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Burke K, Dawson L, Hodgkinson K, Wilson BJ, Etchegary H. Exploring family communication preferences in hereditary breast and ovarian cancer and Lynch syndrome: a national Canadian survey. J Community Genet 2024:10.1007/s12687-024-00720-z. [PMID: 39046652 DOI: 10.1007/s12687-024-00720-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Accepted: 07/10/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Individuals affected with cancer predisposition (CPS) syndromes such as BRCA1, BRCA2 or Lynch syndrome (LS) are at an elevated risk of multiple cancers. Identifying high-risk individuals is important if they are to access risk-reducing strategies. Interventions such as risk-reducing salpingo-oophorectomy in carriers of BRCA pathogenic or likely pathogenic (P/LP) variants or regular colonoscopy for carriers of LS P/LP variants are highly effective and reduce mortality. Despite clear evidence that the identification of at-risk relatives has value, the uptake of cascade testing remains at approximately 50%. It is important to understand strategies and barriers to testing to facilitate communication in families identified as haveing a hereditary cancer syndrome, to improve uptake of counselling and testing. METHOD A national online survey of both Canadian probands (the first member in a family to have genetic testing and who were variant positive, regardless of a cancer diagnosis) and their at-risk relatives. Respondents were individuals affected with hereditary breast and ovarian cancer (HBOC) and LS. The survey was constructed based on a review of the literature and authors' feedback. Both open and closed-ended questions were used for items on demographic characteristics, risk perception, genetic test results and cancer diagnosis. Items on experiences with hereditary cancer risk communication, communication challenges, preferences and supports required were explored using a 5-point Likert scale. RESULTS Responses indicated a high level of acceptance for the proband's direct involvement in family communication with the support of a health care provider (67% among the probands given a family letter and 55-57% among those who were not given a family letter). Respondents without a personal history of cancer were more likely to endorse a health care professional's help with family communication compared to those with a personal history of cancer (p = 0.031). Preferences for family member outreach also varied by education level, annual income, marital status and geographic location. Similarities were noted between the probands and relatives on communication outreach preferences. CONCLUSION While the family-mediated approach to communication remains the standard across many cancer genetics programs, participants note that additional support is necessary for dissemination of result information among relatives. Because family dynamics and communication vary widely, alternative options that retain the probands' involvement in family communication but add support from a health care provider should be explored.
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Affiliation(s)
- Kimberly Burke
- Faculty of Medicine, Division of Community Health and Humanities, Memorial University, St. John's, NL, Canada.
| | - Lesa Dawson
- Faculty of Medicine, Discipline of Obstetrics and Gynecology, Memorial University, St. John's, NL, Canada
- Division of Gynecologic Oncology, University of British Columbia, Vancouver, BC, Canada
| | - Kathleen Hodgkinson
- Faculty of Medicine, Division of Community Health and Humanities, Memorial University, St. John's, NL, Canada
- Faculty of Medicine, Division of BioMedical Sciences, Memorial University, St. John's, NL, Canada
| | - Brenda J Wilson
- Faculty of Medicine, Division of Community Health and Humanities, Memorial University, St. John's, NL, Canada
| | - Holly Etchegary
- Faculty of Medicine, Division of Community Health and Humanities, Memorial University, St. John's, NL, Canada
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Zahid MF, Moriarty K, Dryden C, Weinberg O, Asif M, Ikpefan R, Anderson JM, Collins RH, Chung SS, Chen W, Patel PA, Madanat YF. Identifying patients at risk for hereditary myeloid malignancy syndromes incorporating a novel, self-administered questionnaire to an initial screening platform. Eur J Haematol 2023; 111:844-850. [PMID: 37587783 DOI: 10.1111/ejh.14084] [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: 05/23/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Four to 10% of cases of myeloid malignancies are inherited. We report our experience on hereditary myeloid malignancy syndromes (HMMS) incorporating a novel questionnaire in the screening platform for patients with myeloid malignancies and aplastic anemia. METHODS The questionnaire was sent via electronic patient portal prior to clinic visits. Patients screened positive based on responses to questionnaire items, presence of suspicion disease characteristics (young age, family history, monosomy 7 etc.) and/or presence of signs of HMMS. Those deemed at-risk based on questionnaire responses, clinical features and/or somatic mutation profile were offered germline testing. RESULTS A total of 408 patients were screened, 141 (35%) were deemed at-risk. Fifty-four (38%) of at-risk patients were seen in the genetics clinic. Forty-one (76%) of the patients seen agreed to germline testing and 13 declined due to cost or personal decision. Twenty pathogenic (P)/likely-pathogenic (LP) germline mutations were identified in 16 (39%) of the tested patients. Five patients also had a variant of uncertain significance (VUS) and an additional 13 had at least 1 VUS without P/LP mutations (total 29 VUS's were found in 18 (44%) of tested patients). The median age of diagnosis for patients with P/LP mutations was 56 years versus 66 years in the entire cohort. CONCLUSION Incorporating an electronic questionnaire is an effective screening method for HMMS. Many patients declined testing due to cost. These results highlight the importance of germline testing in patients with myeloid malignancies, further research in HMMS, and coverage by healthcare plans.
