerships, we aim to lessen the gap between sickness and screening.
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Affiliation(s)
- James O Jordano
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Medical Degree Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Tielle Gallion
- Master of Genetic Counseling Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Chloe Cevan
- Master of Genetic Counseling Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Babatunde Carew
- Section of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - M Cooper Lloyd
- Section of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eleanor O Weaver
- Section of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert F Miller
- Section of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Martha Dudek
- Master of Genetic Counseling Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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4
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Bowen A, Gómez-Trillos S, Curran G, Graves KD, Sheppard VB, Schwartz MD, Peshkin BN, Campos C, Garcés N, Dash C, Aburto L, Valencia-Rojas N, Hernández G, Villa A, Cupertino P, Carrera P, Hurtado-de-Mendoza A. Advancing health equity: A qualitative study assessing barriers and facilitators of implementing hereditary breast and ovarian cancer risk screening tools in community-based organizations. J Genet Couns 2023; 32:965-981. [PMID: 37062905 PMCID: PMC10577152 DOI: 10.1002/jgc4.1705] [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: 12/02/2022] [Revised: 02/22/2023] [Accepted: 03/13/2023] [Indexed: 04/18/2023]
Abstract
Genetic counseling and testing (GCT) inform cancer management for persons at risk for hereditary breast and ovarian cancer (HBOC). Community-based organizations (CBOs) may play a role in identifying at-risk Latinx individuals to connect them to GCT but data are lacking. Two academic centers and their four CBO partners planned to implement a validated questionnaire for HBOC risk screening ("HBOC risk screening tool"). This study aimed to assess CBO's preferences for HBOC risk screening tools, as well as the barriers and facilitators anticipated for future implementation. Pre-implementation focus groups were conducted with CBO's staff. Discussions centered on current practices to identify and refer at-risk patients. During the discussion, staff were asked to select one out of five validated HBOC risk screening tools to implement and to discuss anticipated barriers/facilitators for implementation. The four focus groups were coded and qualitative analyzed following the Consolidated Framework for Implementation Research (CFIR) and Health Equity domains. All CBOs chose the Family History Screen 7 (FHS-7). Participants (N = 35) highlighted how the FHS-7 was easy to adapt to better fit the target population and changing guidelines. They had positive attitudes toward implementing the screening tool, stressed how the culture of the organization positioned them to reach the target population, and noted barriers in different CFIR domains (e.g., low knowledge about HBOC and GCT referrals; scarce available resources). Participants pointed to barriers related to health equity domains including limited access to GCT and follow-up care for uninsured and underinsured populations, challenges obtaining accurate family history, and immigration-related barriers. CBOs highlighted the importance of partnering with other stakeholders to overcome barriers. Findings emphasize the need to develop multi-level implementation strategies to overcome barriers and leverage facilitators. This study can inform the development of implementation toolkits for CBOs to implement HBOC screening tools to advance health equity.
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Affiliation(s)
| | - Sara Gómez-Trillos
- Georgetown University Medical Center, Washington, District of Columbia, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics Research, Washington, District of Columbia, USA
| | - Geoffrey Curran
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Kristi D. Graves
- Georgetown University Medical Center, Washington, District of Columbia, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics Research, Washington, District of Columbia, USA
| | | | - Marc D. Schwartz
- Georgetown University Medical Center, Washington, District of Columbia, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics Research, Washington, District of Columbia, USA
| | - Beth N. Peshkin
- Georgetown University Medical Center, Washington, District of Columbia, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics Research, Washington, District of Columbia, USA
| | | | - Nathaly Garcés
- Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Chiranjeev Dash
- Georgetown University Medical Center, Washington, District of Columbia, USA
| | | | | | | | - Antonio Villa
- Virginia Commonwealth University, Richmond, Virginia, USA
- La Casa de la Salud, Richmond, Virginia, USA
| | - Paula Cupertino
- University of Rochester Medical Center, Rochester, New York, USA
| | | | - Alejandra Hurtado-de-Mendoza
- Georgetown University Medical Center, Washington, District of Columbia, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics Research, Washington, District of Columbia, USA
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5
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Kinney AY, Walters ST, Lin Y, Lu SE, Kim A, Ani J, Heidt E, Le Compte CJ, O'Malley D, Stroup A, Paddock LE, Grumet S, Boyce TW, Toppmeyer DL, McDougall JA. Improving Uptake of Cancer Genetic Risk Assessment in a Remote Tailored Risk Communication and Navigation Intervention: Large Effect Size but Room to Grow. J Clin Oncol 2023; 41:2767-2778. [PMID: 36787512 PMCID: PMC10414736 DOI: 10.1200/jco.22.00751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 11/21/2022] [Accepted: 01/04/2023] [Indexed: 02/16/2023] Open
Abstract
PURPOSE Cancer genetic risk assessment (CGRA) is recommended for women with ovarian cancer or high-risk breast cancer, yet fewer than 30% receive recommended genetic services, with the lowest rates among underserved populations. We hypothesized that compared with usual care (UC) and mailed targeted print (TP) education, CGRA uptake would be highest among women receiving a phone-based tailored risk counseling and navigation intervention (TCN). METHODS In this three-arm randomized trial, women with ovarian or high-risk breast cancer were recruited from statewide cancer registries in Colorado, New Jersey, and New Mexico. Participants assigned to TP received a mailed educational brochure. Participants assigned to TCN received the mailed educational brochure, an initial phone-based psychoeducational session with a health coach, a follow-up letter, and a follow-up navigation phone call. RESULTS Participants' average age was 61 years, 25.4% identified as Hispanic, 5.9% identified as non-Hispanic Black, and 17.5% lived in rural areas. At 6 months, more women in TCN received CGRA (18.7%) than those in TP (3%; odds ratio, 7.4; 95% CI, 3.0 to 18.3; P < .0001) or UC (2.5%; odds ratio, 8.9; 95% CI, 3.4 to 23.5; P < .0001). There were no significant differences in CGRA uptake between TP and UC. Commonly cited barriers to genetic counseling were lack of provider referral (33.7%) and cost (26.5%), whereas anticipated difficulty coping with test results (14.0%) and cost (41.2%) were barriers for genetic testing. CONCLUSION TCN increased CGRA uptake in a group of geographically and ethnically diverse high-risk breast and ovarian cancer survivors. Remote personalized interventions that incorporate evidence-based health communication and behavior change strategies may increase CGRA among women recruited from statewide cancer registries.
