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Morganroth J, Bardakjian TM, Dratch L, Quinn CC, Elman LB. Enhancing Clinical Infrastructure for the Delivery of Intrathecal and Genetic Therapies: A Qalsody (Tofersen) Model for Patients With SOD1-ALS. Neurol Clin Pract 2024; 14:e200303. [PMID: 38855716 PMCID: PMC11157423 DOI: 10.1212/cpj.0000000000200303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 02/06/2024] [Indexed: 06/11/2024]
Abstract
Background Qalsody (tofersen), an intrathecal therapy (IT) antisense oligonucleotide (ASO), was granted accelerated approval by the Food and Drug Administration for the treatment of SOD1-mediated amyotrophic lateral sclerosis (ALS) on April 25, 2023. Academic centers need to be prepared for expedited drug delivery. The purpose of this model was to predict the number of SOD1-ALS patients whom we expect to see at our center at the time of Qalsody approval and to use it to extrapolate to a model for a hypothetical sporadic IT ALS therapy. Recent Findings We predicted that 6 symptomatic and 14 presymptomatic SOD1 patients would come to our center, whereas a sporadic therapy would generate 108 patients, creating excess office visits, lumbar punctures, and genetic counseling visits. Implications for Practice As new therapies for neurologic diseases come to market, preparing for increased office volume and complex drug delivery are essential for optimal care.
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Smith AJB, O'Brien C, Haggerty A, Ko EM, Rendle KA. "Having cancer is very expensive": A qualitative study of patients with ovarian cancer and PARP inhibitor treatment. Gynecol Oncol 2024; 186:170-175. [PMID: 38691987 DOI: 10.1016/j.ygyno.2024.04.018] [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: 01/10/2024] [Revised: 03/26/2024] [Accepted: 04/21/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE To examine patient barriers and facilitators to PARP inhibitor (PARP-I) maintenance therapy in ovarian cancer. PARP-I improves survival in ovarian cancer, but these multi-year therapies cost around $100,000 annually and are under-prescribed. METHODS We recruited patients with ovarian cancer treated with PARP-I maintenance therapy at an academic health system for a semi-structured interview. Patient demographics, including genetics and PARP-I cost, were self-reported. We assessed patient experiences with barriers and facilitators of PARP-I usage. Two team members used a thematic approach to analyze and identify key themes. RESULTS In May 2022, we interviewed 10 patients (mean age = 65 years; 80% White; 60% with a germline genetic mutation). Patients paid on average $227.50 monthly for PARP-I, straining resources for some participants. While sampled patients were insured, all patients identified having no or inadequate insurance as a major barrier to PARP-I. At the same time, all participants prioritized clinical effectiveness over costs of care. Patients identified PARP-I delivery from specialty pharmacies, separate and different from other medications, as a potential barrier, but each had been able to navigate delivery. Patients expressed significant initial side effects of PARP-I as a potential barrier yet reported clinician communication and prompt dose reduction as facilitating continuation. CONCLUSIONS Patients identified cost, restrictive pharmacy benefits, and initial side effects as barriers to PARP-I usage. Having insurance and a supportive care team were identified as facilitators. Enhancing communication about PARP-I cost and side effects could improve patient experience and receipt of evidence-based maintenance therapy in ovarian cancer.
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Affiliation(s)
- Anna Jo Bodurtha Smith
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America; Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States of America; Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, United States of America; Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, United States of America.
| | - Caroline O'Brien
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Ashley Haggerty
- Division of Gynecologic Oncology, Hackensack Meridian Health, Red Bank, NJ, United States of America
| | - Emily M Ko
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America; Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, United States of America; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States of America; Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Katharine A Rendle
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States of America; Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, United States of America; Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, United States of America
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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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Peng W, Chuan CH, Morgan SE. Assessing the role of interactivity: An evaluation of information aids to support the enrollment of precision medicine research programs. PATIENT EDUCATION AND COUNSELING 2023; 110:107648. [PMID: 36753934 DOI: 10.1016/j.pec.2023.107648] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Recruiting diverse participants for precision medicine (PM) research programs should overcome low literacy and varied expectations. Information aids (IA) can address these barriers through patient-centered education. The purpose of this study was to evaluate the effectiveness of three information aids (IA) on participating in PM. METHODS An experiment with 290 U.S. participants recruited from Mturk was conducted to compare the effects of three IAs on the outcomes related to participation. Three conditions included an interactive IA (i.e., providing PM-related information responding to each participant's questions), a static IA (i.e., providing uniform PM-related information), and a control condition (i.e., providing non-interactive information irrelevant to PM). RESULTS Both interactive and non-interactive IAs increased attitudes and information-seeking intentions, but not knowledge or participation intention. Perceived control and responsiveness mediated the effects of interactive IA. CONCLUSION Both interactive and static IAs supported enrollment efforts for PM through fostering attitudes and follow-up information-seeking. Increased perceived control and responsiveness are key to the effects of interactive IA. PRACTICE IMPLICATIONS IAs provide effective education and enrollment support for PM. Interactive IA can respond to individuals' inquiries and control the learning process.