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Affiliation(s)
- Mohammad Faizan Zahid
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Internal Medicine, Division of Hematology and Medical Oncology, Leukemia Program, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Kelsey Moriarty
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Courtney Dryden
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Olga Weinberg
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Misha Asif
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ruth Ikpefan
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Julia M Anderson
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Robert H Collins
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Internal Medicine, Division of Hematology and Medical Oncology, Leukemia Program, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Stephen S Chung
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Internal Medicine, Division of Hematology and Medical Oncology, Leukemia Program, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Weina Chen
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Prapti A Patel
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Internal Medicine, Division of Hematology and Medical Oncology, Leukemia Program, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Yazan F Madanat
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Internal Medicine, Division of Hematology and Medical Oncology, Leukemia Program, UT Southwestern Medical Center, Dallas, Texas, USA
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Baker A, Tolwinski K, Atondo J, Davis FD, Goehringer J, Jones LK, Pisieczko CJ, Sturm AC, Williams JL, Williams MS, Rahm AK, Buchanan AH. Understanding the Patient Experience of Receiving Clinically Actionable Genetic Results from the MyCode Community Health Initiative, a Population-Based Genomic Screening Initiative. J Pers Med 2022; 12:jpm12091511. [PMID: 36143296 PMCID: PMC9501087 DOI: 10.3390/jpm12091511] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
Understanding unselected individuals’ experiences receiving genetic results through population genomic screening is critical to advancing clinical utility and improving population health. We conducted qualitative interviews with individuals who received clinically actionable genetic results via the MyCode© Genomic Screening and Counseling program. We purposively sampled cohorts to seek diversity in result-related disease risk (e.g., cancer or cardiovascular) and in personal or family history of related diseases. Transcripts were analyzed using a two-step inductive coding process of broad thematic analysis followed by in-depth coding of each theme. Four thematic domains identified across all cohorts were examined: process assessment, psychosocial response, behavioral change due to the genetic result, and family communication. Coding of 63 interviews among 60 participants revealed that participants were satisfied with the results disclosure process, initially experienced a range of positive, neutral, and negative psychological reactions to results, adjusted positively to results over time, undertook clinically indicated actions in response to results, and communicated results with relatives to whom they felt emotionally close. Our findings of generally favorable responses to receiving clinically actionable genetic results via a genomic screening program may assuage fear of patient distress in such programs and guide additional biobanks, genomic screening programs, and research studies.