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Affiliation(s)
- Anita Y. Kinney
- Rutgers University School of Public Health, Rutgers University, The State University of New Jersey, Newark, NJ
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Yong Lin
- Rutgers University School of Public Health, Rutgers University, The State University of New Jersey, Newark, NJ
| | - Shou-En Lu
- Rutgers University School of Public Health, Rutgers University, The State University of New Jersey, Newark, NJ
| | - Arreum Kim
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Julianne Ani
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Emily Heidt
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Denalee O'Malley
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
- School of Medicine, Rutgers University, The State University of New Jersey, Newark, NJ
| | - Antoinette Stroup
- Rutgers University School of Public Health, Rutgers University, The State University of New Jersey, Newark, NJ
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Lisa E. Paddock
- Rutgers University School of Public Health, Rutgers University, The State University of New Jersey, Newark, NJ
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Sherry Grumet
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Tawny W. Boyce
- UNM Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM
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6
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Wand H, Kalia SS, Helm BM, Suckiel SA, Brockman D, Vriesen N, Goudar RK, Austin J, Yanes T. Clinical genetic counseling and translation considerations for polygenic scores in personalized risk assessments: A Practice Resource from the National Society of Genetic Counselors. J Genet Couns 2023. [PMID: 36617640 DOI: 10.1002/jgc4.1668] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 01/10/2023]
Abstract
Polygenic scores (PGS) are primed for use in personalized risk assessments for common, complex conditions and population health screening. Although there is growing evidence supporting the clinical validity of these scores in certain diseases, presently, there is no consensus on best practices for constructing PGS or demonstrated clinical utility in practice. Despite these evidence gaps, individuals can access their PGS information through commercial entities, research programs, and clinical programs. This prompts the immediate need for educational resources for clinicians encountering PGS information in clinical practice. This practice resource is intended to increase genetic counselors' and other healthcare providers' understanding and comfort with PGS used in personalized risk assessments. Drawing on best practices in clinical genomics, we discuss the unique considerations for polygenic-based (1) testing, (2) clinical genetic counseling, and (3) translation to population health services. This practice resource outlines the emerging uses of PGS, as well as the critical limitations of this technology that need to be addressed before wide-scale implementation.
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Affiliation(s)
- Hannah Wand
- Department of Cardiology and Biomedical Data Sciences, Stanford Medicine, Stanford, California, USA
| | - Sarah S Kalia
- Department of Epidemiology, Harvard Chan School of Public Health, Boston, Massachusetts, USA
| | - Benjamin M Helm
- Department of Medical & Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Epidemiology, Indiana University Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - Sabrina A Suckiel
- Institute for Genomic Health & Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Natalie Vriesen
- Division of Medical Genetics, Department of Women's Health, Henry Ford Health, Detroit, Michigan, USA
| | - Ranjit K Goudar
- Division of Hematology & Oncology, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA.,Virginia Oncology Associates, Hereditary Cancer Clinic, Norfolk, Virginia, USA
| | - Jehannine Austin
- Departments of Psychiatry & Medical Genitics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tatiane Yanes
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia
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7
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Le Compte CG, Lu SE, Ani J, McDougall J, Walters ST, Toppmeyer D, Boyce TW, Stroup A, Paddock L, Grumet S, Lin Y, Heidt E, Kinney AY. Understanding cancer genetic risk assessment motivations in a remote tailored risk communication and navigation intervention randomized controlled trial. Health Psychol Behav Med 2022; 10:1190-1215. [PMID: 36518606 PMCID: PMC9744218 DOI: 10.1080/21642850.2022.2150623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/13/2022] [Indexed: 12/14/2022] Open
Abstract
Background National guidelines recommend cancer genetic risk assessment (CGRA) (i.e. genetic counseling prior to genetic testing) for women at increased risk for hereditary breast and ovarian cancer (HBOC). Less than one-half of eligible women obtain CGRA, leaving thousands of women and their family members without access to potentially life-saving cancer prevention interventions. Purpose The Genetic Risk Assessment for Cancer Education and Empowerment Project (GRACE) addressed this translational gap, testing the efficacy of a tailored counseling and navigation (TCN) intervention vs. a targeted print brochure vs. usual care on CGRA intentions. Selected behavioral variables were theorized to mediate CGRA intentions. Methods Breast and ovarian cancer survivors meeting criteria for guideline-based CGRA were recruited from three state cancer registries (N = 654), completed a baseline survey, and were randomized. TCN and targeted print arms received the brochure; TCN also participated in a tailored, telephone-based decision coaching and navigation session grounded in the Extended Parallel Process Model and Ottawa Decision Support Framework. Participants completed a one-month assessment. Logistic regression was used to compare the rate of CGRA intentions. CGRA intentions and theorized mediator scores (continuous level variables) were calculated using mixed model analysis. Results CGRA intentions increased for TCN (53.2%) vs. targeted print (26.7%) (OR = 3.129; 95% CI: 2.028, 4.827, p < .0001) and TCN vs. usual care (23.1%) (OR = 3.778, CI: 2.422, 5.894, p < .0001). Perceived risk (p = 0.023) and self-efficacy (p = 0.035) mediated CGRA intentions in TCN. Conclusions Improvements in CGRA intentions and theorized mediators support the use of a tailored communication intervention among women at increased HBOC risk. (Clinicaltrials.gov: NCT03326713.)Trial registration: ClinicalTrials.gov identifier: NCT03326713.
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Affiliation(s)
- Circe Gray Le Compte
- Biobehavioral Cancer Health Equity Research Lab, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Shou-En Lu
- Rutgers Environmental Epidemiology and Statistics, Rutgers University School of Public Health, Rutgers, The State University of New Jersey University, New Brunswick, NJ, USA
| | - Julianne Ani
- Biobehavioral Cancer Health Equity Research Lab, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Jean McDougall
- Department of Internal Medicine, Division of Epidemiology, Biostatistics, and Preventive Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Scott T. Walters
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Deborah Toppmeyer
- Stacy Goldstein Breast Cancer Center, LIFE Center, Medical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Tawny W. Boyce
- Biostatistics Shared Resource, UNM Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA
| | - Antoinette Stroup
- New Jersey State Cancer Registry, Stroup Research Center, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Lisa Paddock
- Cancer Surveillance Research Program, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Sherry Grumet
- LIFE Center, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Yong Lin
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey University, New Brunswick, NJ, USA
| | - Emily Heidt
- Biobehavioral Cancer Health Equity Research Lab, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Anita Y. Kinney
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey University, New Brunswick, NJ, USA
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8
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Weldon CB, Trosman JR, Liang SY, Douglas MP, Scheuner MT, Kurian A, Schaa KL, Roscow B, Erwin D, Phillips KA. Genetic counselors' experience with reimbursement and patient out-of-pocket cost for multi-cancer gene panel testing for hereditary cancer syndromes. J Genet Couns 2022; 31:1394-1403. [PMID: 35900261 PMCID: PMC9722528 DOI: 10.1002/jgc4.1614] [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: 08/27/2021] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 12/14/2022]
Abstract
Multi-cancer gene panels for hereditary cancer syndromes (hereditary cancer panels, HCPs) are widely available, and some laboratories have programs that limit patients' out-of-pocket (OOP) cost share. However, little is known about practices by cancer genetic counselors for discussing and ordering an HCP and how insurance reimbursement and patient out-of-pocket share impact these practices. We conducted a survey of cancer genetic counselors based in the United States through the National Society of Genetic Counselors to assess the impact of reimbursement and patient OOP share on ordering of an HCP and hereditary cancer genetic counseling. Data analyses were conducted using chi-square and t tests. We received 135 responses (16% response rate). We found that the vast majority of respondents (94%, 127/135) ordered an HCP for patients rather than single-gene tests to assess hereditary cancer predisposition. Two-thirds of respondents reported that their institution had no protocol related to discussing HCPs with patients. Most respondents (84%, 114/135) indicated clinical indications and patients' requests as important in selecting and ordering HCPs, while 42%, 57/135, considered reimbursement and patient OOP share factors important. We found statistically significant differences in reporting of insurance as a frequently used payment method for HCPs and in-person genetic counseling (84% versus 59%, respectively, p < 0.0001). Perceived patient willingness to pay more than $100 was significantly higher for HCPs than for genetic counseling(41% versus 22%, respectively, p < 0.01). In sum, genetic counselors' widespread selection and ordering of HCPs is driven more by clinical indications and patient preferences than payment considerations. Respondents perceived that testing is more often reimbursed by insurance than genetic counseling, and patients are more willing to pay for an HCP than for genetic counseling. Policy efforts should address this incongruence in reimbursement and patient OOP share. Patient-centered communication should educate patients on the benefit of genetic counseling.