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Affiliation(s)
- Wei Peng
- Edward R. Murrow College of Communication, Washington State University, Pullman, WA 99164, USA.
| | - Ching-Hua Chuan
- Department of Interactive Media, University of Miami, Coral Gables, FL 33146, USA
| | - Susan E Morgan
- Department of Communication Studies, University of Miami, Coral Gables, FL 33146, USA
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Schick S, Manghelli J, Ludwig KK. The Role of the Surgeon in the Germline Testing of the Newly Diagnosed Breast Cancer Patient. Curr Oncol 2023; 30:4677-4687. [PMID: 37232811 DOI: 10.3390/curroncol30050353] [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: 02/28/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 05/27/2023] Open
Abstract
For patients with newly diagnosed breast cancer, information regarding hereditary predisposition can influence treatment decisions. From a surgical standpoint, patients with known germline mutations may alter decisions of local therapy to reduce the risk of second breast primaries. This information may also be considered in the choice of adjuvant therapies or eligibility for clinical trials. In recent years, the criteria for the consideration of germline testing in patients with breast cancer has expanded. Additionally, studies have shown a similar prevalence of pathogenic mutations in those patients outside of these traditional criteria, prompting calls for genetic testing for all patients with a history of breast cancer. While data confirms the benefit of counseling by certified genetics professionals, the capacity of genetic counselors may no longer meet the needs of these growing numbers of patients. National societies assert that counseling and testing can be performed by providers with training and experience in genetics. Breast surgeons are well positioned to offer this service, as they receive formal genetics training during their fellowship, manage these patients daily in their practices, and are often the first providers to see patients after their cancer diagnosis.
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Affiliation(s)
- Stephanie Schick
- Department of Surgery, School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| | - Joshua Manghelli
- Department of Surgery, School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| | - Kandice K Ludwig
- Department of Surgery, School of Medicine, Indiana University, Indianapolis, IN 46202, USA
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Gerido LH, Griggs JJ, Resnicow K, Kidwell KM, Delacroix E, Austin S, Hanson EN, Bacon E, Koeppe E, Goodall S, Demerath M, Rizzo EA, Weiner S, Hawley ST, Uhlmann WR, Roberts JS, Stoffel EM. The Michigan Genetic Hereditary Testing (MiGHT) study's innovative approaches to promote uptake of clinical genetic testing among cancer patients: a study protocol for a 3-arm randomized controlled trial. Trials 2023; 24:105. [PMID: 36765432 PMCID: PMC9911941 DOI: 10.1186/s13063-023-07125-2] [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: 12/05/2022] [Accepted: 01/28/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Although most cancers are sporadic, germline genetic variants are implicated in 5-10% of cancer cases. Clinical genetic testing identifies pathogenic germline genetic variants for hereditary cancers. The Michigan Genetic Hereditary Testing (MiGHT) study is a three-arm randomized clinical trial that aims to test the efficacy of two patient-level behavioral interventions on uptake of cancer genetic testing. METHODS The two interventions being tested are (1) a virtual genetics navigator and (2) motivational interviewing by genetic health coaches. Eligible participants are adults with a diagnosis of breast, prostate, endometrial, ovarian, colorectal, or pancreatic cancer who meet the National Comprehensive Cancer Network (NCCN) criteria for genetic testing. Participants are recruited through community oncology practices affiliated with the Michigan Oncology Quality Consortium (MOQC) and have used the Family Health History Tool (FHHT) to determine testing eligibility. The recruitment goal is 759 participants, who will be randomized to usual care or to either the virtual genetics navigator or the motivational interviewing intervention arms. The primary outcome will be the proportion of individuals who complete germline genetic testing within 6 months. DISCUSSION This study addresses patient-level factors which are associated with the uptake of genetic testing. The study will test two different intervention approaches, both of which can help address the shortage of genetic counselors and improve access to care. TRIAL REGISTRATION This study has been approved by the Institutional Review Board of the University of Michigan Medical School (HUM00192898) and registered in ClinicalTrials.gov (NCT05162846).
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Affiliation(s)
| | - Jennifer J Griggs
- University of Michigan School of Public Health, Ann Arbor, USA
- University of Michigan Rogel Cancer Center, Ann Arbor, USA
- University of Michigan School of Medicine, Ann Arbor, USA
| | - Ken Resnicow
- University of Michigan School of Public Health, Ann Arbor, USA
- University of Michigan Rogel Cancer Center, Ann Arbor, USA
| | - Kelley M Kidwell
- University of Michigan School of Public Health, Ann Arbor, USA
- University of Michigan Rogel Cancer Center, Ann Arbor, USA
| | - Emerson Delacroix
- University of Michigan School of Public Health, Ann Arbor, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, USA
| | - Sarah Austin
- University of Michigan Rogel Cancer Center, Ann Arbor, USA
| | - Erika N Hanson
- Department of Internal Medicine, University of Michigan, Ann Arbor, USA
| | - Elizabeth Bacon
- Department of Internal Medicine, University of Michigan, Ann Arbor, USA
| | - Erika Koeppe
- University of Michigan Rogel Cancer Center, Ann Arbor, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, USA
| | | | | | | | - Shayna Weiner
- University of Michigan Rogel Cancer Center, Ann Arbor, USA
| | - Sarah T Hawley
- University of Michigan Rogel Cancer Center, Ann Arbor, USA
| | - Wendy R Uhlmann
- University of Michigan School of Medicine, Ann Arbor, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, USA
| | - J Scott Roberts
- University of Michigan School of Public Health, Ann Arbor, USA
| | - Elena M Stoffel
- University of Michigan Rogel Cancer Center, Ann Arbor, USA
- University of Michigan School of Medicine, Ann Arbor, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, USA
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Ramsey ML, Tomlinson J, Pearlman R, Abushahin L, Aeilts A, Chen HZ, Chen Y, Compton A, Elkhatib R, Geiger L, Hays J, Jeter J, Jin N, Malalur P, Roychowdhury S, Ruple J, Prebish J, Stanich PP, Hampel H. Mainstreaming germline genetic testing for patients with pancreatic cancer increases uptake. Fam Cancer 2023; 22:91-97. [PMID: 35713757 PMCID: PMC9204376 DOI: 10.1007/s10689-022-00300-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/29/2022] [Indexed: 01/17/2023]
Abstract
Germline genetic testing is recommended for all patients with pancreatic cancer (PC) but uptake rates are low. We implemented a mainstreaming program in oncology clinics to increase testing for PC patients. Genetic counselors trained oncology providers to offer a standardized multigene panel and obtain informed consent using an educational video. Pre-test genetic counseling was available upon request. Otherwise, patients with identified pathogenic variants, strong family history, or questions regarding their results were referred for post-test genetic counseling. We measured rates of testing and genetic counseling visits. From September 2019 to April 2021, 245 patients with PC underwent genetic testing. This represents a 6.5-fold increase in germline testing volume (95% confidence interval 5.2-8.1) compared to previous years. At least one pathogenic or likely pathogenic variant (PV/LPV) was found in 34 (13.9%) patients, including 17 (6.9%) PV/LPVs in high or moderate risk genes and 18 (7.3%) in low risk or recessive genes. Five (2.0%) PVs had implications on treatment selection. 22 of the positive patients (64.7%) and an additional 8 PC patients (1 negative, 3 VUS, and 4 pre-test) underwent genetic counseling during the study period. Genetic counselors saw 2.0 PC patients/month prior to this project, 1.6 PC patients/month during this project, and would have seen 2.2 PC patients/month if all patients with pathogenic variants attended post-test counseling. Conclusions Mainstreaming genetic testing expands access for PC patients without overwhelming genetic counseling resources.
