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George A, Herbertson RA, Stillie A, McCormack S, Drean AM, Wesselbaum A, Hudson E, Miles T, Ryan NAJ, Maxwell H, Le Treust L, McCormack M. Current Management Practices for Endometrial Cancer (EC) in the UK: A National Healthcare Professional Survey (KNOW-EC). Clin Oncol (R Coll Radiol) 2024:S0936-6555(24)00212-7. [PMID: 39048405 DOI: 10.1016/j.clon.2024.05.017] [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: 01/19/2024] [Revised: 05/09/2024] [Accepted: 05/29/2024] [Indexed: 07/27/2024]
Abstract
The clinical landscape for endometrial cancer in the UK is evolving to include new management guidelines and targeted treatment options. An understanding of current treatment and management practices in the UK will help services plan and adapt to upcoming changes. AIM The purpose of this survey was to understand current and anticipated real-world practices for endometrial cancer care in the UK and potential areas for optimisation. MATERIALS AND METHODS Telephone interviews were conducted in November/December 2021 with UK-based healthcare professionals involved in endometrial cancer management. Questions were aligned with the British Gynaecological Cancer Society/European Society for Medical Oncology recommendations, covering the pathway from diagnosis and treatment to follow-up. RESULTS A total of 63 healthcare professionals (HCPs) involved in the management of patients with endometrial cancer participated in telephone interviews. The results highlighted variations in management and treatment practices for endometrial cancer and suggest that current UK practice appears to diverge from national and international guidance in some instances. While somatic mismatch repair deficiency testing was used by 89.7% of respondents as mainstream testing, the survey highlighted a lack of access to other key molecular biomarker tests, such as polymerase epsilon (POLE) sequencing (used by only 9.8% of HCPs at the time of the survey). CONCLUSION The results highlighted several perceived practical barriers to the swift adoption of new therapeutic options, including funding access, limited staff, treatment-related resources, staff education, and support. Our findings support the need for better access to biomarkers that could enable more effective and targeted treatments.
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Affiliation(s)
- A George
- The Royal Marsden NHS Foundation Trust, London, UK.
| | - R A Herbertson
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK.
| | - A Stillie
- Edinburgh Cancer Centre, Edinburgh, UK.
| | | | | | | | - E Hudson
- Velindre University NHS Trust, Cardiff, UK.
| | - T Miles
- NHS South West Genomic Medicine Service Alliance, Bristol, UK.
| | - N A J Ryan
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK.
| | - H Maxwell
- Dorset County Hospital NHS Foundation Trust, Dorchester, UK.
| | - L Le Treust
- Open Health Evidence and Access, Marlow, UK.
| | - M McCormack
- University College London Hospitals NHS Foundation Trust, London, UK.
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Shaw T, Fok R, Courtney E, Li ST, Chiang J, Ngeow J. Missed diagnosis or misdiagnosis: Common pitfalls in genetic testing. Singapore Med J 2023; 64:67-73. [PMID: 36722519 PMCID: PMC9979802 DOI: 10.4103/singaporemedj.smj-2021-467] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Genetic testing has the power to identify individuals with increased predisposition to disease, allowing individuals the opportunity to make informed management, treatment and reproductive decisions. As genomic medicine continues to be integrated into aspects of everyday patient care and the indications for genetic testing continue to expand, genetic services are increasingly being offered by non-genetic clinicians. The current complexities of genetic testing highlight the need to support and ensure non-genetic professionals are adequately equipped with the knowledge and skills to provide services. We describe a series of misdiagnosed/mismanaged cases, highlighting the common pitfalls in genetic testing to identify the knowledge gaps and where education and support is needed. We highlight that education focusing on differential diagnoses, test selection and result interpretation is needed. Collaboration and communication between genetic and non-genetic clinicians and integration of genetic counsellors into different medical settings are important. This will minimise the risks and maximise the benefits of genetic testing, ensuring adverse outcomes are mitigated.
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Affiliation(s)
- Tarryn Shaw
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Rose Fok
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Eliza Courtney
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Shao-Tzu Li
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Jianbang Chiang
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore,Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Joanne Ngeow
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore,Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore,Correspondence: A/Prof Joanne Ngeow, Lee Kong Chian School of Medicine, Nanyang Technological University, Novena Campus, Headquarters & Clinical Sciences Building, 11 Mandalay Road, 308232, Singapore. E-mail:
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3
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McCuaig JM, Stockley TL, Ferguson SE, Vicus D, Brennenstuhl S, Ott K, Kim RH, Metcalfe KA. Patient‐reported outcomes associated with reflex
BRCA1
/2
tumor and subsequent germline panel genetic testing for high‐grade serous ovarian cancer. J Genet Couns 2022; 32:503-513. [PMID: 36478486 DOI: 10.1002/jgc4.1661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022]
Abstract
Reflex genetic testing of tumor tissue is being completed to direct cancer treatment; however, the patient impact of this genetic testing model is unknown. This survey study evaluates psychological outcomes following tumor and germline genetic testing in individuals with a new diagnosis of high-grade serous ovarian cancer (HGSOC). Individuals were recruited from two hospitals in Toronto, Canada. Participants completed surveys 1 week after receiving tumor results and 1 week after receiving germline results (which included genetic counseling). Outcomes included cancer-related distress (Impact of Events Scale: IES), genetic testing-related distress (Multidimensional Impact of Cancer Risk Assessment: MICRA), and patient satisfaction. Paired t-tests were used to evaluate differences in outcomes following each genetic test result; Cohen's d was used to evaluate effect size. Subgroup analyses were undertaken according to age at diagnosis (<60 years vs. ≥60 years) and test results (any positive vs. both negative). McNemar's test assessed differences in satisfaction. Fifty-two individuals were included in the analyses. Mean IES scores were similar following disclosure of tumor and germline results (27.39 vs. 26.14; p = 0.481; d = 0.101). Compared to following tumor result disclosure, MICRA scores were significantly lower following receipt of germline results with genetic counseling (27.23 vs. 22.69; p = 0.007; d = 0.435). Decreases in MICRA scores from tumor to germline result disclosure were greater for those diagnosed <60 years or those who received only negative test results. Most individuals were satisfied/highly satisfied following tumor (85.7%) and germline (89.8%) results disclosure (p = 0.774). Reflex tumor, and subsequent germline, genetic testing is a new model of care for cancer patients. In our cohort, genetic testing-related distress decreased significantly following receipt of germline results with genetic counseling, especially for individuals diagnosed under 60 years and those receiving only negative results. Most individuals were satisfied with this model of care.