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Affiliation(s)
- Anna Baker
- Department of Psychology, Bucknell University, Lewisburg, PA 17837, USA or
- Department of Psychology, Clemson University, Clemson, SC 29634, USA
| | - Kasia Tolwinski
- Biomedical Ethics Unit, McGill University, Montreal, QC H3A 0G4, Canada
| | - Jamie Atondo
- Department of Genomic Health, Geisinger, Danville, PA 17822, USA or
| | | | | | - Laney K. Jones
- Department of Genomic Health, Geisinger, Danville, PA 17822, USA or
- Heart and Vascular Institute, Geisinger, Danville, PA 17822, USA
| | | | - Amy C. Sturm
- Department of Genomic Health, Geisinger, Danville, PA 17822, USA or
- 23andMe, Sunnyvale, CA 94086, USA
| | | | - Marc S. Williams
- Department of Genomic Health, Geisinger, Danville, PA 17822, USA or
| | | | - Adam H. Buchanan
- Department of Genomic Health, Geisinger, Danville, PA 17822, USA or
- Correspondence:
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Zhang Y, Yi S, Trace CB, Williams-Brown MY. Understanding the Information Needs of Patients With Ovarian Cancer Regarding Genetic Testing to Inform Intervention Design: Interview Study. JMIR Cancer 2022; 8:e31263. [PMID: 35133282 PMCID: PMC8864522 DOI: 10.2196/31263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/30/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background Experts in gynecological cancer care recommend that all patients with invasive or high-grade ovarian cancer (OC) undergo genetic testing. However, even patients who intend to take or have taken genetic tests have many unaddressed information needs regarding genetic testing. Existing genetic counseling falls short of adequately addressing this challenge. Objective This study aims to investigate the genetic testing–related information needs of patients with OC to inform the design of interactive technology-based interventions that can enhance communication of genetic testing information to patients. Methods We interviewed 20 patients with OC who had taken genetic tests and gathered genetic testing–related messages from an active OC web-based community. The interview transcripts and web-based community messages were analyzed using the qualitative content analysis method. Results Data analyses produced a comprehensive taxonomy of the genetic testing–related information needs of patients with OC, which included five major topic clusters: knowledge of genetic testing as a medical test, genetic testing process, genetic testing implications for patients, implications for family members, and medical terminology. Findings indicated that patients wanted to receive information that was relevant, understandable, concise, usable, appropriate, sympathetic, and available when needed. They also preferred various channels to receive information, including internet-based technologies, print, and conversations with health care providers. Conclusions Patients with OC need a range of information to address the uncertainties and challenges that they encounter while taking genetic tests. Their preferences for channels to receive information vary widely. A multichannel information delivery solution that combines both provider-led and peer-to-peer education models is needed to supplement existing genetic counseling to effectively meet the genetic testing–related information needs of patients with OC.
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Affiliation(s)
- Yan Zhang
- School of Information, The University of Texas at Austin, Austin, TX, United States
- Center for Health Communication, Moody College of Communication and Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - Siqi Yi
- School of Information, The University of Texas at Austin, Austin, TX, United States
| | - Ciaran B Trace
- School of Information, The University of Texas at Austin, Austin, TX, United States
- Center for Health Communication, Moody College of Communication and Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - Marian Yvette Williams-Brown
- Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
- Department of Oncology, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
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Yoon S, Goh H, Fung SM, Tang S, Matchar D, Ginsburg GS, Orlando LA, Ngeow J, Wu RR. Experience and Perceptions of a Family Health History Risk Assessment Tool among Multi-Ethnic Asian Breast Cancer Patients. J Pers Med 2021; 11:jpm11101046. [PMID: 34683187 PMCID: PMC8536959 DOI: 10.3390/jpm11101046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/07/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022] Open
Abstract
A family health history-based risk assessment is particularly valuable for guiding cancer screening and treatment strategies, yet an optimal implementation depends upon end-users' values and needs. This is not only true prior to disease development, but also for those already affected. The aim of this study is to explore perceptions of the value of knowing one's family health history (FHH)-based risk, experience using a patient-facing FHH tool and the potential of the tool for wider implementation. Twenty multi-ethnic Asian patients undergoing breast cancer treatment in Singapore completed an FHH-based risk assessment. Semi-structured one-on-one interviews were conducted and data were thematically analyzed. All participants were female and slightly more than half were Chinese. The acceptance and usage of an FHH risk assessment tool for cancers and its broader implementation was affected by a perceived importance of personal control over early detection, patient concerns of anxiety for themselves and their families due to risk results, concerns for genetic discrimination, adequacy of follow-up care plans and Asian cultural beliefs toward disease and dying. This study uniquely sheds light on the factors affecting Asian breast cancer patients' perceptions about undergoing an FHH-based risk assessment, which should inform steps for a broader implementation in Asian healthcare systems.