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Affiliation(s)
- Mitchell L Ramsey
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jewel Tomlinson
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rachel Pearlman
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Laith Abushahin
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Amber Aeilts
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Hui-Zi Chen
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Yan Chen
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ashley Compton
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rifat Elkhatib
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Levi Geiger
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John Hays
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Joanne Jeter
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ning Jin
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Pannaga Malalur
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sameek Roychowdhury
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jessica Ruple
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jennifer Prebish
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Peter P Stanich
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Heather Hampel
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
- The Ohio State University Comprehensive Cancer Center, 2012 Kenny Road, Room 257, Columbus, OH, 43221, USA.
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Murray MF, Khoury MJ, Abul-Husn NS. Addressing the routine failure to clinically identify monogenic cases of common disease. Genome Med 2022; 14:60. [PMID: 35672798 PMCID: PMC9175445 DOI: 10.1186/s13073-022-01062-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 05/16/2022] [Indexed: 12/14/2022] Open
Abstract
Changes in medical practice are needed to improve the diagnosis of monogenic forms of selected common diseases. This article seeks to focus attention on the need for universal genetic testing in common diseases for which the recommended clinical management of patients with specific monogenic forms of disease diverges from standard management and has evidence for improved outcomes.We review evidence from genomic screening of large patient cohorts, which has confirmed that important monogenic case identification failures are commonplace in routine clinical care. These case identification failures constitute diagnostic misattributions, where the care of individuals with monogenic disease defaults to the treatment plan offered to those with polygenic or non-genetic forms of the disease.The number of identifiable and actionable monogenic forms of common diseases is increasing with time. Here, we provide six examples of common diseases for which universal genetic test implementation would drive improved care. We examine the evidence to support genetic testing for common diseases, and discuss barriers to widespread implementation. Finally, we propose recommendations for changes to genetic testing and care delivery aimed at reducing diagnostic misattributions, to serve as a starting point for further evaluation and development of evidence-based guidelines for implementation.
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Affiliation(s)
- Michael F. Murray
- grid.47100.320000000419368710Yale Center for Genomic Health, Department of Genetics, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520 USA
| | - Muin J. Khoury
- grid.416738.f0000 0001 2163 0069Office of Genomics and Precision Public Health, Office of Science, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329 USA
| | - Noura S. Abul-Husn
- grid.59734.3c0000 0001 0670 2351Institute for Genomic Health, Division of Genomic Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1041, New York, NY 10029 USA
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Higashigawa S, Matsubayashi H, Kiyozumi Y, Kado N, Nishimura S, Oishi T, Sugino T, Fushiki K, Shirasu H, Yasui H, Mamesaya N, Fukuzaki N, Kunitomo K, Horiuchi Y, Kenmotsu H, Serizawa M. Present status of germline findings in precision medicine for Japanese cancer patients: issues in the current system. Jpn J Clin Oncol 2022; 52:599-608. [PMID: 35411369 DOI: 10.1093/jjco/hyac046] [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: 09/14/2021] [Revised: 12/11/2021] [Accepted: 03/07/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Since 2019, precision cancer medicine has been covered by national insurance in Japan; however, to date, germline findings have not been fully reported. The aim of this study was to evaluate the current status and raise a problem of germline finding analysis and disclosure in Japanese precision cancer medicine. METHODS Germline findings of 52 genes were examined in 296 cases with advanced cancer by a case series study. RESULTS Six (2.0%) cases were examined by the Oncoguide™ NCC Oncopanel with germline testing, but no germline findings were reported. The remaining 290 (98.0%) cases were analyzed by FoundationOne® CDx (tumor-only testing), which recognized 404 pathogenic variants; those of BRCA1/2 were recognized in 16 (5.5%) tumors. Our institutional algorithm suggested 39 candidate germline findings in 34 cases, while the public algorithm listed at least 91 candidate germline findings. Four germline findings had been previously identified (BRCA1: 3 and ATM: 1). Nine of 30 cases with candidate germline findings excluding these known germline findings refused or deferred germline testing. Only 4 of 16 cases that received counseling underwent germline testing, and those 4 revealed 3 germline findings (BRCA2, CDK4 and RAD51C); in total, 8 (2.7%) germline findings were revealed. Reasons for refusing genetic counseling and/or germline testing included extra hospital visits, added expense for germline testing due to limited national insurance coverage, poor patient physical condition and no known family members associated with the possible germline finding. CONCLUSIONS In current Japanese precision cancer medicine, only a small fraction of the patients undergoes germline testing and demonstrated germline finding. The current results suggested a need for earlier indications for precision cancer medicine, broader insurance coverage and more efficient germline finding prediction algorithms, to increase the number of germline testings and to improve the following managements.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Yasue Horiuchi