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Affiliation(s)
- Jeanna M. McCuaig
- University Health Network Toronto Canada
- Lawrence S. Bloomberg Faculty of Nursing University of Toronto Toronto Canada
- Department of Molecular Genetics University of Toronto Toronto Canada
| | - Tracy L. Stockley
- University Health Network Toronto Canada
- Department of Laboratory Medicine and Pathobiology University of Toronto Toronto Canada
| | - Sarah E. Ferguson
- University Health Network Toronto Canada
- Department of Obstetrics and Gynecology University of Toronto Toronto Canada
- Sinai Health Systems Toronto Canada
| | - Danielle Vicus
- Department of Obstetrics and Gynecology University of Toronto Toronto Canada
- Sunnybrook Health Sciences Centre‐ Odette Cancer Centre Toronto Canada
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing University of Toronto Toronto Canada
| | - Karen Ott
- Sunnybrook Health Sciences Centre‐ Odette Cancer Centre Toronto Canada
| | - Raymond H. Kim
- University Health Network Toronto Canada
- Hospital for Sick Children Toronto Canada
- Department of Medicine University of Toronto Toronto Canada
- Adaptive Oncology Ontario Institute for Cancer Research Toronto Canada
| | - Kelly A. Metcalfe
- Lawrence S. Bloomberg Faculty of Nursing University of Toronto Toronto Canada
- Women's College Research Institute Toronto Canada
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4
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Torr B, Jones C, Choi S, Allen S, Kavanaugh G, Hamill M, Garrett A, MacMahon S, Loong L, Reay A, Yuan L, Valganon Petrizan M, Monson K, Perry N, Fallowfield L, Jenkins V, Gold R, Taylor A, Gabe R, Wiggins J, Lucassen A, Manchanda R, Gandhi A, George A, Hubank M, Kemp Z, Evans DG, Bremner S, Turnbull C. A digital pathway for genetic testing in UK NHS patients with cancer: BRCA-DIRECT randomised study internal pilot. J Med Genet 2022; 59:1179-1188. [PMID: 35868849 PMCID: PMC9691828 DOI: 10.1136/jmg-2022-108655] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/03/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Germline genetic testing affords multiple opportunities for women with breast cancer, however, current UK NHS models for delivery of germline genetic testing are clinician-intensive and only a minority of breast cancer cases access testing. METHODS We designed a rapid, digital pathway, supported by a genetics specialist hotline, for delivery of germline testing of BRCA1/BRCA2/PALB2 (BRCA-testing), integrated into routine UK NHS breast cancer care. We piloted the pathway, as part of the larger BRCA-DIRECT study, in 130 unselected patients with breast cancer and gathered preliminary data from a randomised comparison of delivery of pretest information digitally (fully digital pathway) or via telephone consultation with a genetics professional (partially digital pathway). RESULTS Uptake of genetic testing was 98.4%, with good satisfaction reported for both the fully and partially digital pathways. Similar outcomes were observed in both arms regarding patient knowledge score and anxiety, with <5% of patients contacting the genetics specialist hotline. All progression criteria established for continuation of the study were met. CONCLUSION Pilot data indicate preliminary demonstration of feasibility and acceptability of a fully digital pathway for BRCA-testing and support proceeding to a full powered study for evaluation of non-inferiority of the fully digital pathway, detailed quantitative assessment of outcomes and operational economic analyses. TRIAL REGISTRATION NUMBER ISRCTN87845055.
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Affiliation(s)
- Bethany Torr
- Institute of Cancer Research, Division of Genetics and Epidemiology, Sutton, UK
| | - Christopher Jones
- Clinical Trials Unit, Brighton and Sussex Medical School, Brighton, UK
| | - Subin Choi
- Institute of Cancer Research, Division of Genetics and Epidemiology, Sutton, UK
| | - Sophie Allen
- Institute of Cancer Research, Division of Genetics and Epidemiology, Sutton, UK
| | - Grace Kavanaugh
- Institute of Cancer Research, Division of Genetics and Epidemiology, Sutton, UK
| | - Monica Hamill
- Institute of Cancer Research, Division of Genetics and Epidemiology, Sutton, UK
| | - Alice Garrett
- Institute of Cancer Research, Division of Genetics and Epidemiology, Sutton, UK
| | - Suzanne MacMahon
- Centre for Molecular Pathology, Institute of Cancer Research Sutton, Sutton, UK
| | - Lucy Loong
- Institute of Cancer Research, Division of Genetics and Epidemiology, Sutton, UK
| | - Alistair Reay
- Centre for Molecular Pathology, Institute of Cancer Research Sutton, Sutton, UK
| | - Lina Yuan
- Centre for Molecular Pathology, Institute of Cancer Research Sutton, Sutton, UK
| | | | - Kathryn Monson
- Sussex Health Outcomes, Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, Brighton, UK
| | - Nicky Perry
- Clinical Trials Unit, Brighton and Sussex Medical School, Brighton, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes, Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, Brighton, UK
| | - Valerie Jenkins
- Sussex Health Outcomes, Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, Brighton, UK
| | | | - Amy Taylor
- Clinical Genetics, East Anglian Medical Genetics Service, Cambridge, UK
| | - Rhian Gabe
- Wolfson Institute of Population Health, Queen Mary's University of London, London, UK
| | - Jennifer Wiggins
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Anneke Lucassen
- Clinical Ethics and Law at Southampton (CELS), University of Southampton, Southampton, UK
- Department of Medicine, Univerity of Oxford Nuffield, Oxford, UK
| | - Ranjit Manchanda
- Wolfson Institute of Population Health, Queen Mary's University of London, London, UK
- Department of Gynaecological Oncology, Barts Health NHS Trust, London, UK
- Department of Health Services Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ashu Gandhi
- School of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Prevent Breast Cancer Centre, Wythenshawe Hospital Manchester Universities Foundation Trust, Manchester, UK
| | - Angela George
- Institute of Cancer Research, Division of Genetics and Epidemiology, Sutton, UK
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Michael Hubank
- Centre for Molecular Pathology, Institute of Cancer Research Sutton, Sutton, UK
| | - Zoe Kemp
- Institute of Cancer Research, Division of Genetics and Epidemiology, Sutton, UK
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - D Gareth Evans
- Nightingale and Genesis Breast Cancer Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
- Division of Evolution and Genomic Sciences, The University of Manchester, Manchester, UK
| | - Stephen Bremner
- Clinical Trials Unit, Brighton and Sussex Medical School, Brighton, UK
| | - Clare Turnbull
- Institute of Cancer Research, Division of Genetics and Epidemiology, Sutton, UK
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, London, UK
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5
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Pfeffer G, Lee G, Pontifex CS, Fanganiello RD, Peck A, Weihl CC, Kimonis V. Multisystem Proteinopathy Due to VCP Mutations: A Review of Clinical Heterogeneity and Genetic Diagnosis. Genes (Basel) 2022; 13:genes13060963. [PMID: 35741724 PMCID: PMC9222868 DOI: 10.3390/genes13060963] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 02/06/2023] Open
Abstract
In this work, we review clinical features and genetic diagnosis of diseases caused by mutations in the gene encoding valosin-containing protein (VCP/p97), the functionally diverse AAA-ATPase. VCP is crucial to a multitude of cellular functions including protein quality control, stress granule formation and clearance, and genomic integrity functions, among others. Pathogenic mutations in VCP cause multisystem proteinopathy (VCP-MSP), an autosomal dominant, adult-onset disorder causing dysfunction in several tissue types. It can result in complex neurodegenerative conditions including inclusion body myopathy, frontotemporal dementia, amyotrophic lateral sclerosis, or combinations of these. There is also an association with other neurodegenerative phenotypes such as Alzheimer-type dementia and Parkinsonism. Non-neurological presentations include Paget disease of bone and may also include cardiac dysfunction. We provide a detailed discussion of genotype-phenotype correlations, recommendations for genetic diagnosis, and genetic counselling implications of VCP-MSP.