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Affiliation(s)
- Sungwon Yoon
- Health Services and Systems Research, Center for Population Health Research Institute, Duke-NUS Medical School, Singapore Health Services, 8 College Road, Singapore 169857, Singapore;
| | - Hendra Goh
- Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore; (H.G.); (S.T.); (D.M.)
| | - Si Ming Fung
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore; (S.M.F.); (J.N.)
| | - Shihui Tang
- Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore; (H.G.); (S.T.); (D.M.)
| | - David Matchar
- Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore; (H.G.); (S.T.); (D.M.)
- Department of Medicine, Duke University School of Medicine, Durham, NC 27708, USA
| | - Geoffrey S. Ginsburg
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC 27708, USA; (G.S.G.); (L.A.O.)
| | - Lori A. Orlando
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC 27708, USA; (G.S.G.); (L.A.O.)
| | - Joanne Ngeow
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore; (S.M.F.); (J.N.)
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Rebekah Ryanne Wu
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, Durham, NC 27708, USA
- Correspondence:
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Germline Mutations in Other Homologous Recombination Repair-Related Genes Than BRCA1/2: Predictive or Prognostic Factors? J Pers Med 2021; 11:jpm11040245. [PMID: 33800556 PMCID: PMC8066561 DOI: 10.3390/jpm11040245] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/20/2021] [Accepted: 03/24/2021] [Indexed: 02/08/2023] Open
Abstract
The homologous recombination repair (HRR) pathway repairs double-strand DNA breaks, mostly by BRCA1 and BRCA2, although other proteins such as ATM, CHEK2, and PALB2 are also involved. BRCA1/2 germline mutations are targeted by PARP inhibitors. The aim of this commentary is to explore whether germline mutations in HRR-related genes other than BRCA1/2 have to be considered as prognostic factors or predictive to therapies by discussing the results of two articles published in December 2020. The TBCRC 048 trial published by Tung et al. showed an impressive objective response rate to olaparib in metastatic breast cancer patients with germline PALB2 mutation compared to germline ATM and CHEK2 mutation carriers. Additionally, Yadav et al. observed a significantly longer overall survival in pancreatic adenocarcinoma patients with germline HRR mutations compared to non-carriers. In our opinion, assuming that PALB2 is a high-penetrant gene with a key role in the HRR system, PALB2 mutations are predictive factors for response to treatment. Moreover, germline mutations in the ATM gene provide a better outcome in pancreatic adenocarcinoma, being more often associated to wild-type KRAS. In conclusion, sequencing of HRR-related genes other than BRCA1/2 should be routinely offered as part of a biological characterization of pancreatic and breast cancers.
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Srinivasan S, Hampel H, Leeman J, Patel A, Kulchak Rahm A, Reuland DS, Roberts MC. Stakeholder Perspectives on Overcoming Barriers to Cascade Testing in Lynch Syndrome: A Qualitative Study. Cancer Prev Res (Phila) 2020; 13:1037-1046. [PMID: 32727822 DOI: 10.1158/1940-6207.capr-20-0141] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/15/2020] [Accepted: 07/22/2020] [Indexed: 11/16/2022]
Abstract
Cascade testing (i.e., genetic testing of family members of individuals with disease) among families affected by hereditary cancer disorders, such as Lynch syndrome, is suboptimal and thus represents a missed opportunity in cancer prevention. We aimed to fill a gap in the literature by exploring multilevel barriers and facilitators to the implementation of cascade testing for Lynch syndrome. We conducted semistructured, in-depth interviews guided by the Consolidated Framework for Implementation Research and the Integrated Behavioral Model among key stakeholders (n = 60): Patients with Lynch syndrome and relatives (n = 20), providers (n = 20), and administrators (n = 20). Transcripts were double-coded (20% sample) using template analysis in ATLAS.ti. Barriers identified included (i) low awareness about Lynch syndrome, (ii) psychosocial barriers, (iii) lack of provider follow-up, (iv) accessibility to genetic counseling, and (v) fear of discrimination. Facilitators included (i) motivation to engage in cascade testing and (ii) free genetic testing offered to relatives. Stakeholders also recommended strategies to overcome implementation barriers in the short-term (increasing education, preparing patients for communicating with relatives), medium-term (optimizing clinical workflow and staffing resources), and long-term (nationwide standardization). These findings indicate that modifiable, multilevel barriers to the implementation of cascade testing in Lynch syndrome are experienced across stakeholders. Understanding and targeting implementation barriers is imperative to achieving public health impact of precision health interventions such as cascade testing.