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Affiliation(s)
| | - Julia R. Trosman
- Center for Business Models in Healthcare, Glencoe, IL, USA
- Department of Clinical Pharmacy; Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), University of California-San Francisco, San Francisco, CA, USA
| | - Su-Ying Liang
- Sutter Health-Palo Alto Medical Foundation Research Institute, Palo Alto, CA
| | - Michael P. Douglas
- Department of Clinical Pharmacy; Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), University of California-San Francisco, San Francisco, CA, USA
| | - Maren T. Scheuner
- Departments of Medicine and Pediatrics, School of Medicine, University of California, San Francisco, CA, USA
- San Francisco VA Health Care System, San Francisco, CA, USA
| | - Allison Kurian
- Departments of Medicine and of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Kendra L. Schaa
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Breanna Roscow
- Oncology Regional Medical Specialists Department, Myriad Genetics, Inc, Salt Lake City, UT
| | - Deanna Erwin
- Genetic Counseling Services, Color Health, Burlingame, CA
| | - Kathryn A. Phillips
- Department of Clinical Pharmacy; Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), University of California-San Francisco, San Francisco, CA, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
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9
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Gereis J, Hetherington K, Ha L, Robertson EG, Ziegler DS, Barlow-Stewart K, Tucker KM, Marron JM, Wakefield CE. Parents' understanding of genome and exome sequencing for pediatric health conditions: a systematic review. Eur J Hum Genet 2022; 30:1216-1225. [PMID: 35999452 PMCID: PMC9626631 DOI: 10.1038/s41431-022-01170-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 07/13/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023] Open
Abstract
Genome and exome sequencing (GS/ES) are increasingly being used in pediatric contexts. We summarize evidence regarding the actual and perceived understanding of GS/ES of parents of a child offered testing for diagnosis and/or management of a symptomatic health condition. We searched four databases (2008-2021) and identified 1264 unique articles, of which 16 met inclusion criteria. We synthesized data from qualitative and quantitative studies and organized results using Ayuso et al. (2013)'s framework of key elements of information for informed consent to GS/ES. Many of the parents represented had prior experience with genetic testing and accessed a form of genetic counseling. Parents' understanding was varied across the domains evaluated. Parents demonstrated understanding of the various potential direct clinical benefits to their child undergoing GS/ES, including in relation to other genetic tests. We found parents had mixed understanding of the nature of potential secondary findings, and of issues related to data privacy, confidentiality, and usage of sequencing results beyond their child's clinical care. Genetic counseling consultations improved understanding. Our synthesis indicates that ES/GS can be challenging for families to understand and underscores the importance of equipping healthcare professionals to explore parents' understanding of ES/GS and the implications of testing for their child.
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Affiliation(s)
- Jessica Gereis
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia ,grid.414009.80000 0001 1282 788XBehavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW Australia
| | - Kate Hetherington
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia ,grid.414009.80000 0001 1282 788XBehavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW Australia
| | - Lauren Ha
- grid.414009.80000 0001 1282 788XBehavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432School of Health Sciences, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia
| | - Eden G. Robertson
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia
| | - David S. Ziegler
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia ,grid.414009.80000 0001 1282 788XKids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432Children’s Cancer Institute, UNSW Sydney, Sydney, NSW Australia
| | - Kristine Barlow-Stewart
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432Children’s Cancer Institute, UNSW Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XNorthern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Katherine M. Tucker
- grid.1005.40000 0004 4902 0432Prince of Wales Clinical School, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia
| | - Jonathan M. Marron
- grid.65499.370000 0001 2106 9910Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA USA ,grid.2515.30000 0004 0378 8438Division of Hematology/Oncology, Boston Children’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XCenter for Bioethics, Harvard Medical School, Boston, MA USA
| | - Claire E. Wakefield
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia ,grid.414009.80000 0001 1282 788XBehavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW Australia
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10
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Bednar EM, Nitecki R, Krause KJ, Rauh-Hain JA. Interventions to improve delivery of cancer genetics services in the United States: A scoping review. Genet Med 2022; 24:1176-1186. [PMID: 35389342 DOI: 10.1016/j.gim.2022.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Interventions that decrease barriers and improve clinical processes can increase patient access to guideline-recommended cancer genetics services. We sought to identify and describe interventions to improve patient receipt of guideline-recommended cancer genetics services in the United States. METHODS We performed a comprehensive search in Ovid MEDLINE and Embase, Scopus, and Web of Science from January 1, 2000 to February 12, 2020. Eligible articles reported interventions to improve the identification, referral, genetic counseling (GC), and genetic testing (GT) of patients in the United States. We independently screened titles and abstracts and reviewed full-text articles. Data were synthesized by grouping articles by clinical process. RESULTS Of 44 included articles, 17 targeted identification of eligible patients, 14 targeted referral, 15 targeted GC, and 16 targeted GT. Patient identification interventions included universal tumor testing and screening of medical/family history. Referral interventions included medical record system adaptations, standardizing processes, and provider notifications. GC interventions included supplemental patient education, integrated GC within oncology clinics, appointment coordination, and alternative service delivery models. One article directly targeted the GT process by implementing provider-coordinated testing. CONCLUSION This scoping review identified and described interventions to improve US patients' access to and receipt of guideline-recommended cancer genetics services.