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Affiliation(s)
- Gerald Pfeffer
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada;
- Alberta Child Health Research Institute, Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Correspondence:
| | - Grace Lee
- Division of Genetic and Genomic Medicine, Department of Pediatrics, University of California Irvine Medical Center, Orange, CA 92868, USA; (G.L.); (V.K.)
| | - Carly S. Pontifex
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada;
| | - Roberto D. Fanganiello
- Oral Ecology Research Group, Faculty of Dental Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada;
| | - Allison Peck
- Cure VCP Disease, Inc., Americus, GA 31709, USA;
| | - Conrad C. Weihl
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA;
| | - Virginia Kimonis
- Division of Genetic and Genomic Medicine, Department of Pediatrics, University of California Irvine Medical Center, Orange, CA 92868, USA; (G.L.); (V.K.)
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6
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Andoni T, Wiggins J, Robinson R, Charlton R, Sandberg M, Eeles R. Half of germline pathogenic and likely pathogenic variants found on panel tests do not fulfil NHS testing criteria. Sci Rep 2022; 12:2507. [PMID: 35190596 PMCID: PMC8861039 DOI: 10.1038/s41598-022-06376-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 01/20/2022] [Indexed: 12/22/2022] Open
Abstract
Genetic testing for cancer predisposition has been curtailed by the cost of sequencing, and testing has been restricted by eligibility criteria. As the cost of sequencing decreases, the question of expanding multi-gene cancer panels to a broader population arises. We evaluated how many additional actionable genetic variants are returned by unrestricted panel testing in the private sector compared to those which would be returned by adhering to current NHS eligibility criteria. We reviewed 152 patients referred for multi-gene cancer panels in the private sector between 2014 and 2016. Genetic counselling and disclosure of all results was standard of care provided by the Consultant. Every panel conducted was compared to current eligibility criteria. A germline pathogenic / likely pathogenic variant (P/LP), in a gene relevant to the personal or family history of cancer, was detected in 15 patients (detection rate of 10%). 46.7% of those found to have the P/LP variants (7 of 15), or 4.6% of the entire set (7 of 152), did not fulfil NHS eligibility criteria. 46.7% of P/LP variants in this study would have been missed by national testing guidelines, all of which were actionable. However, patients who do not fulfil eligibility criteria have a higher Variant of Uncertain Significance (VUS) burden. We demonstrated that the current England NHS threshold for genetic testing is missing pathogenic variants which would alter management in 4.6%, nearly 1 in 20 individuals. However, the clinical service burden that would ensue is a detection of VUS of 34%.
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Affiliation(s)
- Tala Andoni
- The Institute of Cancer Research, London, UK.
| | | | - Rachel Robinson
- Leeds Genetics Laboratory, St James's University Hospital, Leeds, UK
| | - Ruth Charlton
- Leeds Genetics Laboratory, St James's University Hospital, Leeds, UK
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7
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Coffin T, Bowen D, Swisher E, Lu K, Lu K, Lu K, Rayes N, Norquist B, Norquist B, Norquist B, Blank S, Levine D, Levine D, Levine D, Bakkum-Gamez J, Bakkum-Gamez J, Bakkum-Gamez J, Bakkum-Gamez J, Fleming G, Fleming G, Olopade O, Olopade O, Olopade O, D’Andrea A, D’Andrea A, Nebgen D, Nebgen D, Nebgen D, Nebgen D, Peterson C, Peterson C, Peterson C, Munsell M, Gavin K, Gavin K, Lechner R, Lechner R, Crase J, Crase J, Polinsky D, Romero I. Development and assessment of an accessible communication system for population based genetic testing (Preprint). JMIR Form Res 2021; 6:e34055. [DOI: 10.2196/34055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
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8
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Yoon SY, Wong SW, Lim J, Ahmad S, Mariapun S, Padmanabhan H, Hassan NT, Lau SY, Ch'ng GS, Haniffa M, Ong WP, Rethanavelu K, Moey LH, Keng WT, Omar J, Mohd Abas MN, Yong CM, Ramasamy V, Md Noor MR, Aliyas I, Lim MCK, Suberamaniam A, Mat Adenan NA, Ahmad ZA, Ho GF, Abdul Malik R, Subramaniam S, Khoo BP, Raja A, Chin YS, Sim WW, Teh BH, Kho SK, Ong ESE, Voon PJ, Ismail G, Lee CL, Abdullah BZ, Loo KS, Lim CS, Lee SJ, Lim KJL, Shafiee MN, Ismail F, Latiff ZA, Ismail MP, Mohamed Jamli MF, Kumarasamy S, Leong KW, Low J, Md Yusof M, Ahmad Mustafa AM, Mat Ali NH, Makanjang M, Tayib S, Cheah N, Lim BK, Fong CK, Foo YC, Mellor Abdullah M, Tan TS, Chow DSY, Ho KF, Raman R, Radzi A, Deniel A, Teoh DCY, Ang SF, Joseph JK, Ng PHO, Tho LM, Ahmad AR, Muin I, Bleiker E, George A, Thong MK, Woo YL, Teo SH. Oncologist-led BRCA counselling improves access to cancer genetic testing in middle-income Asian country, with no significant impact on psychosocial outcomes. J Med Genet 2021; 59:220-229. [PMID: 33526602 DOI: 10.1136/jmedgenet-2020-107416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/28/2020] [Accepted: 11/29/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Identifying patients with BRCA mutations is clinically important to inform on the potential response to treatment and for risk management of patients and their relatives. However, traditional referral routes may not meet clinical needs, and therefore, mainstreaming cancer genetics has been shown to be effective in some high-income and high health-literacy settings. To date, no study has reported on the feasibility of mainstreaming in low-income and middle-income settings, where the service considerations and health literacy could detrimentally affect the feasibility of mainstreaming. METHODS The Mainstreaming Genetic Counselling for Ovarian Cancer Patients (MaGiC) study is a prospective, two-arm observational study comparing oncologist-led and genetics-led counselling. This study included 790 multiethnic patients with ovarian cancer from 23 sites in Malaysia. We compared the impact of different method of delivery of genetic counselling on the uptake of genetic testing and assessed the feasibility, knowledge and satisfaction of patients with ovarian cancer. RESULTS Oncologists were satisfied with the mainstreaming experience, with 95% indicating a desire to incorporate testing into their clinical practice. The uptake of genetic testing was similar in the mainstreaming and genetics arm (80% and 79%, respectively). Patient satisfaction was high, whereas decision conflict and psychological impact were low in both arms of the study. Notably, decisional conflict, although lower than threshold, was higher for the mainstreaming group compared with the genetics arm. Overall, 13.5% of patients had a pathogenic variant in BRCA1 or BRCA2, and there was no difference between psychosocial measures for carriers in both arms. CONCLUSION The MaGiC study demonstrates that mainstreaming cancer genetics is feasible in low-resource and middle-resource Asian setting and increased coverage for genetic testing.