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Affiliation(s)
- Swetha Srinivasan
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Heather Hampel
- Division of Human Genetics, The Ohio State Comprehensive Cancer Center, Columbus, Ohio
| | - Jennifer Leeman
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Amit Patel
- Medical Marketing Economics, Oxford, Mississippi
| | | | - Daniel S Reuland
- Division of General Internal Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Megan C Roberts
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
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McCuaig JM, Care M, Ferguson SE, Kim RH, Stockley TL, Metcalfe KA. Year 1: Experiences of a tertiary cancer centre following implementation of reflex BRCA1 and BRCA2 tumor testing for all high-grade serous ovarian cancers in a universal healthcare system. Gynecol Oncol 2020; 158:747-753. [PMID: 32674931 DOI: 10.1016/j.ygyno.2020.06.507] [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: 05/14/2020] [Accepted: 06/28/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study compares the rate and time to genetic referral, and patient uptake of germline genetic services, before and after implementation of reflex BRCA1/2 tumor testing for high-grade serous ovarian cancer (HGSOC) in a universal healthcare system. METHODS A retrospective chart review of HSGOC patients diagnosed in the year before (PRE) and after (POST) implementation of reflex BRCA1/2 tumor testing was conducted. Clinical information (date/age at diagnosis, personal/family history of breast/ovarian cancer, cancer stage, primary treatment, tumor results) and dates of genetics referral, counseling, and germline testing were obtained. Incident rate ratios (IRR) and 95% CI were calculated using negative binomial regression. Time to referral was evaluated using Kaplan-Meier survival analysis. Fisher Exact tests were used to evaluate uptake of genetic services. RESULTS 175 HGSOC patients were identified (81 PRE; 94 POST). Post-implementation of tumor testing, there was a higher rate of genetics referral (12.88 versus 7.10/1000 person-days; IRR = 1.60, 95% CI: 1.07-2.42) and a shorter median time from diagnosis to referral (59 days PRE, 33 days POST; p = .04). In the POST cohort, most patients were referred prior to receiving their tumor results (n = 63/77; 81.8%). Once referred, most patients attended genetic counseling (94.5% PRE, 97.6% POST; p = .418) and pursue germline testing (98.6% PRE; 100% POST; p = .455). CONCLUSIONS Following implementation of reflex BRCA1/2 tumor testing for HGSOC, significant improvements to the rate and time to genetics referral were identified. Additional studies are needed to evaluate physician referral practices and the long-term impact of reflex tumor testing.
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Affiliation(s)
- Jeanna M McCuaig
- Familial Cancer Clinic, University Health Network, 610 University Avenue, Toronto, ON M5G 2M9, Canada; Lawrence S Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON M5T 1P8, Canada.