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Affiliation(s)
- Erica M Bednar
- Cancer Prevention and Control Platform, Moon Shots Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Roni Nitecki
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kate J Krause
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jose Alejandro Rauh-Hain
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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11
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Mittendorf KF, Ukaegbu C, Gilmore MJ, Lindberg NM, Kauffman TL, Eubanks DJ, Shuster E, Allen J, McMullen C, Feigelson HS, Anderson KP, Leo MC, Hunter JE, Sasaki SO, Zepp JM, Syngal S, Wilfond BS, Goddard KAB. Adaptation and early implementation of the PREdiction model for gene mutations (PREMM 5™) for lynch syndrome risk assessment in a diverse population. Fam Cancer 2022; 21:167-180. [PMID: 33754278 PMCID: PMC8458476 DOI: 10.1007/s10689-021-00243-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/04/2021] [Indexed: 01/20/2023]
Abstract
Lynch syndrome (LS) is the most common inherited cause of colorectal and endometrial cancers. Identifying individuals at risk for LS without personal cancer history requires detailed collection and assessment of family health history. However, barriers exist to family health history collection, especially in historically underserved populations. To improve LS risk assessment in historically underserved populations, we adapted the provider-facing PREdiction Model for gene Mutations (PREMM5™ model), a validated LS risk assessment model, into a patient-facing electronic application through an iterative development process involving expert and patient stakeholders. We report on preliminary findings based on the first 500 individuals exposed to the adapted application in a primary care population enriched for low-literacy and low-resource patients. Major adaptations to the PREMM5™ provider module included reduction in reading level, addition of interactive literacy aids, incorporation of family history assessment for both maternal and paternal sides of the family, and inclusion of questions about individual relatives or small groups of relatives to reduce cognitive burden. In the first 500 individuals, 90% completed the PREMM5™ independently; of those, 94% did so in 5 min or less (ranged from 0.2 to 48.8 min). The patient-facing application was able to accurately classify 84% of patients as having clinically significant or not clinically significant LS risk. Our preliminary results suggest that in this diverse study population, most participants were able to rapidly, accurately, and independently complete an interactive application collecting family health history assessment that accurately assessed for Lynch syndrome risk.
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Affiliation(s)
- Kathleen F Mittendorf
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA.
| | - Chinedu Ukaegbu
- Dana Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Marian J Gilmore
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Nangel M Lindberg
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Tia L Kauffman
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Donna J Eubanks
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Elizabeth Shuster
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Jake Allen
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Carmit McMullen
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | | | | | - Michael C Leo
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Jessica Ezzell Hunter
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | | | - Jamilyn M Zepp
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Sapna Syngal
- Dana Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute and Hospital, Seattle, WA, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Katrina A B Goddard
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
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12
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Butler EN, Umar A, Heckman-Stoddard BM, Kundrod KA, Signorello LB, Castle PE. Redefining precision cancer prevention to promote health equity. Trends Cancer 2022; 8:295-302. [PMID: 35181273 DOI: 10.1016/j.trecan.2022.01.009] [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: 11/19/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 11/15/2022]
Abstract
Precision cancer prevention as it is currently envisioned is a targeted, molecular-based approach to intercept carcinogenesis before cancer develops or before it becomes untreatable. Unfortunately, due to systemic biases, current precision cancer prevention interventions might not be effective in all populations, especially in minoritized communities. In addition, not all cancer risk is attributable to genetic or even biological factors, but includes social determinants of health (SDH). Here, we propose a broader framework for precision cancer prevention, anchored in optimizing the benefits to harms for all people. We propose that precision cancer prevention considers not only what is being delivered, but also for whom, where, and how, with a goal of achieving cancer prevention health equity.
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Affiliation(s)
- Eboneé N Butler
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA; Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Asad Umar
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Brandy M Heckman-Stoddard
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Kathryn A Kundrod
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Lisa B Signorello
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Philip E Castle
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA; Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA.
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13
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Reid S, Spalluto LB, Lang K, Weidner A, Pal T. An overview of genetic services delivery for hereditary breast cancer. Breast Cancer Res Treat 2022; 191:491-500. [PMID: 35079980 PMCID: PMC8789372 DOI: 10.1007/s10549-021-06478-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/02/2021] [Indexed: 02/06/2023]
Abstract
Breast cancer is the most common cancer diagnosed in women worldwide, with approximately 5-10% of cases attributed to high penetrance hereditary breast cancer (HBC) genes. The tremendous advances in precision oncology have broadened indications for germline genetic testing to guide both systemic and surgical treatment, with increasing demand for cancer genetic services. The HBC continuum of care includes (1) identification, access, and uptake of genetic counseling and testing; (2) the delivery of genetic counseling and testing services; and (3) initiation of guideline-adherent follow-up care and family communication of results. Challenges to delivering care on the HBC care continuum include factors such as access to services, cost, discrimination and bias, and lack of education and awareness, which can be mitigated through implementing a multi-level approach. This includes strategies such as increasing awareness and utilization of genetic counseling and testing, developing new methods to meet the growing demand for genetic services, and improving the uptake of follow-up care by increasing patient and provider awareness of the management recommendations.
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Affiliation(s)
- Sonya Reid
- Vanderbilt University Medical Center (VUMC)/Vanderbilt-Ingram Cancer Center (VICC), 2220 Pierce Ave. 777 PRB, Nashville, TN, 37232, USA.
| | - Lucy B Spalluto
- Vanderbilt University Medical Center (VUMC)/Vanderbilt-Ingram Cancer Center (VICC), 2220 Pierce Ave. 777 PRB, Nashville, TN, 37232, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine/Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center, Nashville, USA
| | - Katie Lang
- Department of Medicine/Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anne Weidner
- Department of Medicine/Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tuya Pal
- Vanderbilt University Medical Center (VUMC)/Vanderbilt-Ingram Cancer Center (VICC), 2220 Pierce Ave. 777 PRB, Nashville, TN, 37232, USA.
- Department of Medicine/Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
- Vanderbilt University Medical Center (VUMC)/Vanderbilt-Ingram Cancer Center (VICC), 1500 21st Avenue South. Suite 2810, Nashville, TN, 37212, USA.
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14
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Cragun D, Beckstead J, Farmer M, Hooker G, Dean M, Matloff E, Reid S, Tezak A, Weidner A, Whisenant JG, Pal T. IMProving care After inherited Cancer Testing (IMPACT) study: protocol of a randomized trial evaluating the efficacy of two interventions designed to improve cancer risk management and family communication of genetic test results. BMC Cancer 2021; 21:1099. [PMID: 34645413 PMCID: PMC8513202 DOI: 10.1186/s12885-021-08822-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/01/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Implementing genetic testing for inherited cancer predisposition into routine clinical care offers a tremendous opportunity for cancer prevention and early detection. However, genetic testing itself does not improve outcomes; rather, outcomes depend on implemented follow-up care. The IMPACT study is a hybrid type I randomized effectiveness-implementation trial to simultaneously evaluate the effectiveness of two interventions for individuals with inherited cancer predisposition focused on: 1) increasing family communication (FC) of genetic test results; and 2) improving engagement with guideline-based cancer risk management (CRM). METHODS This prospective study will recruit a racially, geographically, and socioeconomically diverse population of individuals with a documented pathogenic/likely pathogenic (P/LP) variant in an inherited cancer gene. Eligible participants will be asked to complete an initial trial survey and randomly assigned to one of three arms: A) GeneSHARE, a website designed to increase FC of genetic test results; B) My Gene Counsel's Living Lab Report, a digital tool designed to improve understanding of genetic test results and next steps, including CRM guidelines; or C) a control arm in which participants continue receiving standard care. Follow-up surveys will be conducted at 1, 3, and 12 months following randomization. These surveys include single-item measures, scales, and indices related to: 1) FC and CRM behaviors and behavioral factors following the COM-B theoretical framework (i.e., capability, opportunity, and motivation); 2) implementation outcomes (i.e., acceptability, appropriateness, exposure, and reach); and 3) other contextual factors (i.e., sociodemographic and clinical factors, and uncertainty, distress, and positive aspects of genetic test results). The primary outcomes are an increase in FC of genetic test results (Arm A) and improved engagement with guideline-based CRM without overtreatment or undertreatment (Arm B) by the 12-month follow-up survey. DISCUSSION Our interventions are designed to shift the paradigm by which individuals with P/LP variants in inherited cancer genes are provided with information to enhance FC of genetic test results and engagement with guideline-based CRM. The information gathered through evaluating the effectiveness and implementation of these real-world approaches is needed to modify and scale up adaptive, stepped interventions that have the potential to maximize FC and CRM. TRIAL REGISTRATION This study is registered at Clinicaltrials.gov (NCT04763915, date registered: February 21, 2021). PROTOCOL VERSION September 17th, 2021 Amendment Number 04.