- Division of Genetic Medicine Promotion.,Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
| | | | - Masakuni Serizawa
- Clinical Research Center, Shizuoka Cancer Center, Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
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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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Whitaker KD, Obeid E, Daly MB, Hall MJ. Cascade Genetic Testing for Hereditary Cancer Risk: An Underutilized Tool for Cancer Prevention. JCO Precis Oncol 2022; 5:1387-1396. [PMID: 34994636 DOI: 10.1200/po.21.00163] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Kristen D Whitaker
- Department of Clinical Genetics, Fox Chase Cancer Center. Philadelphia, PA
| | - Elias Obeid
- Department of Clinical Genetics, Fox Chase Cancer Center. Philadelphia, PA
| | - Mary B Daly
- Department of Clinical Genetics, Fox Chase Cancer Center. Philadelphia, PA
| | - Michael J Hall
- Department of Clinical Genetics, Fox Chase Cancer Center. Philadelphia, PA
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12
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Doulaveris G, Igel CM, Estrada Trejo F, Fiorentino D, Rabin-Havt S, Klugman S, Dar P. Impact of introducing cell-free DNA screening into clinical care on first trimester ultrasound. Prenat Diagn 2022; 42:254-259. [PMID: 34989002 DOI: 10.1002/pd.6086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/07/2021] [Accepted: 12/30/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE First-trimester ultrasound is an important component of prenatal care. We investigated the impact of introducing cell-free DNA (cfDNA) aneuploidy screening into routine care, on performance of first-trimester ultrasound. METHODS Retrospective study of patients who had prenatal care at a tertiary referral center. We compared the performance of any first-trimester ultrasound between three different aneuploidy screening protocols, used consecutively during the study period: (1) combined first-trimester screening (FTS); (2) FTS and cfDNA offered together; (3) patients requested to choose between FTS and cfDNA. Secondary outcomes included performance of nuchal translucency (NT), aneuploidy screens and diagnostic genetic procedures. RESULTS The number of patients undergoing first-trimester ultrasound remained similar with the second protocol but decreased in the third (68.7% vs. 40.9%, OR 0.32, 95% CI 0.25-0.4, p < 0.001). Diagnostic procedures decreased between protocol 1 and 2 (7.6% vs. 4.4%, OR 0.59, 95% CI 0.37-0.93, p = 0.02) while NT scans decreased between protocol 2 and 3 (6.8% vs. 1.3%, OR 0.18, 95% CI 0.09-0.4, p < 0.001). The rate of FTS decreased over the study period and less women had cfDNA when they had to choose one method (p < 0.001). CONCLUSIONS Introducing cfDNA screening as an alternative to FTS, resulted in fewer patients receiving ultrasound in the first-trimester.
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Affiliation(s)
- Georgios Doulaveris
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Catherine M Igel
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Fatima Estrada Trejo
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Desiree Fiorentino
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sara Rabin-Havt
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Susan Klugman
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Pe'er Dar
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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13
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Lin GA, Trosman JR, Douglas MP, Weldon CB, Scheuner MT, Kurian A, Phillips KA. Influence of payer coverage and out-of-pocket costs on ordering of NGS panel tests for hereditary cancer in diverse settings. J Genet Couns 2021; 31:130-139. [PMID: 34231930 DOI: 10.1002/jgc4.1459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/27/2021] [Accepted: 05/30/2021] [Indexed: 11/06/2022]
Abstract
The landscape of payment for genetic testing has been changing, with an increase in the number of laboratories offering testing, larger panel offerings, and lower prices. To determine the influence of payer coverage and out-of-pocket costs on the ordering of NGS panel tests for hereditary cancer in diverse settings, we conducted semi-structured interviews with providers who conduct genetic counseling and order next-generation sequencing (NGS) panels purposefully recruited from 11 safety-net clinics and academic medical centers (AMCs) in California and North Carolina, states with diverse populations and divergent Medicaid expansion policies. Thematic analysis was done to identify themes related to the impact of reimbursement and out-of-pocket expenses on test ordering. Specific focus was put on differences between settings. Respondents from both safety-net clinics and AMCs reported that they are increasingly ordering panels instead of single-gene tests, and tests were ordered primarily from a few commercial laboratories. Surprisingly, safety-net clinics reported few barriers to testing related to cost, largely due to laboratory assistance with prior authorization requests and patient payment assistance programs that result in little to no patient out-of-pocket expenses. AMCs reported greater challenges navigating insurance issues, particularly prior authorization. Both groups cited non-coverage of genetic counseling as a major barrier to testing. Difficulty of access to cascade testing, particularly for family members that do not live in the United States, was also of concern. Long-term sustainability of laboratory payment assistance programs was a major concern; safety-net clinics were particularly concerned about access to testing without such programs. There were few differences between states. In conclusion, the use of laboratories with payment assistance programs reduces barriers to NGS panel testing among diverse populations. Such programs represent a major change to the financing and affordability of genetic testing. However, access to genetic counseling is a barrier and must be addressed to ensure equity in testing.