| | - Melanie Care
- Department of Molecular Genetics, University of Toronto, 27 King's College Circle, Toronto5, ON M5S 1A8, Canada; Division of Clinical Laboratory Medicine, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
| | - Sarah E Ferguson
- Division of Gynecologic Oncology, University Health Network, 610 University Avenue, Toronto, ON M5G 2M9, Canada; Department of Obstetrics and Gynecology, University of Toronto, 27 King's College Circle, Toronto, ON M5S 1A8, Canada
| | - Raymond H Kim
- Familial Cancer Clinic, University Health Network, 610 University Avenue, Toronto, ON M5G 2M9, Canada; Division of Medical Oncology, University Health Network, 610 University Avenue, Toronto, ON M5G 2M9, Canada; Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, ON M5S 1A8, Canada
| | - Tracy L Stockley
- Division of Clinical Laboratory Medicine, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, 27 King's College Circle, Toronto, ON M5S 1A8, Canada
| | - Kelly A Metcalfe
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON M5T 1P8, Canada; Women's College Research Institute, 72 Grenville Street, Toronto, ON M5S 1B2, Canada
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Van de Beek I, Smets EMA, Legdeur MA, de Hullu JA, Lok CAR, Buist MR, Mourits MJE, Kets CM, van der Kolk LE, Oosterwijk JC, Aalfs CM. Genetic counseling of patients with ovarian carcinoma: acceptance, timing, and psychological wellbeing. J Community Genet 2019; 11:183-191. [PMID: 31168696 PMCID: PMC7062983 DOI: 10.1007/s12687-019-00427-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 05/27/2019] [Indexed: 12/15/2022] Open
Abstract
The new Dutch guidelines on hereditary and familial ovarian carcinoma recommend genetic testing of all patients with epithelial ovarian cancer (EOC). With this study, we aimed to obtain insight into (1) the acceptance and timing of the offer of genetic counseling in women with EOC, (2) reasons for accepting or declining genetic counseling, and (3) psychological differences between women who did and did not have genetic counseling. A multicenter questionnaire survey was performed in patients with EOC in four Dutch oncology centers. The questionnaire addressed whether, how, and when genetic counseling was offered, women’s arguments to accept or decline genetic counseling, and included the Cancer Worry Scale (CWS) and the Hospital Anxiety and Depression Scale (HADS). A total of 67 women completed the questionnaire, of which 43 had genetic counseling. Despite a wide variability in the timing of the offer of genetic counseling, 89% of the women were satisfied with the timing. No significant differences were found between the CWS and HADS scores for the timing of the offer of genetic counseling and whether or not women had genetic counseling. Taking the small sample size into account, the results tentatively suggest that genetic counseling may have limited impact on the psychosocial wellbeing of women with EOC. Therefore, we assume that implementation of the new guidelines offering genetic counseling to all patients with EOC will not cause considerable additional burden to these patients.
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Affiliation(s)
- I Van de Beek
- Department of Clinical Genetics, Amsterdam UMC, location VUmc, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. .,Department of Clinical Genetics, Amsterdam UMC, location AMC, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - E M A Smets
- Department of Clinical Genetics, Amsterdam UMC, location AMC, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.,Department of Medical Psychology, Amsterdam UMC, location AMC, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - M A Legdeur
- Department of Clinical Genetics, Amsterdam UMC, location AMC, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - J A de Hullu
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - C A R Lok
- Department of Obstetrics and Gynaecology, Center of Gynaecologic Oncology Amsterdam, PO Box 90203, 1006 BE, Amsterdam, The Netherlands
| | - M R Buist
- Department of Obstetrics and Gynaecology, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - M J E Mourits
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
| | - C M Kets
- Department of Human Genetics, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - L E van der Kolk
- Family Cancer Clinic, Netherlands Cancer Institute, PO Box 90203, 1006 BE, Amsterdam, the Netherlands
| | - J C Oosterwijk
- Department of Genetics, University Medical Center, University of Groningen, PO Box 30001, 9700 RB, Groningen, the Netherlands
| | - C M Aalfs
- Department of Clinical Genetics, Amsterdam UMC, location VUmc, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.,Department of Clinical Genetics, Amsterdam UMC, location AMC, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
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Moss CA, Cojocaru E, Hanwell J, Ward S, Xu W, van Zyl M, O'Leary L, de Bono JS, Banerji U, Kaye SB, Minchom A, George AJ, Lopez J, McVeigh TP. Multidisciplinary interventions in a specialist Drug Development Unit to improve family history documentation and onward referral of patients with advanced cancer to cancer genetics services. Eur J Cancer 2019; 114:97-106. [PMID: 31078974 DOI: 10.1016/j.ejca.2019.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/26/2019] [Accepted: 04/02/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Molecular aberrations in cancer may represent therapeutic targets, and, if arising from the germline, may impact further cancer risk management in patients and their blood relatives. Annually, 600-700 patients are referred for consideration of experimental drug trials in the Drug Development Unit (DDU) in our institution. A proportion of patients may merit germline genetic testing because of suspicious personal/family history or findings of tumour-based testing. We aimed to assess the impact of different multidisciplinary interventions on family history taking and referral rates from DDU to Cancer Genetics Unit (CGU). METHODS Over 42 months, three interventions were undertaken at different intervals: (1) embedding a genetics provider in the DDU review clinic, (2) 'traffic light' system flagging cancers with a heritable component and (3) virtual multidisciplinary meeting (MDM). Comparative analyses between intervals were undertaken, including referral rates to CGU, investigations and patient outcomes. Family history taking in a sample of 20 patients managed in each interval was assessed by a retrospective chart review. RESULTS Frequency of family history taking and referral to CGU, increased with each intervention, particularly, the virtual MDM (40% vs 85%). Referral rates increased over the study period, from 0.1 referral/week (5/year, 0.36% total referrals) to 1.2/week (projected 63/year, 3.81%). Forty-four (52%) patients referred required germline testing; in three of whom, variants were identified. Non-attendance rates were low (6, 7%). CONCLUSION Patients in the DDU are unique, with long cancer histories and often short estimated life expectancy. Multidisciplinary working between CGU and DDU facilitates germline testing of those patients who may otherwise miss the opportunity.