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Affiliation(s)
- Deborah Cragun
- College of Public Health, University of South Florida, 13201 Bruce B Downs Boulevard, IDRB 304, Tampa, FL, 33612, USA
| | - Jason Beckstead
- College of Public Health, University of South Florida, 13201 Bruce B Downs Boulevard, IDRB 304, Tampa, FL, 33612, USA
| | - Meagan Farmer
- My Gene Counsel, PO Box 612, Branford, CT, 06405, USA
| | - Gillian Hooker
- Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2810, Nashville, TN, 37212, USA
| | - Marleah Dean
- Department of Communication, University of South Florida, 4202 East Fowler Avenue, CIS 3043, Tampa, FL, 33620, USA
- Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
| | - Ellen Matloff
- My Gene Counsel, PO Box 612, Branford, CT, 06405, USA
| | - Sonya Reid
- Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2810, Nashville, TN, 37212, USA
| | - Ann Tezak
- Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2810, Nashville, TN, 37212, USA
| | - Anne Weidner
- Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2810, Nashville, TN, 37212, USA
| | - Jennifer G Whisenant
- Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2810, Nashville, TN, 37212, USA
| | - Tuya Pal
- Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2810, Nashville, TN, 37212, USA.
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15
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Florentine MM, Rouse SL, Stephans J, Conrad D, Czechowicz J, Matthews IR, Meyer AK, Nadaraja GS, Parikh R, Virbalas J, Weinstein JE, Chan DK. Racial and ethnic disparities in diagnostic efficacy of comprehensive genetic testing for sensorineural hearing loss. Hum Genet 2021; 141:495-504. [PMID: 34515852 PMCID: PMC9035005 DOI: 10.1007/s00439-021-02338-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/09/2021] [Indexed: 11/25/2022]
Abstract
Understanding racial and ethnic disparities in diagnostic rates of genetic testing is critical for health equity. We sought to understand the extent and cause of racial and ethnic disparities in diagnostic efficacy of comprehensive genetic testing (CGT) for sensorineural hearing loss (SNHL). We performed a retrospective cohort study at two tertiary children’s hospitals on a diverse cohort of 240 consecutive pediatric patients (76% publicly insured, 82% non-White) with SNHL of unknown etiology who underwent CGT. Definite and possible genetic diagnoses were assigned for each patient, representing the likelihood of a genetic cause of hearing loss. Associations between diagnostic rates were examined. 3.8 ± 2.1 variants were detected per patient; this frequency did not vary between White/Asian and Hispanic/Black cohorts. Overall, 82% of variants were variants of uncertain significance (VUS). Compared with White and Asian subjects, variants identified among Hispanic and Black children were less likely to be classified as pathogenic/likely pathogenic (15% vs. 24%, p < 0.001), and Hispanic and Black children were less likely to have a definite genetic diagnosis (10% vs. 37%, p < 0.001). The adjusted odds ratio for definite genetic diagnosis in Black and Hispanic children compared with White and Asian children was 0.19. Expanding genetic diagnostic criteria to include predicted deleterious VUSs reduced these disparities between White/Asian and Hispanic/Black children, with comparable molecular diagnostic rates (41% vs. 38%, p = 0.72). However, in silico predictions are insufficiently valid for clinical use. Increased inclusion of underrepresented groups in genetic hearing-loss studies to clinically validate these variants is necessary to reduce racial and ethnic disparities in diagnostic efficacy of comprehensive genetic testing.
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Affiliation(s)
- Michelle M Florentine
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, 2233 Post Street, Third Floor, San Francisco, CA, 94115, USA.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Stephanie L Rouse
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, 2233 Post Street, Third Floor, San Francisco, CA, 94115, USA
| | - Jihyun Stephans
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, 2233 Post Street, Third Floor, San Francisco, CA, 94115, USA.,Division of Pediatric Otolaryngology-Head and Neck Surgery, University of California-San Francisco, 2233 Post Street, Third Floor, San Francisco, CA, 94115, USA
| | - David Conrad
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, 2233 Post Street, Third Floor, San Francisco, CA, 94115, USA.,Division of Pediatric Otolaryngology-Head and Neck Surgery, University of California-San Francisco, 2233 Post Street, Third Floor, San Francisco, CA, 94115, USA
| | - Josephine Czechowicz
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, 2233 Post Street, Third Floor, San Francisco, CA, 94115, USA.,Division of Pediatric Otolaryngology-Head and Neck Surgery, University of California-San Francisco, 2233 Post Street, Third Floor, San Francisco, CA, 94115, USA
| | - Ian R Matthews
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, 2233 Post Street, Third Floor, San Francisco, CA, 94115, USA
| | - Anna K Meyer
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, 2233 Post Street, Third Floor, San Francisco, CA, 94115, USA.,Division of Pediatric Otolaryngology-Head and Neck Surgery, University of California-San Francisco, 2233 Post Street, Third Floor, San Francisco, CA, 94115, USA
| | - Garani S Nadaraja
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, 2233 Post Street, Third Floor, San Francisco, CA, 94115, USA.,Division of Pediatric Otolaryngology-Head and Neck Surgery, University of California-San Francisco, 2233 Post Street, Third Floor, San Francisco, CA, 94115, USA
| | - Rajan Parikh
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, 2233 Post Street, Third Floor, San Francisco, CA, 94115, USA
| | - Jordan Virbalas
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, 2233 Post Street, Third Floor, San Francisco, CA, 94115, USA.,Division of Pediatric Otolaryngology-Head and Neck Surgery, University of California-San Francisco, 2233 Post Street, Third Floor, San Francisco, CA, 94115, USA
| | - Jacqueline E Weinstein
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, 2233 Post Street, Third Floor, San Francisco, CA, 94115, USA.,Division of Pediatric Otolaryngology-Head and Neck Surgery, University of California-San Francisco, 2233 Post Street, Third Floor, San Francisco, CA, 94115, USA
| | - Dylan K Chan
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, 2233 Post Street, Third Floor, San Francisco, CA, 94115, USA. .,Division of Pediatric Otolaryngology-Head and Neck Surgery, University of California-San Francisco, 2233 Post Street, Third Floor, San Francisco, CA, 94115, USA.