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Affiliation(s)
- Sook-Yee Yoon
- Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Siu Wan Wong
- Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Joanna Lim
- Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Syuhada Ahmad
- Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Shivaani Mariapun
- Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | | | - Nur Tiara Hassan
- Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Shao Yan Lau
- Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Gaik-Siew Ch'ng
- Genetics, Penang Hospital, Penang, Penang, Malaysia.,Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Muzhirah Haniffa
- Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Winnie P Ong
- Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Kavitha Rethanavelu
- Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Lip Hen Moey
- Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Wee Teik Keng
- Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Jamil Omar
- Gynaeoncology, Institut Kanser Negara, Putrajaya, Wilayah Persekutuan Putra, Malaysia
| | | | | | | | - Mohd Rushdan Md Noor
- Gynaeoncology, Hospital Sultanah Bahiyah, Alor Setar, Kedah Darul Aman, Malaysia
| | - Ismail Aliyas
- Gynaeoncology, Hospital Sultanah Bahiyah, Alor Setar, Kedah Darul Aman, Malaysia
| | - Michael C K Lim
- Department of O&G, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Anuradha Suberamaniam
- Gynaeoncology, University of Malaya Medical Centre, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Noor Azmi Mat Adenan
- Department of O&G, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Zatul Akmar Ahmad
- Department of O&G, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Gwo Fuang Ho
- Clinical Oncology, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Rozita Abdul Malik
- Clinical Oncology, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Suguna Subramaniam
- Gynaeoncology, Hospital Wanita Dan Kanak-Kanak Sabah, Kota Kinabalu, Malaysia
| | - Boom Ping Khoo
- Gynaeoncology, Hospital Wanita Dan Kanak-Kanak Sabah, Kota Kinabalu, Malaysia
| | - Arivendran Raja
- Gynaeoncology, Hospital Wanita Dan Kanak-Kanak Sabah, Kota Kinabalu, Malaysia
| | - Yeung Sing Chin
- Gynaeoncology, Hospital Wanita Dan Kanak-Kanak Sabah, Kota Kinabalu, Malaysia
| | - Wee Wee Sim
- Gynaeoncology, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
| | - Beng Hock Teh
- Gynaeoncology, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
| | - Swee Kiong Kho
- Oncology, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
| | - Eunice S E Ong
- Oncology, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
| | - Pei Jye Voon
- Oncology, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
| | - Ghazali Ismail
- Gynaeoncology, Hospital Sultan Ismail, Johor Bharu, Johor Darul Ta'zim, Malaysia
| | - Chui Ling Lee
- Gynaeoncology, Hospital Sultan Ismail, Johor Bharu, Johor Darul Ta'zim, Malaysia
| | | | - Kwong Sheng Loo
- Gynaeoncology, Hospital Sultan Ismail, Johor Bharu, Johor Darul Ta'zim, Malaysia
| | - Chun Sen Lim
- Gynaeoncology, Hospital Sultan Ismail, Johor Bharu, Johor Darul Ta'zim, Malaysia
| | - Saw Joo Lee
- Gynaeoncology, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | | | - Mohamad Nasir Shafiee
- Gynaeoncology, Hospital Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Fuad Ismail
- Oncology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Zarina Abdul Latiff
- Clinical Genetics, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Mohd Pazudin Ismail
- Gynaeoncology, Hospital Universiti Sains Malaysia, Kota Bahru, Kelantan, Malaysia
| | | | | | - Kin Wah Leong
- Oncology, Gleneagles Penang, Penang, Penang, Malaysia
| | - John Low
- Oncology, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Mastura Md Yusof
- Oncology, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | | | - Nor Huda Mat Ali
- Gynaeoncology, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia
| | - Mary Makanjang
- Gynaeoncology, KPJ Sabah Specialist Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Shahila Tayib
- Gynaeoncology, Penang General Hospital, Georgetown, Pulau Pinang, Malaysia
| | - Nellie Cheah
- Oncology, Loh Guan Lye Specialist Centre, Penang, Malaysia
| | - Boon Kiong Lim
- Department of O&G, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Chee Kin Fong
- Gynaeoncology, Subang Jaya Medical Centre, Subang Jaya, Malaysia
| | - Yoke Ching Foo
- Oncology, Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
| | | | - Teck Sin Tan
- Gynaeoncology, Subang Jaya Medical Centre, Subang Jaya, Malaysia
| | - Doris S Y Chow
- Oncology, Mount Miriam Cancer Hospital, Tanjong Bungah, Penang, Malaysia
| | - Kean Fatt Ho
- Oncology, Mount Miriam Cancer Hospital, Tanjong Bungah, Penang, Malaysia
| | - Rakesh Raman
- Oncology, Mount Miriam Cancer Hospital, Tanjong Bungah, Penang, Malaysia
| | - Ahmad Radzi
- Oncology, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Azura Deniel
- Oncology, KPJ Ampang Puteri Specialist Hospital, Ampang, Kuala Lumpur, Malaysia
| | - Daren C Y Teoh
- Oncology, KPJ Sabah Specialist Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Soo Fan Ang
- Oncology, Penang Adventist Hospital, Penang, Penang, Malaysia
| | - Joseph K Joseph
- Oncology, Sunway Medical Centre, Bandar Sunway, Selangor, Malaysia
| | - Paul Hock Oon Ng
- Oncology, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Lye-Mun Tho
- Oncology, Beacon Hospital Sdn Bhd, Petaling Jaya, Malaysia
| | | | - Ileena Muin
- Oncology, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Eveline Bleiker
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Angela George
- Oncology, Royal Marsden Hospital Chelsea, London, London, UK
| | - Meow-Keong Thong