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Affiliation(s)
- Grace A Lin
- Department of Medicine, University of California, San Francisco, CA, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.,Department of Clinical Pharmacy, Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), University of California-San Francisco, San Francisco, CA, USA
| | - Julia R Trosman
- Department of Clinical Pharmacy, Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), University of California-San Francisco, San Francisco, CA, USA.,Center for Business Models in Healthcare, Glencoe, IL, USA
| | - 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
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.,Department of Clinical Pharmacy, Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), University of California-San Francisco, San Francisco, CA, USA.,UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Allison Kurian
- Departments of Medicine and of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Kathryn A Phillips
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.,Department of Clinical Pharmacy, Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), University of California-San Francisco, San Francisco, CA, USA.,UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
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14
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Grant P, Langlois S, Lynd LD, Austin JC, Elliott AM. Out-of-pocket and private pay in clinical genetic testing: A scoping review. Clin Genet 2021; 100:504-521. [PMID: 34080181 DOI: 10.1111/cge.14006] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 12/19/2022]
Abstract
Full coverage of the cost of clinical genetic testing is not always available through public or private insurance programs, or a public healthcare system. Consequently, some patients may be faced with the decision of whether to finance testing out-of-pocket (OOP), meet OOP expenses required by their insurer, or not proceed with testing. A scoping review was conducted to identify literature associated with patient OOP and private pay in clinical genetic testing. Seven databases (EMBASE, MEDLINE, CINAHL, PsychINFO, PAIS, the Cochrane Database of Systematic Reviews, and the JBI Evidence-Based Practice database) were searched, resulting in 83 unique publications included in the review. The presented evidence includes a descriptive analysis, followed by a narrative account of the extracted data. Results were divided into four groups according to clinical indication: (1) hereditary breast and ovarian cancer, (2) other hereditary cancers, (3) prenatal testing, (4) other clinical indications. The majority of studies focused on hereditary cancer and prenatal genetic testing. Overall trends indicated that OOP costs have fallen and payer coverage has improved, but OOP expenses continue to present a barrier to patients who do not qualify for full coverage.
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Affiliation(s)
- Peter Grant
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (BC), Canada
| | - Sylvie Langlois
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (BC), Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation (CORE), Department of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jehannine C Austin
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (BC), Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Alison M Elliott
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (BC), Canada.,BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada
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15
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Gamble CR, Huang Y, Wright JD, Hou JY. Precision medicine testing in ovarian cancer: The growing inequity between patients with commercial vs medicaid insurance. Gynecol Oncol 2021; 162:18-23. [PMID: 33958212 DOI: 10.1016/j.ygyno.2021.04.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/20/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Precision medicine technologies have significant impact in the care of patients with ovarian cancer. Compared to affluent patients, socioeconomically vulnerable patients are less likely to have access to this testing. There is little data that demonstrate this inequity over time. METHODS We used the IBM Truven Health MarketScan Research Database to identify patients in the United States who underwent surgery for ovarian cancer between 2011 and 2017. The presence of claims for precision medicine testing within six months of surgery was assessed for each patient. Precision medicine testing included both molecular genetic testing (BRCA limited or full sequencing, somatic and germline testing) as well as ancillary pathology tests (immunohistochemistry, microsatellite instability). Demographic data was extracted. RESULTS We identified 27,181 patients who met eligibility. Of these, 88.6% had commercial insurance, and 11.4% had Medicaid. While the proportion of patients who underwent precision medicine testing increased over time for both cohorts (47.0% to 66.6% for commercially insured, 41.4% to 57.6% for Medicaid insured, p < 0.0001), the inequity in testing rates widened (5.6% disparity to 9.0%, p < 0.0001). This was driven by growing inequity in germline and somatic genetic testing (7.6% disparity to 21.3%, p < 0.0001). CONCLUSIONS There is widening inequity in precision medicine testing rates between commercially insured and Medicaid insured poate patients with ovarian cancer.
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Affiliation(s)
- Charlotte R Gamble
- Columbia University College of Physicians and Surgeons, United States of America; New York Presbyterian Hospital, United States of America.
| | - Yongmei Huang
- Columbia University College of Physicians and Surgeons, United States of America; Joseph L. Mailman School of Public Health, Columbia University, United States of America
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons, United States of America; Herbert Irving Comprehensive Cancer Center, United States of America; New York Presbyterian Hospital, United States of America
| | - June Y Hou
- Columbia University College of Physicians and Surgeons, United States of America; Herbert Irving Comprehensive Cancer Center, United States of America; New York Presbyterian Hospital, United States of America
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16
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Dragojlovic N, Kopac N, Borle K, Tandun R, Salmasi S, Ellis U, Birch P, Adam S, Friedman JM, Elliott AM, Lynd LD. Utilization and uptake of clinical genetics services in high-income countries: A scoping review. Health Policy 2021; 125:877-887. [PMID: 33962789 DOI: 10.1016/j.healthpol.2021.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 02/11/2021] [Accepted: 04/14/2021] [Indexed: 12/23/2022]
Abstract
Ongoing rapid growth in the need for genetic services has the potential to severely strain the capacity of the clinical genetics workforce to deliver this care. Unfortunately, assessments of the scale of this health policy challenge and potential solutions are hampered by the lack of a consolidated evidence base on the growth in genetic service utilization. To enable health policy research and strategic planning by health systems in this area, we conducted a scoping review of the literature on the utilization and uptake of clinical genetics services in high-income countries published between 2010 and 2018. One-hundred-and-ninety-five unique studies were included in the review. Most focused on cancer (85/195; 44%) and prenatal care (50/195; 26%), which are consistently the two areas with the greatest volume of genetic service utilization in both the United States and other high-income countries. Utilization and uptake rates varied considerably and were influenced by contextual factors including health system characteristics, provider knowledge, and patient preferences. Moreover, growth in genetic service utilization appears to be driven to a significant degree by technological advances and the integration of new tests into clinical care. Our review highlights both the policy challenge posed by the rapid growth in the utilization of genetic services and the variability in this trend across clinical indications and health systems.