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16
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Lindberg NM, Gutierrez AM, Mittendorf KF, Ramos MA, Anguiano B, Angelo F, Joseph G. Creating accessible Spanish language materials for Clinical Sequencing Evidence-Generating Research consortium genomic projects: challenges and lessons learned. Per Med 2021; 18:441-454. [PMID: 34448595 PMCID: PMC8438935 DOI: 10.2217/pme-2020-0075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/26/2021] [Indexed: 01/31/2023]
Abstract
Aim: To increase Spanish speakers' representation in genomics research, accessible study materials on genetic topics must be made available in Spanish. Materials & methods: The Clinical Sequencing Evidence-Generating Research consortium is evaluating genome sequencing for underserved populations. All sites needed Spanish translation of recruitment materials, surveys and return of results. Results: We describe our process for translating site-specific materials, as well as shared measures across sites, to inform future efforts to engage Spanish speakers in research. Conclusion: In translating and adapting study materials for roughly 1000 Spanish speakers across the USA, and harmonizing translated measures across diverse sites, we overcame numerous challenges. Translation should be performed by professionals. Studies must allocate sufficient time, effort and budget to translate and adapt participant materials.
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Affiliation(s)
- Nangel M Lindberg
- Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Ave, Portland, OR 97227, USA
| | - Amanda M Gutierrez
- Baylor College of Medicine Center for Medical Ethics & Health Policy, One Baylor Plaza, Suite 310D, Houston, TX 77030, USA
| | - Kathleen F Mittendorf
- Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Ave, Portland, OR 97227, USA
| | - Michelle A Ramos
- Department of Population Health Science & Policy Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY 10029, USA
| | - Beatriz Anguiano
- University of California, San Francisco (UCSF) Program in Bioethics, 3333 California Ave (suite 340), San Francisco, CA 94606, USA
| | - Frank Angelo
- CSER Coordinating Center, University of Washington, Division of Medical Genetics, Health Sciences Building, K-253 Box 357720 Seattle, WA 98195, USA
| | - Galen Joseph
- University of California San Francisco Department of Humanities & Social Sciences, 1450 3rd Street, Rm. 551 San Francisco, CA 94143, USA
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17
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Krivokuca A, Mihajlovic M, Susnjar S, Spasojevic IB, Minic I, Popovic L, Brankovic-Magic M. Mutational profile of hereditary breast and ovarian cancer - Establishing genetic testing guidelines in a developing country. Curr Probl Cancer 2021; 46:100767. [PMID: 34284872 DOI: 10.1016/j.currproblcancer.2021.100767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 05/16/2021] [Accepted: 06/15/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Because many countries lack the capacity to follow the international guidelines for genetic testing, we suggest the specific approach for establishing local genetic testing guidelines that could be applied in developing countries. We focus on hereditary breast (BC) and ovarian cancer (OC) in Serbia. METHODS From the cohort of 550 persons who were referred for genetic counseling at the Institute for Oncology and Radiology of Serbia, 392 were selected. Personal and family histories were collected and germline DNA was sequenced with NGS in a panel of 20 genes. RESULTS Pathogenic (PV) and likely-pathogenic variants (LPV) were detected in 8 genes with the frequency of 23.7%. The most frequent were in BRCA1(7.6%), BRCA2(4.8%), PALB2(4.1%) and CHEK2(3.8%). They were also detected in ATM(1.8%), NBN(0.8%), TP53(0.5%) and RAD51C(0.3%). Whereas high carrier probability (CP), bilateral BC, BC and OC in the same patient and family history (FH) of BC/OC, were the strongest predictors for BRCA1/2 PV/LPV, lower CP values and early age of BC onset without FH were associated with higher frequency of PALB2 and CHEK2 PV/LPV. CONCLUSIONS Population specific studies to identify specific mutational patterns and predictors of PV/LPV should be conducted in order to make scientifically sound and cost-effective guidelines for genetic testing in developing countries.
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Affiliation(s)
- Ana Krivokuca
- Department for genetic counseling for hereditary cancers, Institute for Oncology and radiology of Serbia, Belgrade.
| | - Milica Mihajlovic
- Department for genetic counseling for hereditary cancers, Institute for Oncology and radiology of Serbia, Belgrade
| | - Snezana Susnjar
- Medical Oncology Department, Institute of Oncology and Radiology of Serbia, Belgrade
| | | | - Ivana Minic
- Medical Oncology Department, Institute of Oncology and Radiology of Serbia, Belgrade
| | - Lazar Popovic
- Medical Oncology Department, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Mirjana Brankovic-Magic
- Department for genetic counseling for hereditary cancers, Institute for Oncology and radiology of Serbia, Belgrade
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18
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Riddle L, Amendola LM, Gilmore MJ, Guerra C, Biesecker B, Kauffman TL, Anderson K, Rope AF, Leo MC, Caruncho M, Jarvik GP, Wilfond B, Goddard KAB, Joseph G. Development and early implementation of an Accessible, Relational, Inclusive and Actionable approach to genetic counseling: The ARIA model. PATIENT EDUCATION AND COUNSELING 2021; 104:969-978. [PMID: 33549385 PMCID: PMC8881934 DOI: 10.1016/j.pec.2020.12.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 12/07/2020] [Accepted: 12/21/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To describe the training and early implementation of the ARIA model of genetic counseling (Accessible, Relational, Inclusive, Actionable). METHODS As part of the Cancer Health Assessments Reaching Many (CHARM) study, an interdisciplinary workgroup developed the ARIA curriculum and trained genetic counselors to return exome sequencing results using the ARIA model. CURRICULUM The ARIA curriculum includes didactic elements, discussion, readings, role plays, and observations of usual care genetic counseling sessions. The ARIA model provides the skills and strategies needed for genetic counseling to be accessible to all patients, regardless of prior knowledge or literacy level; involves appropriate psychological and social counseling without overwhelming the patient with information; and leaves the patient with clear and actionable next steps. CONCLUSION With sufficient training and practice, the ARIA model appears to be feasible, with promise for ensuring that genetic counselors' communication is accessible, relational, inclusive and actionable for the diverse patients participating in genomic medicine. PRACTICE IMPLICATIONS ARIA offers a coherent set of principles and strategies for effective communication with patients of all literacy levels and outlines specific techniques to practice and incorporate these skills into routine practice. The ARIA model could be integrated into genetic counseling training programs and practice, making genetic counseling more accessible and meaningful for all patients.