- Genetic Medicine Unit, University of Malaya Medical Centre, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Yin Ling Woo
- Department of O&G, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Soo Hwang Teo
- Cancer Prevention and Population Science, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia.,University Malaya Cancer Research Institute, Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
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9
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Powell CB, Laurent C, Ciaravino G, Garcia C, Han L, Hoodfar E, Karlea A, Kobelka C, Lee J, Littell RD, Roh J, Vay A, Kushi LH. Streamlining genetic testing for women with ovarian cancer in a Northern California health care system. Gynecol Oncol 2020; 159:221-228. [PMID: 32778409 DOI: 10.1016/j.ygyno.2020.07.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/18/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Referral to Genetics for pre-testing counseling may be inefficient for women with ovarian cancer. This study assesses feasibility of gynecologic oncologists directly offering genetic testing. METHODS A prospective pilot study was conducted at two gynecologic oncology hubs in an integrated healthcare system from May 1 to November 6, 2019. Gynecologic oncologists offered multigene panel testing to women with newly diagnosed ovarian cancer, followed by selective genetic counseling. Outcomes were compared between study participants and women from other hubs in the health system. RESULTS Of ovarian cancer patients at study sites, 40 participated and all underwent genetic testing. Of 101 patients diagnosed at other sites, 85% were referred to genetics (p = .0061 compared to pilot participants) and 67% completed testing (p < .0001). The time from diagnosis to blood draw and notification of result was 18.5 and 34 days for the pilot group compared to 25.5 and 53 days at other sites. Panel testing detected 9 (22.5%) and 7 (10.3%, p = .08) pathogenic mutations in each group, respectively. Patients and providers were highly satisfied with the streamlined process. CONCLUSION Genetic testing performed at the gynecologic oncology point of care for patients with ovarian cancer is feasible, increases uptake of testing, and improves time to results.
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Affiliation(s)
- C Bethan Powell
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States of America; Kaiser Permanente Northern California Gynecologic Cancer Program San Francisco, United States of America.
| | - Cecile Laurent
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States of America
| | - Giuseppe Ciaravino
- Kaiser Permanente Northern California Gynecologic Cancer Program Oakland, United States of America
| | - Christine Garcia
- Kaiser Permanente Northern California Gynecologic Cancer Program San Francisco, United States of America
| | - Liz Han
- Kaiser Permanente Northern California Gynecologic Cancer Program Oakland, United States of America
| | - Elizabeth Hoodfar
- Kaiser Permanente Northern California Genetics Department, United States of America
| | - Audrey Karlea
- Kaiser Permanente Northern California Genetics Department, United States of America
| | - Christine Kobelka
- Kaiser Permanente Northern California Genetics Department, United States of America
| | - Jaimie Lee
- Kaiser Permanente Oakland Obstetrics and Gynecology Residency Program, United States of America
| | - Ramey D Littell
- Kaiser Permanente Northern California Gynecologic Cancer Program San Francisco, United States of America
| | - Janise Roh
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States of America
| | - Agniezka Vay
- Kaiser Permanente Northern California Gynecologic Cancer Program Oakland, United States of America
| | - Lawrence H Kushi
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States of America
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10
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Gleeson M, Kentwell M, Meiser B, Do J, Nevin S, Taylor N, Barlow-Stewart K, Kirk J, James P, Scott CL, Williams R, Gamet K, Burke J, Murphy M, Antill YC, Pearn A, Pachter N, Ebzery C, Poplawski N, Friedlander M, Tucker KM. The development and evaluation of a nationwide training program for oncology health professionals in the provision of genetic testing for ovarian cancer patients. Gynecol Oncol 2020; 158:431-439. [PMID: 32451123 DOI: 10.1016/j.ygyno.2020.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/03/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND BRCA1/2 mutation status has increasing relevance for ovarian cancer treatments, making traditional coordination of genetic testing by genetic services unsustainable. Consequently alternative models of genetic testing have been developed to improve testing at the initial diagnosis for all eligible women. METHODS A training module to enable mainstreamed genetic testing by oncology healthcare professionals was developed by genetic health professionals. Oncology healthcare professionals completed questionnaires before and 12 months post-training to assess perceived skills, competence and barriers to their coordinating genetic testing for women with high-grade non-mucinous epithelial ovarian cancer. Genetic health professionals were surveyed 12 months post-training to assess perceived barriers to implementation of mainstreaming. RESULTS 185 oncology healthcare professionals were trained in 42 workshops at 35 Australasian hospitals. Of the 273 tests ordered by oncology healthcare professionals post-training, 241 (93.1%) met national testing guidelines. The number of tests ordered by genetic health professionals reduced significantly (z = 45.0, p = 0.008). Oncology healthcare professionals' perceived barriers to mainstreamed testing decreased from baseline to follow-up (t = 2.39, p = 0.023), particularly perceived skills, knowledge and attitudes. However, only 58% reported either 'always' or 'nearly always' having ordered BRCA testing for eligible patients at 12 months, suggesting oncology healthcare professionals' perceived barriers were not systematically addressed through training. CONCLUSIONS Oncology healthcare professionals have demonstrated a willingness to be involved in the provision of genetic testing in a mainstreaming model. If oncology services are to hold responsibility for coordinating genetic testing, their readiness will require understanding of barriers not addressed by training alone to inform future intervention design.