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Affiliation(s)
- Nick Dragojlovic
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Nicola Kopac
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Kennedy Borle
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Rachel Tandun
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Shahrzad Salmasi
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Ursula Ellis
- Woodward Library, University of British Columbia, 2198 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Patricia Birch
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, C201 - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada; BC Children's Hospital Research Institute, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
| | - Shelin Adam
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, C201 - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada; BC Children's Hospital Research Institute, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
| | - Jan M Friedman
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, C201 - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada; BC Children's Hospital Research Institute, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
| | | | - Alison M Elliott
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, C201 - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada; BC Children's Hospital Research Institute, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada; BC Women's Hospital Research Institute, H214 - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada; Centre for Health Evaluation and Outcomes Sciences, Providence Health Research Institute, 588-1081 Burrard Street, St. Paul's Hospital, Vancouver, BC, V6Z 1Y6.
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17
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Shin W, Jeong G, Son Y, Seo SS, Kang S, Park SY, Lim MC. The Knowledge and Attitude of Patients Diagnosed with Epithelial Ovarian Cancer towards Genetic Testing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052312. [PMID: 33652933 PMCID: PMC7956717 DOI: 10.3390/ijerph18052312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 11/16/2022]
Abstract
This study assessed the knowledge and attitude of patients with ovarian cancer (OC) toward OC and next generation sequencing (NGS). The data, including characteristics of patients, their knowledge about OC and their knowledge and attitude of NGS, were collected from June to October 2018. Of the 103 participants, 70.9% (n = 73) had cancer within the second-degree relatives, and 18.4% (n = 19) had BRCA pathogenic mutations. The percentage of right answer for the knowledge about OC and NGS was 64.7% (11/17) and 50% (6/12), respectively. The median number of patients who had positive expectations for the genetic test was 34 (range, 22-44). Based on a first-degree familial history, patients had a different degree of knowledge about OC (11 vs. 8.5, p = 0.026) and NGS (6.5 vs. 5, p = 0.011), but patients with a BRCA pathogenic mutation did not have a different degree of knowledge about OC and NGS panel testing. High-income families had a more positive attitude towards the genetic test than low-income families (p = 0.005). Women with OC do not have enough knowledge about OC (11/17, 64.7%) and NGS (6/12, 50%) but they showed a positive attitude toward the NGS test. These women need OC and NGS educational intervention.
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Affiliation(s)
- Wonkyo Shin
- Center for Gynecologic Cancer, National Cancer Center, 323 Ilsan-ro, Goyang 10408, Korea; (W.S.); (G.J.); (S.-S.S.); (S.K.); (S.-Y.P.)
| | - Gowoon Jeong
- Center for Gynecologic Cancer, National Cancer Center, 323 Ilsan-ro, Goyang 10408, Korea; (W.S.); (G.J.); (S.-S.S.); (S.K.); (S.-Y.P.)
| | - Yedong Son
- College of Nursing, Woosuk University, Wanju 55338, Korea;
| | - Sang-Soo Seo
- Center for Gynecologic Cancer, National Cancer Center, 323 Ilsan-ro, Goyang 10408, Korea; (W.S.); (G.J.); (S.-S.S.); (S.K.); (S.-Y.P.)
| | - Sokbom Kang
- Center for Gynecologic Cancer, National Cancer Center, 323 Ilsan-ro, Goyang 10408, Korea; (W.S.); (G.J.); (S.-S.S.); (S.K.); (S.-Y.P.)
- Division of Precision Medicine, Research Institute, National Cancer Center, 323 Ilsan-ro, Goyang 10408, Korea
- Department of Cancer Control & Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Korea
| | - Sang-Yoon Park
- Center for Gynecologic Cancer, National Cancer Center, 323 Ilsan-ro, Goyang 10408, Korea; (W.S.); (G.J.); (S.-S.S.); (S.K.); (S.-Y.P.)
| | - Myong Cheol Lim
- Center for Gynecologic Cancer, National Cancer Center, 323 Ilsan-ro, Goyang 10408, Korea; (W.S.); (G.J.); (S.-S.S.); (S.K.); (S.-Y.P.)
- Department of Cancer Control & Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Korea
- Center for Clinical Trials, Hospital, National Cancer Center, 323 Ilsan-ro, Goyang 10408, Korea
- Division of Tumor Immunology, National Cancer Center, 323 Ilsan-ro, Goyang 10408, Korea
- Correspondence: ; Tel.: +82-31-920-1763
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18
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Hereditary Cancer Genetic Risk Assessment, Testing, and Counseling: A Nurse Practitioner–Led Program in a Community Setting. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2020.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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19
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Reid S, Cadiz S, Pal T. Disparities in Genetic Testing and Care among Black women with Hereditary Breast Cancer. CURRENT BREAST CANCER REPORTS 2020; 12:125-131. [PMID: 33603954 PMCID: PMC7885902 DOI: 10.1007/s12609-020-00364-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW Despite a steady improvement in breast cancer survival rates over the past several decades, mortality disparities remain among Black women, who have a 42% higher death rate compared to non-Hispanic white (NHW) women. Hereditary breast cancer (HBC) accounts for 5-10% of all breast cancer cases, the majority of which are due to the BRCA1 and BRCA2 (BRCA) genes. Despite the availability of BRCA testing for over 25 years, there remain disproportionately lower rates of genetic testing among Blacks compared to NHW due to a multitude of factors. The intent of this review is to discuss racial disparities focused on HBC across diverse populations and review the existing gaps to be addressed when delivering gene-based care. RECENT FINDINGS The factors contributing to the racial survival disparity are undoubtedly complex and likely an interplay between tumor biology, genomics, patterns of care and socioeconomic factors. Advances in genomic technologies that now allow for full characterization of germline DNA sequencing are integral in defining the complex and multifactorial cause of breast cancer and may help to explain the existing racial survival disparities. SUMMARY Identification of inherited cancer risk may lead to cancer prevention, early cancer detection, treatment guidance, and ultimately has great potential to improve outcomes. Consequently, advances in HBC diagnosis and treatment without widespread implementation have the potential to further widen the existing breast cancer mortality gap between Black and NHW women.