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Affiliation(s)
- Leslie Riddle
- Department of Humanities and Social Sciences, University of California, San Francisco, 1450 3rd St., San Francisco, CA 94158, USA
| | - Laura M Amendola
- Division of Medical Genetics, Department of Medicine, University of Washington Medical Center, 1705 NE Pacific St. Box 357720, Seattle, WA 98195, USA
| | - Marian J Gilmore
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227, USA
| | - Claudia Guerra
- Department of General Internal Medicine, University of California, San Francisco, 1450 3rd St. Box 0128, San Francisco, CA 94158, USA
| | | | - Tia L Kauffman
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227, USA
| | - Katherine Anderson
- Denver Health and Hospital Authority, MC 3150, 777 Bannock, Denver, CO 80204, USA
| | - Alan F Rope
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227, USA
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227, USA
| | - Mikaella Caruncho
- Department of Humanities and Social Sciences, University of California, San Francisco, 1450 3rd St., San Francisco, CA 94158, USA
| | - Gail P Jarvik
- Division of Medical Genetics, Department of Medicine, University of Washington Medical Center, 1705 NE Pacific St. Box 357720, Seattle, WA 98195, USA
| | - Benjamin Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, M/S JMB-6, 1900 Ninth Ave., Seattle, WA 98101, USA
| | - Katrina A B Goddard
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227, USA
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, 1450 3rd St., San Francisco, CA 94158, USA
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19
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Abdel-Razeq H. Expanding the search for germline pathogenic variants for breast cancer. How far should we go and how high should we jump? The missed opportunity! Oncol Rev 2021; 15:544. [PMID: 34267891 PMCID: PMC8256373 DOI: 10.4081/oncol.2021.544] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/08/2021] [Indexed: 12/09/2022] Open
Abstract
Since the identification of BRCA1 and BRCA2 genes 3 decades ago, genetic testing and genetic counseling have become an integral part of routine clinical practice. The risk of breast cancer among carriers of germline pathogenic variants, like BRCA1 and BRCA2, is well established. Risk-reducing interventions, including bilateral mastectomies and salpingo-oophorectomies are both effective and have become more acceptable. Many researchers and professional societies view current guidelines as restrictive and may miss many at-risk women, and are calling to expand testing to include all patients with breast cancer, regardless of their personal or family history of cancer, while others are calling for wider adoption to even include all healthy women at age 30 or older. This review will address expanding testing in two directions; horizontally to include more patients, and even healthy women, and vertically to include more genes using next-generation sequencing-based multi-gene panel testing.
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Affiliation(s)
- Hikmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, School of Medicine, University of Jordan, Amman, Jordan
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20
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Reid S, Pal T. Update on multi-gene panel testing and communication of genetic test results. Breast J 2020; 26:1513-1519. [PMID: 32639074 PMCID: PMC7484453 DOI: 10.1111/tbj.13971] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 11/14/2019] [Indexed: 12/20/2022]
Abstract
With technological advances, multi-gene panel testing has become increasingly used to identify patients at risk for hereditary breast cancer (HBC). There are currently evidence-based interventions and breast cancer screening strategies that exist for cancer prevention and early detection among patients with HBC. Moreover, in addition to the personal impact of identifying HBC, this information may be shared with at-risk family members to amplify the benefits of testing and subsequent care among those at high risk. Opportunities and challenges with the utilization of updated multi-gene panel testing for HBC, including: (a) tumor sequencing with germline consequences; (b) genetic counseling implications; and (c) strategies to improve the communication of genetic test results to family members will be reviewed. With the advances and expansion of genetic testing, all health care providers need to be updated on both the importance and complexities of HBC counseling and testing, in order to optimize patient care.
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Affiliation(s)
- Sonya Reid
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tuya Pal
- Vanderbilt University Medical Center, Nashville, Tennessee
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21
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Roberts ME, Susswein LR, Janice Cheng W, Carter NJ, Carter AC, Klein RT, Hruska KS, Marshall ML. Ancestry-specific hereditary cancer panel yields: Moving toward more personalized risk assessment. J Genet Couns 2020; 29:598-606. [PMID: 32227564 DOI: 10.1002/jgc4.1257] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/20/2020] [Accepted: 02/23/2020] [Indexed: 12/11/2022]
Abstract
Healthcare disparities in genomic medicine are well described. Despite some improvements, we continue to see fewer individuals of African American, Asian, and Hispanic ancestry undergo genetic counseling and testing compared to those of European ancestry. It is well established that variant of uncertain significance (VUS) rates are higher among non-European ancestral groups undergoing multi-gene hereditary cancer panel testing. However, pathogenic variant (PV) yields, and genomic data in general, are often reported in aggregate and derived from cohorts largely comprised of individuals of European ancestry. We performed a retrospective review of clinical and ancestral data for individuals undergoing multi-gene hereditary cancer panel testing to determine ancestry-specific PV and VUS rates. An ancestry other than European was reported in 29,042/104,851 (27.7%) of individuals. Compared to Europeans (9.4%), individuals of Middle Eastern ancestry were more likely to test positive for one or more pathogenic variants (12.1%, p = .0025), while African Americans were less likely (7.9%, p < .0001). Asian and Middle Eastern individuals were most likely (34.8% and 33.2%, respectively) to receive a report with an overall classification of VUS, while individuals of Ashkenazi Jewish and European ancestry were least likely (17.1% and 20.4%, respectively). These data suggest that in addition to higher VUS rates, there may be ancestry-specific PV yields. Providing aggregate data derived from cohorts saturated with European individuals does not adequately reflect genetic testing outcomes in minority groups, and interrogation of ancestry-specific data is a step toward a more personalized risk assessment.