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Affiliation(s)
- M Gleeson
- Hunter Family Cancer Service, Newcastle, Australia.
| | - M Kentwell
- Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia; The Royal Women's Hospital, Oncology and Dysplasia, Melbourne, Australia
| | - B Meiser
- Prince of Wales Clinical School, UNSW Sydney, Australia
| | - J Do
- Prince of Wales Clinical School, UNSW Sydney, Australia
| | - S Nevin
- Prince of Wales Clinical School, UNSW Sydney, Australia
| | - N Taylor
- The Cancer Council New South Wales, Sydney and Faculty of Health Science, University of Sydney, Australia
| | | | - J Kirk
- Familial Cancer Service, Westmead Hospital, Sydney Medical School, University of Sydney and Centre for Cancer Research, The Westmead Institute for Medical Research, Australia
| | - P James
- Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - C L Scott
- Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology and Department of Medical Biology, University of Melbourne, Australia
| | - R Williams
- Prince of Wales Clinical School, UNSW Sydney, Australia; Hereditary Cancer Centre, Prince of Wales Hospital, Sydney, Australia
| | - K Gamet
- Genetic Health Service NZ Northern Hub, Auckland City Hospital, Auckland, New Zealand
| | - J Burke
- Tasmanian Clinical Genetics Service, Royal Hobart Hospital, Hobart, Australia
| | - M Murphy
- Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia; Bendigo Health Cancer Centre, Bendigo, Australia
| | - Y C Antill
- Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia; Familial Cancer Centre, Monash Health, Victoria, Australia
| | - A Pearn
- Genetic Services of Western Australia, King Edward Memorial Hospital, Perth, Australia
| | - N Pachter
- Genetic Services of Western Australia, King Edward Memorial Hospital, Perth, Australia; School of Medicine, University of Western Australia, Perth, Australia
| | - C Ebzery
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - N Poplawski
- Adult Genetics Unit, Royal Adelaide Hospital, Adelaide and School of Medicine, University of Adelaide, Australia
| | - M Friedlander
- Dept Medical Oncology, Prince of Wales Hospital, Sydney, Australia
| | - K M Tucker
- Prince of Wales Clinical School, UNSW Sydney, Australia; Hereditary Cancer Centre, Prince of Wales Hospital, Sydney, Australia
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11
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Offit K, Tkachuk KA, Stadler ZK, Walsh MF, Diaz-Zabala H, Levin JD, Steinsnyder Z, Ravichandran V, Sharaf RN, Frey MK, Lipkin SM, Robson ME, Hamilton JG, Vijai J, Mukherjee S. Cascading After Peridiagnostic Cancer Genetic Testing: An Alternative to Population-Based Screening. J Clin Oncol 2020; 38:1398-1408. [PMID: 31922925 PMCID: PMC7193752 DOI: 10.1200/jco.19.02010] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2019] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Despite advances in DNA sequencing technology and expanded medical guidelines, the vast majority of individuals carrying pathogenic variants of common cancer susceptibility genes have yet to be identified. An alternative to population-wide genetic screening of healthy individuals would exploit the trend for genetic testing at the time of cancer diagnosis to guide therapy and prevention, combined with augmented familial diffusion or "cascade" of genomic risk information. METHODS Using a multiple linear regression model, we derived the time interval to detect an estimated 3.9 million individuals in the United States with a pathogenic variant in 1 of 18 cancer susceptibility genes. We analyzed the impact of the proportion of incident patients sequenced, varying observed frequencies of pathogenic germline variants in patients with cancer, differential rates of diffusion of genetic information in families, and family size. RESULTS The time to detect inherited cancer predisposing variants in the population is affected by the extent of cascade to first-, second-, and third-degree relatives (FDR, SDR, TDR, respectively), family size, prevalence of mutations in patients with cancer, and the proportion of patients with cancer sequenced. In a representative scenario, assuming a 7% prevalence of pathogenic variants across cancer types, an average family size of 3 per generation, and 15% of incident patients with cancer in the United States undergoing germline testing, the time to detect all 3.9 million individuals with pathogenic variants in 18 cancer susceptibility genes would be 46.2, 22.3, 13.6, and 9.9 years if 10%, 25%, 50%, and 70%, respectively, of all FDR, SDR, and TDR were tested for familial mutations. CONCLUSION Peridiagnostic and cascade cancer genetic testing offers an alternative strategy to achieve population-wide identification of cancer susceptibility mutations.