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Affiliation(s)
- Sonya Reid
- Vanderbilt University Medical Center, Nashville, TN
| | | | - Tuya Pal
- Vanderbilt University Medical Center, Nashville, TN
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20
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Spalding R, Edelstein B. Factors predicting collaborative willingness of surrogates making medical decisions on the Physician Order for Scope of Treatment (POST). Aging Ment Health 2020; 24:1543-1552. [PMID: 31496268 DOI: 10.1080/13607863.2019.1660854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: The Physician's Order for Scope of Treatment (POST) indicates patient preferences regarding cardiopulmonary resuscitation (CPR), levels of care, and fluids/nutrition provision decisions. When patients become incapacitated, 'surrogates' often collaborate with physicians on POST decisions. Surrogates may vary in their willingness to collaborate, which can be problematic when physicians expect shared decision-making. No research has yet investigated collaborative decision-making among surrogates on the POST. This study investigated how six psychological variables predicted participants' desires for collaboration when completing an online decision-making task.Methods: Participants served as hypothetical surrogates and made decisions for another person on the three sections of the West Virginia POST. One-hundred-and-seventy-two adults were recruited from Amazon Mechanical Turk.Results: The six variables contributed significantly to the prediction of collaborative willingness, F (6, 163) = 5.29, p < .001, R2= 0.19. Two variables uniquely contributed: confidence and consideration of future consequences. The model most strongly predicted collaborative willingness for the CPR decision.Conclusion: This study provides a novel examination of under-researched areas: surrogate collaborative willingness and the POST. Differing risks associated with the three POST decisions may influence how surrogates value collaboration. Ways to enhance collaborative willingness when making POST decisions are discussed.
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Affiliation(s)
- Rachael Spalding
- Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Barry Edelstein
- Department of Psychology, West Virginia University, Morgantown, WV, USA
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21
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Cragun D, Weidner A, Tezak A, Zuniga B, Wiesner GL, Pal T. A Web-Based Tool to Automate Portions of Pretest Genetic Counseling for Inherited Cancer. J Natl Compr Canc Netw 2020; 18:841-847. [PMID: 32634774 DOI: 10.6004/jnccn.2020.7546] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/07/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Increasing demand for genetic testing for inherited cancer risk coupled with a shortage of providers trained in genetics highlight the potential for automated tools embedded in the clinic process to meet this demand. We developed and tested a scalable, easy-to-use, 12-minute web-based educational tool that included standard pretest genetic counseling elements related to panel-based testing for multiple genes associated with cancer risk. METHODS The tool was viewed by new patients at the Vanderbilt Hereditary Cancer Clinic before meeting with a board-certified genetics professional. Pre- and post-tool surveys measured knowledge, feeling informed/empowered to decide about testing, attitudinal values about genetic testing, and health literacy. Of the initial 100 participants, 50 were randomized to only have knowledge measured on the post-tool survey to assess for a priming effect. RESULTS Of 360 patients approached, 305 consented and completed both the pre- and post-tool surveys, with a mean age of 47 years, including 80% female patients and 48% patients with cancer. Survey results showed an increase in knowledge and feeling informed/empowered after viewing the tool (P<.001), but no significant change in attitude (P=.64). Post-tool survey data indicated no difference in median knowledge between low and high health literacy groups (P=.30). No priming effect was present among the initial 100 participants (P=.675). CONCLUSIONS Viewing the educational tool resulted in significant gains in knowledge across health literacy levels, and most individuals felt informed and empowered to decide about genetic testing. These findings indicate that the use of an automated pretest genetic counseling tool may help streamline the delivery of genetic services.
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Affiliation(s)
- Deborah Cragun
- 1College of Public Health, University of South Florida, Tampa, Florida; and
| | - Anne Weidner
- 2Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, and
| | - Ann Tezak
- 2Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, and
| | - Brenda Zuniga
- 2Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, and
| | - Georgia L Wiesner
- 2Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, and.,3Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Tuya Pal
- 2Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, and.,3Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
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22
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Reid S, Cragun D, Tezak A, Weidner A, Moore J, Mayer IA, Shu XO, Ye F, Fan R, Vadaparampil S, Pal T. Disparities in BRCA counseling across providers in a diverse population of young breast cancer survivors. Genet Med 2020; 22:1088-1093. [PMID: 32066870 PMCID: PMC7275890 DOI: 10.1038/s41436-020-0762-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/29/2020] [Accepted: 02/04/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE All women diagnosed with breast cancer (BC) ≤age 50 should be referred for genetic counseling (GC) and testing. We sought to compare differences in provider practices and access across a racially and ethnically diverse population of young BC survivors. METHODS A registry-based sample of women diagnosed with invasive BC ≤age 50 from 2009 to 2012 was recruited through the Florida Cancer Registry, and completed a questionnaire and medical record release. Differences were compared across those tested with or without the involvement of a board-certified or credentialed genetics health professional (GHP) in (1) clinical and demographic variables and (2) pretest GC elements. RESULTS Of 1622 participants, there were 440 Blacks, 285 Hispanics, and 897 Non-Hispanic Whites. Of 831 participants with medical record verification of testing provider, 170 (20%) had documentation of GHP involvement. Among the 613 who recalled a pretest discussion and had GC elements collected, those with GHP involvement were significantly more likely to recall the seven recognized GC elements. CONCLUSION GHP involvement was associated with adherence to nationally recommended best practices. With the expanding importance of identifying inherited cancers, it is critical to ensure equitable access to best practices across all populations.