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Affiliation(s)
| | | | - Wanchun Janice Cheng
- BioReference Laboratories, Inc., Elmwood Park, New Jersey.,Sarah Lawrence College, Genetic Counseling Program, Bronxville, New York
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22
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Pal T, Agnese D, Daly M, La Spada A, Litton J, Wick M, Klugman S, Esplin ED, Jarvik GP. Points to consider: is there evidence to support BRCA1/2 and other inherited breast cancer genetic testing for all breast cancer patients? A statement of the American College of Medical Genetics and Genomics (ACMG). Genet Med 2019; 22:681-685. [PMID: 31831881 DOI: 10.1038/s41436-019-0712-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 11/14/2019] [Indexed: 01/26/2023] Open
Affiliation(s)
- Tuya Pal
- Department of Medicine Division of Genetic Medicine, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Doreen Agnese
- Department of Internal Medicine Division of Surgical Oncology, The Ohio State University, Columbus, OH, USA
| | - Mary Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Albert La Spada
- Departments of Neurology, Neurobiology, and Cell Biology, Duke Center for Neurodegeneration & Neurotherapeutics, Duke University Medical Center, Durham, NC, USA
| | - Jennifer Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Myra Wick
- Departments of Obstetrics and Gynecology and Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Susan Klugman
- Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | | | - Gail P Jarvik
- Departments of Medicine (Medical Genetics) and Genome Sciences, University of Washington Medical Center, Seattle, WA, USA
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23
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Catana A, Apostu AP, Antemie RG. Multi gene panel testing for hereditary breast cancer - is it ready to be used? Med Pharm Rep 2019; 92:220-225. [PMID: 31460501 PMCID: PMC6709965 DOI: 10.15386/mpr-1083] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 02/28/2019] [Accepted: 03/27/2019] [Indexed: 02/06/2023] Open
Abstract
Breast cancer is one of the most common malignancies and the leading cause of death among women worldwide. About 20% of breast cancers are hereditary. Approximately 30% of the mutations have remained negative after testing BRCA1/2 even in families with a Mendelian inheritance pattern for breast cancer. Additional non-BRCA genes have been identified as predisposing for breast cancer. Multi gene panel testing tries to cover and explain the BRCA negative inherited breast cancer, improving efficiency, speed and costs of the breast cancer screening. We identified 23 studies reporting results from individuals who have undergone multi gene panel testing for hereditary breast cancer and noticed a prevalence of 1-12% of non-BRCA genes, but also a high level of variants of uncertain significance. A result with a high level of variants of uncertain significance is likely to be more costly than bring benefits, as well as increase the anxiety for patients. Regarding further development of multi gene panel testing, more research is required to establish both the optimal care of patients with cancer (specific treatments like PARP inhibitors) and the management of unaffected individuals (chemoprevention and/or prophylactic surgeries). Early detection in these patients as well as prophylactic measures will significantly increase the chance of survival. Therefore, multi gene panel testing is not yet ready to be used outside clear guidelines. In conclusion, studies on additional cohorts will be needed to better define the real prevalence, penetrance and the variants of these genes, as well as to describe clear evidence-based guidelines for these patients.
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Affiliation(s)
- Andreea Catana
- Genetics Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Razvan-Geo Antemie
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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24
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Cragun D, Weidner A, Kechik J, Pal T. Genetic Testing Across Young Hispanic and Non-Hispanic White Breast Cancer Survivors: Facilitators, Barriers, and Awareness of the Genetic Information Nondiscrimination Act. Genet Test Mol Biomarkers 2019; 23:75-83. [PMID: 30676117 DOI: 10.1089/gtmb.2018.0253] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AIMS This study compared facilitators and barriers to genetic testing and determined awareness about the Genetic Information Nondiscrimination Act (GINA) across young Hispanic and non-Hispanic white (NHW) breast cancer (BC) survivors. MATERIALS AND METHODS Women diagnosed with BC of age ≤50 years in 2009-2012 were recruited through the Florida State Cancer Registry to complete a questionnaire. RESULTS There were 1182 participants of which 61% (174/285) of Hispanic patients, and 65% (580/897) of NHW patients had BC testing. Among untested participants, the most common barriers were lack of testing recommendation (44% Hispanics, 32% NHW; p = 0.02) and cost-related concerns (41% Hispanics, 40% NHW; p = 0.83). Among tested participants, the top facilitators were as follows: (1) "To benefit my family's future" (70% Hispanic, 68% NHW), (2) "My doctor recommended testing" (60% Hispanic, 54% NHW), and (3) "Minimal cost to me" (59% Hispanic, 72% NHW). Only 27% of tested and 15% of untested women were aware of GINA; misuse of test results was reported as a barrier for only 6.5%. CONCLUSIONS Rates of genetic testing recommendation are lower among Hispanics, but both groups reported additional barriers. Most are unaware of GINA, yet misuse is not a highly cited barrier. Findings suggest the need to educate providers on the importance of recommending testing to all who meet criteria; increase awareness of newer options for more affordable testing; and bolster facilitators that may increase testing uptake.
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Affiliation(s)
- Deborah Cragun
- 1 Department of Global Health, College of Public Health, University of South Florida, Tampa, Florida.,2 Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Anne Weidner
- 3 Vanderbilt University Medical Center, Department of Medicine, Division of Genetic Medicine, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Joy Kechik
- 1 Department of Global Health, College of Public Health, University of South Florida, Tampa, Florida
| | - Tuya Pal
- 3 Vanderbilt University Medical Center, Department of Medicine, Division of Genetic Medicine, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
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25
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Affiliation(s)
- Violeta Lopez
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Nursing, National University of Singapore, Singapore
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26
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Cragun DL, Kechik J, Pal T. Complexities of genetic screening and testing in hereditary colorectal cancer. SEMINARS IN COLON AND RECTAL SURGERY 2018. [DOI: 10.1053/j.scrs.2018.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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27
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Steffen LE, Du R, Gammon A, Mandelblatt JS, Kohlmann WK, Lee JH, Buys SS, Stroup AM, Campo RA, Flores KG, Vicuña B, Schwartz MD, Kinney AY. Genetic Testing in a Population-Based Sample of Breast and Ovarian Cancer Survivors from the REACH Randomized Trial: Cost Barriers and Moderators of Counseling Mode. Cancer Epidemiol Biomarkers Prev 2017; 26:1772-1780. [PMID: 28971986 DOI: 10.1158/1055-9965.epi-17-0389] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/12/2017] [Accepted: 09/14/2017] [Indexed: 11/16/2022] Open
Abstract
Background: This study evaluates predictors of BRCA1/2 testing among breast and ovarian cancer survivors who received genetic counseling as part of a randomized trial and evaluates moderators of counseling mode on testing uptake.Methods: Predictors of BRCA1/2 testing within one year postcounseling were evaluated using multivariable logistic regression in a population-based sample of breast and ovarian cancer survivors at increased hereditary risk randomly assigned to in-person counseling (IPC; n = 379) versus telephone counseling (TC; n = 402). Variables that moderated the association between counseling mode and testing were identified by subgroup analysis.Results: Testing uptake was associated with higher perceived comparative mutation risk [OR = 1.32; 95% confidence interval (CI), 1.11-1.57] in the adjusted analysis. Those without cost barriers had higher testing uptake (OR = 18.73; 95% CI, 7.09-49.46). Psychologic distress and perceived comparative mutation risk moderated the effect of counseling and testing. Uptake between IPC versus TC did not differ at low levels of distress and risk, but differed at high distress (26.3% TC vs. 44.3% IPC) and high perceived comparative risk (33.9% TC vs. 50.5% IPC).Conclusions: Cost concerns are a strong determinant of testing. Differences in testing uptake by counseling mode may depend on precounseling distress and risk perceptions.Impact: Cost concerns may contribute to low testing in population-based samples of at-risk cancer survivors. Precounseling psychosocial characteristics should be considered when offering in-person versus telephone counseling. Cancer Epidemiol Biomarkers Prev; 26(12); 1772-80. ©2017 AACR.
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Affiliation(s)
- Laurie E Steffen
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ruofei Du
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico.,Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Amanda Gammon
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Jeanne S Mandelblatt
- Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC
| | - Wendy K Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Ji-Hyun Lee
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico.,Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Saundra S Buys
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Antoinette M Stroup
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.,Department of Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - Rebecca A Campo
- National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Kristina G Flores
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico
| | - Belinda Vicuña
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Marc D Schwartz
- Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC
| | - Anita Y Kinney
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico. .,Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
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