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Affiliation(s)
- Kenneth Offit
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; and Program in Cancer Biology and Genetics, Sloan Kettering Institute, New York, NY
- Weill Cornell College of Medicine, Cornell University, New York, NY
| | - Kaitlyn A. Tkachuk
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; and Program in Cancer Biology and Genetics, Sloan Kettering Institute, New York, NY
| | - Zsofia K. Stadler
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; and Program in Cancer Biology and Genetics, Sloan Kettering Institute, New York, NY
- Weill Cornell College of Medicine, Cornell University, New York, NY
| | - Michael F. Walsh
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; and Program in Cancer Biology and Genetics, Sloan Kettering Institute, New York, NY
| | - Hector Diaz-Zabala
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; and Program in Cancer Biology and Genetics, Sloan Kettering Institute, New York, NY
| | - Jeffrey D. Levin
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; and Program in Cancer Biology and Genetics, Sloan Kettering Institute, New York, NY
| | - Zoe Steinsnyder
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; and Program in Cancer Biology and Genetics, Sloan Kettering Institute, New York, NY
| | - Vignesh Ravichandran
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; and Program in Cancer Biology and Genetics, Sloan Kettering Institute, New York, NY
| | - Ravi N. Sharaf
- Weill Cornell College of Medicine, Cornell University, New York, NY
| | - Melissa K. Frey
- Weill Cornell College of Medicine, Cornell University, New York, NY
| | - Steven M. Lipkin
- Weill Cornell College of Medicine, Cornell University, New York, NY
| | - Mark E. Robson
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; and Program in Cancer Biology and Genetics, Sloan Kettering Institute, New York, NY
- Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell College of Medicine, Cornell University, New York, NY
| | - Jada G. Hamilton
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; and Program in Cancer Biology and Genetics, Sloan Kettering Institute, New York, NY
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell College of Medicine, Cornell University, New York, NY
| | - Joseph Vijai
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; and Program in Cancer Biology and Genetics, Sloan Kettering Institute, New York, NY
- Weill Cornell College of Medicine, Cornell University, New York, NY
| | - Semanti Mukherjee
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; and Program in Cancer Biology and Genetics, Sloan Kettering Institute, New York, NY
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12
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Nisselle A, Martyn M, Jordan H, Kaunein N, McEwen A, Patel C, Terrill B, Bishop M, Metcalfe S, Gaff C. Ensuring Best Practice in Genomic Education and Evaluation: A Program Logic Approach. Front Genet 2019; 10:1057. [PMID: 31781158 PMCID: PMC6857516 DOI: 10.3389/fgene.2019.01057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/02/2019] [Indexed: 11/15/2022] Open
Abstract
Targeted genomic education and training of professionals have been identified as core components of strategies and implementation plans for the use of genomics in health care systems. Education needs to be effective and support the sustained and appropriate use of genomics in health care. Evaluation of education programs to identify effectiveness is challenging. Furthermore, those responsible for development and delivery are not necessarily trained in education and/or evaluation. Program logic models have been used to support the development and evaluation of education programs by articulating a logical explanation as to how a program intends to produce the desired outcomes. These are highly relevant to genomic education programs, but do not appear to have been widely used to date. To assist those developing and evaluating genomic education programs, and as a first step towards enabling identification of effective genomic education approaches, we developed a consensus program logic model for genomic education. We drew on existing literature and a co-design process with 24 international genomic education and evaluation experts to develop the model. The general applicability of the model to the development of programs was tested by program convenors across four diverse settings. Conveners reported on the utility and relevance of the logic model across development, delivery and evaluation. As a whole, their feedback suggests that the model is flexible and adaptive across university award programs, competency development and continuing professional development activities. We discuss this program logic model as a potential best practice mechanism for developing genomic education, and to support development of an evaluation framework and consistent standards to evaluate and report genomic education program outcomes and impacts.
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Affiliation(s)
- Amy Nisselle
- Australian Genomics Health Alliance, Melbourne, VIC, Australia.,Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Melissa Martyn
- Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Melbourne Genomics Health Alliance, Melbourne, VIC, Australia
| | - Helen Jordan
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Nadia Kaunein
- Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Alison McEwen
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Chirag Patel
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Bronwyn Terrill
- Australian Genomics Health Alliance, Melbourne, VIC, Australia.,Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Sydney, NSW, Australia.,St Vincent's Clinical School, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Michelle Bishop
- Genomics Education Program, Health Education England, Birmingham, United Kingdom
| | - Sylvia Metcalfe
- Australian Genomics Health Alliance, Melbourne, VIC, Australia.,Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Clara Gaff
- Australian Genomics Health Alliance, Melbourne, VIC, Australia.,Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
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13
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From Targeting Somatic Mutations to Finding Inherited Cancer Predispositions: The Other Side of the Coin. Diagnostics (Basel) 2019; 9:diagnostics9030083. [PMID: 31357515 PMCID: PMC6787697 DOI: 10.3390/diagnostics9030083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 07/25/2019] [Accepted: 07/25/2019] [Indexed: 02/06/2023] Open
Abstract
The expanding use of tumor genome analysis by next generation sequencing to drive target therapies has led to increased germline findings in genes predisposing to hereditary cancer. These putative germline findings obtained from theranostic analyses, such as BRCA1/2 gene testing, large panels, whole-exome, or whole-genome sequencing, need to be managed carefully and in an anticipated way with the patient. Before the genetic analysis of a tumor, specific information should be given to patients, who should be aware that the results may have extra-therapeutic medical issues for themselves and relatives. We previously published a list of 36 actionable genes predisposing to cancer for which informing the patient is recommended prior to pangenomic germline analysis because of available screening or preventive strategies. Here, we report clinical practice considerations and schemes for managing germline findings in tumor analyses, including written informed consent and a multidisciplinary approach involving an oncologist, molecular biologist/pathologist, and geneticist in case of germline findings. A somatic result showing a deleterious mutation in a known predisposing gene in a patient who has consented to this purpose should result in referral to a geneticist who is part of the multidisciplinary team. At any time of the somatic analysis process, the patient may have access to a geneticist consultation if additional information is required. This framework will optimally manage both personalized theranostic issues and specific preventive strategies for individuals and relatives; it will also simplify and accelerate the process of genetic testing.
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14
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Hallowell N, Wright S, Stirling D, Gourley C, Young O, Porteous M. Moving into the mainstream: healthcare professionals' views of implementing treatment focussed genetic testing in breast cancer care. Fam Cancer 2019; 18:293-301. [PMID: 30689103 PMCID: PMC6560008 DOI: 10.1007/s10689-019-00122-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A proportion of breast cancers are attributable to BRCA1 or BRCA2 mutations. Technological advances has meant that mutation testing in newly diagnosed cancer patients can be used to inform treatment plans. Although oncologists increasingly deliver treatment-focused genetic testing (TFGT) as part of mainstream ovarian cancer care, we know little about non-genetics specialists' views about offering genetic testing to newly diagnosed breast cancer patients. This study sought to determine genetics and non-genetics specialists' views of a proposal to mainstream BRCA1 and 2 testing in newly diagnosed breast cancer patients. Qualitative interview study. Nineteen healthcare professionals currently responsible for offering TFGT in a standard (triage + referral) pathway (breast surgeons + clinical genetics team) and oncologists preparing to offer TFGT to breast cancer patients in a mainstreamed pathway participated in in-depth interviews. Genetics and non-genetics professionals' perceptions of mainstreaming are influenced by their views of: their clinical roles and responsibilities, the impact of TFGT on their workload and the patient pathway and the perceived relevance of genetic testing for patient care in the short-term. Perceived barriers to mainstreaming may be overcome by: more effective communication between specialities, clearer guidelines/patient pathways and the recruitment of mainstreaming champions.