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Affiliation(s)
- Cathryn A Moss
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, Fulham Road, London, UK
| | - Elena Cojocaru
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Janet Hanwell
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Simon Ward
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, Fulham Road, London, UK
| | - Wen Xu
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Mary van Zyl
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Lorraine O'Leary
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Johann S de Bono
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Udai Banerji
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Stan B Kaye
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Anna Minchom
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Angela J George
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, Fulham Road, London, UK; Gynaecological Oncology Unit, Royal Marsden NHS Foundation Trust, Fulham Road, London, UK
| | - Juanita Lopez
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Terri P McVeigh
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, Fulham Road, London, UK.
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11
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Vogel RI, Niendorf K, Petzel S, Lee H, Teoh D, Blaes AH, Argenta P, Rivard C, Winterhoff B, Lee HY, Geller MA. A patient-centered mobile health application to motivate use of genetic counseling among women with ovarian cancer: A pilot randomized controlled trial. Gynecol Oncol 2019; 153:100-107. [PMID: 30718125 DOI: 10.1016/j.ygyno.2019.01.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/17/2019] [Accepted: 01/22/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Despite current guidelines recommending women with ovarian cancer receive genetic risk evaluation by a genetic counselor, utilization has historically been low. We sought to assess the feasibility and effectiveness of a week-long mobile Application for Genetic Information on Cancer (mAGIC) intervention aimed to persuade women with ovarian cancer to pursue genetic counseling. METHODS The mobile application intervention was based on the Fogg Behavior Model, and consisted of three parts: (1) identifying barriers, (2) developing motivators, and (3) providing triggers to action. The Health Belief Model was used to guide content development. We conducted a prospective, randomized, controlled pilot trial among 104 untested women with a history of epithelial ovarian, primary peritoneal or fallopian tube cancer with the primary objective of increasing uptake of cancer genetic counseling services. RESULTS Utilization of cancer genetic counseling services improved in both study arms over historical controls, however there was no statistically significant difference between them (intervention: 54.5% versus control: 38.6%; p = 0.14). However, compared to controls, women randomized to the mAGIC intervention demonstrated greater knowledge of hereditary cancer (0-10 scale; 9.4 ± 1.0 vs. 7.1 ± 1.5; p < 0.0001), which persisted for at least three months. Additionally, 96% of women in the intervention group reported they had talked with their family about genetic counseling compared to 77% in the control group (p = 0.01). CONCLUSIONS The mAGIC intervention did not result in increased uptake of genetic counseling, however it provided significant secondary benefits, including increased participants' knowledge about hereditary ovarian cancer, self-efficacy, and their reported communication with family members. ClinicalTrials.gov Identifier: NCT02877862.
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Affiliation(s)
- Rachel I Vogel
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, United States of America
| | - Kristin Niendorf
- Department of Surgery, Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis, MN, United States of America
| | - Sue Petzel
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, United States of America
| | - Heewon Lee
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, United States of America
| | - Deanna Teoh
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, United States of America
| | - Anne H Blaes
- Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN, United States of America
| | - Peter Argenta
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, United States of America
| | - Colleen Rivard
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, United States of America
| | - Boris Winterhoff
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, United States of America
| | - Hee Yun Lee
- School of Social Work, University of Alabama, Tuscaloosa, AL, United States of America
| | - Melissa A Geller
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, United States of America.
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