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Affiliation(s)
- Sonya Reid
- Vanderbilt University Medical Center, Nashville, TN
| | | | - Ann Tezak
- Vanderbilt University Medical Center, Nashville, TN
| | - Anne Weidner
- Vanderbilt University Medical Center, Nashville, TN
| | | | | | - Xiao-ou Shu
- Vanderbilt University Medical Center, Nashville, TN
| | - Fei Ye
- Vanderbilt University Medical Center, Nashville, TN
| | - Run Fan
- Vanderbilt University Medical Center, Nashville, TN
| | | | - Tuya Pal
- Vanderbilt University Medical Center, Nashville, TN, USA.
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Delivering genomic medicine in the United Kingdom National Health Service: a systematic review and narrative synthesis. Genet Med 2019; 21:2667-2675. [PMID: 31186523 DOI: 10.1038/s41436-019-0579-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/30/2019] [Indexed: 01/28/2023] Open
Abstract
PURPOSE We sought to assess the readiness of the United Kingdom (UK) National Health Service to implement a Genomic Medicine Service. We conducted a systematic literature review to identify what is known about factors related to the implementation of genomic medicine in routine health care and to draw out the implications for the UK and other settings. METHODS Relevant studies were identified in Web of Science and PubMed from their date of inception to April 2018. The review included primary research studies using quantitative, qualitative, or mixed methods, and systematic reviews. A narrative synthesis was conducted. RESULTS Fifty-five studies met our inclusion criteria. The majority of studies reviewed were conducted in the United States. We identified four domains: (1) systems, (2) training and workforce needs, (3) professional attitudes and values, and (4) the role of patients and the public. CONCLUSION Mainstreaming genomic medicine into routine clinical practice requires actions at each level of the health-care system. Our synthesis emphasized the organizational, social, and cultural implications of reforming practice, highlighting that demonstration of clinical utility and cost-effectiveness, attending to the compatibility of genomic medicine with clinical principles, and involving and engaging patients are key to successful implementation.
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Plichta JK, Hughes KS. ASO Author Reflections: The Pressing Need for Germline Genetic Testing. Ann Surg Oncol 2019; 26:612-613. [PMID: 31098782 DOI: 10.1245/s10434-019-07428-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Indexed: 11/18/2022]
Affiliation(s)
| | - Kevin S Hughes
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
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25
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Plichta JK, Sebastian ML, Smith LA, Menendez CS, Johnson AT, Bays SM, Euhus DM, Clifford EJ, Jalali M, Kurtzman SH, Taylor WA, Hughes KS. Germline Genetic Testing: What the Breast Surgeon Needs to Know. Ann Surg Oncol 2019; 26:2184-2190. [PMID: 30941656 DOI: 10.1245/s10434-019-07341-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Indexed: 01/21/2023]
Abstract
PURPOSE The American Society of Breast Surgeons (ASBrS) sought to provide educational guidelines for breast surgeons on how to incorporate genetic information and genomics into their practice. METHODS A comprehensive nonsystematic review was performed of selected peer-reviewed literature. The Genetics Working Group of the ASBrS convened to develop guideline recommendations. RESULTS Clinical and educational guidelines were prepared to outline the essential knowledge for breast surgeons to perform germline genetic testing and to incorporate the findings into their practice, which have been approved by the ASBrS Board of Directors. RECOMMENDATIONS Thousands of women in the USA would potentially benefit from genetic testing for BRCA1, BRCA2, and other breast cancer genes that markedly increase their risk of developing breast cancer. As genetic testing is now becoming more widely available, women should be made aware of these tests and consider testing. Breast surgeons are well positioned to help facilitate this process. The areas where surgeons need to be knowledgeable include: (1) identification of patients for initial breast cancer-related genetic testing, (2) identification of patients who tested negative in the past but now need updated testing, (3) initial cancer genetic testing, (4) retesting of patients who need their genetic testing updated, (5) cancer genetic test interpretation, posttest counseling and management, (6) management of variants of uncertain significance, (7) cascade genetic testing, (8) interpretation of genetic tests other than clinical cancer panels and the counseling and management required, and (9) interpretation of somatic genetic tests and the counseling and management required.
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Affiliation(s)
| | - Molly L Sebastian
- Reinsch Pierce Family Center for Breast Health, Virginia Hospital Center, Arlington, VA, USA
| | | | | | - Anita T Johnson
- Cancer Treatment Centers of America, Atlanta, GA, USA.,Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
| | | | - David M Euhus
- Department of Surgery, Johns Hopkins University Hospital, Baltimore, MD, USA
| | | | - Mena Jalali
- American Society of Breast Surgeons, Dallas, TX, USA
| | | | | | - Kevin S Hughes
- Department of Surgery, Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.
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Verma A, Nag S, Hasan Q, Priya Selvakumar V. Mainstreaming genetic counseling for BRCA testing into oncology clinics – Indian perspective. Indian J Cancer 2019; 56:S38-S47. [DOI: 10.4103/ijc.ijc_458_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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