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Affiliation(s)
- Nina Hallowell
- Wellcome Centre for Ethics and Humanities and the Ethox Centre, Nuffield Department of Population Health, Big Data Institute Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK.
| | - S Wright
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - D Stirling
- MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - C Gourley
- MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
- Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - O Young
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK
| | - M Porteous
- MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
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15
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Unim B, Pitini E, Lagerberg T, Adamo G, De Vito C, Marzuillo C, Villari P. Current Genetic Service Delivery Models for the Provision of Genetic Testing in Europe: A Systematic Review of the Literature. Front Genet 2019; 10:552. [PMID: 31275354 PMCID: PMC6593087 DOI: 10.3389/fgene.2019.00552] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 05/24/2019] [Indexed: 11/13/2022] Open
Abstract
Background: The provision of genetic services, along with research in the fields of genomics and genetics, has evolved in recent years to meet the increasing demand of consumers interested in prediction of genetic diseases and various inherited traits. The aim of this study is to evaluate genetic services in order to identify and classify delivery models for the provision of genetic testing in European and in extra-European countries. Methods: A systematic review of the literature was conducted using five electronic resources. Inclusion criteria were that studies be published in English or Italian during the period 2000-2015 and carried out in European or extra-European countries (Canada, USA, Australia, or New Zealand). Results: 148 genetic programs were identified in 117 articles and were delivered mostly in the UK (59, 40%), USA (35, 24%) or Australia (16, 11%). The programs were available nationally (66; 45%), regionally (49; 33%) or in urban areas (21, 14%). Ninety-six (64%) of the programs were integrated into healthcare systems, 48 (32.21%) were pilot programs and five (3%) were direct-to-consumer genetic services. The genetic tests offered were mainly for BRCA1/2 (59, 40%), Lynch syndrome (23, 16%), and newborn screening (18, 12%). Healthcare professionals with different backgrounds are increasingly engaged in the provision of genetic services. Based on which healthcare professionals have prominent roles in the respective patient care pathways, genetic programs were classified into five models: (i) the geneticists model; (ii) the primary care model; (iii) the medical specialist model; (iv) the population screening programs model; and (v) the direct-to-consumer model. Conclusions: New models of genetic service delivery are currently under development worldwide to address the increasing demand for accessible and affordable services. These models require the integration of genetics into all medical specialties, collaboration among different healthcare professionals, and the redistribution of professional roles. An appropriate model for genetic service provision in a specific setting should ideally be defined according to the type of healthcare system, the genetic test provided within a genetic program, and the cost-effectiveness of the intervention. Only applications with proven efficacy and cost-effectiveness should be implemented in healthcare systems and made available to all citizens.
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Affiliation(s)
- Brigid Unim
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Erica Pitini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | - Giovanna Adamo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Carolina Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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16
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Vassilakopoulou P, Aanestad M. Communal data work: Data sharing and re-use in clinical genetics. Health Informatics J 2019; 25:511-525. [PMID: 30887878 DOI: 10.1177/1460458219833117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In this article, we examine work with communal data in the context of clinical genetic testing. Drawing from prior research on digital research infrastructures and from the analysis of our empirical data on genetic testing, we describe how data generated in laboratories distributed all over the world are shared and re-used. Our research findings point to six different human-driven activities related to expanding, disambiguating, sanitizing and assessing the relevance, validity and combinability of data. We contribute to research within Health Informatics with a framework that foregrounds human-driven activities for data interoperability.
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17
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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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18
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Love-Koh J, Peel A, Rejon-Parrilla JC, Ennis K, Lovett R, Manca A, Chalkidou A, Wood H, Taylor M. The Future of Precision Medicine: Potential Impacts for Health Technology Assessment. PHARMACOECONOMICS 2018; 36:1439-1451. [PMID: 30003435 PMCID: PMC6244622 DOI: 10.1007/s40273-018-0686-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Precision medicine allows healthcare interventions to be tailored to groups of patients based on their disease susceptibility, diagnostic or prognostic information, or treatment response. We analysed what developments are expected in precision medicine over the next decade and considered the implications for health technology assessment (HTA) agencies. METHODS We performed a pragmatic literature search to account for the large size and wide scope of the precision medicine literature. We refined and enriched these results with a series of expert interviews up to 1 h in length, including representatives from HTA agencies, research councils and researchers designed to cover a wide spectrum of precision medicine applications and research. RESULTS We identified 31 relevant papers and interviewed 13 experts. We found that three types of precision medicine are expected to emerge in clinical practice: complex algorithms, digital health applications and 'omics'-based tests. These are expected to impact upon each stage of the HTA process, from scoping and modelling through to decision-making and review. The complex and uncertain treatment pathways associated with patient stratification and fast-paced technological innovation are central to these effects. DISCUSSION Innovation in precision medicine promises substantial benefits but will change the way in which some health services are delivered and evaluated. The shelf life of guidance may decrease, structural uncertainty may increase and new equity considerations will emerge. As biomarker discovery accelerates and artificial intelligence-based technologies emerge, refinements to the methods and processes of evidence assessments will help to adapt and maintain the objective of investing in healthcare that is value for money.
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Affiliation(s)
- James Love-Koh
- York Health Economics Consortium, University of York, York, UK.
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK.
| | - Alison Peel
- York Health Economics Consortium, University of York, York, UK
| | | | - Kate Ennis
- York Health Economics Consortium, University of York, York, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Rosemary Lovett
- National Institute for Health and Care Excellence, Manchester, UK
| | - Andrea Manca
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK
- Luxembourg Institute of Health, Strassen, Luxembourg
| | | | - Hannah Wood
- York Health Economics Consortium, University of York, York, UK
| | - Matthew Taylor
- York Health Economics Consortium, University of York, York, UK
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Wright S, Porteous M, Stirling D, Lawton J, Young O, Gourley C, Hallowell N. Patients' Views of Treatment-Focused Genetic Testing (TFGT): Some Lessons for the Mainstreaming of BRCA1 and BRCA2 Testing. J Genet Couns 2018; 27:10.1007/s10897-018-0261-5. [PMID: 29752676 PMCID: PMC6209051 DOI: 10.1007/s10897-018-0261-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/25/2018] [Indexed: 12/20/2022]
Abstract
This paper explores patients' views and experiences of undergoing treatment-focused BRCA1 and BRCA2 genetic testing (TFGT), either offered following triaging to clinical genetics (breast cancer) or as part of a mainstreamed care pathway in oncology (ovarian cancer). Drawing on 26 in-depth interviews with patients with breast or ovarian cancer who had undergone TFGT, this retrospective study examines patients' views of genetic testing at this point in their care pathway, focusing on issues, such as initial response to the offer of testing, motivations for undergoing testing, and views on care pathways. Patients were amenable to the incorporation of TFGT at an early stage in their cancer care irrespective of (any) prior anticipation of having a genetic test or family history. While patients were glad to have been offered TFGT as part of their care, some questioned the logic of the test's timing in relation to their cancer treatment. Crucially, patients appeared unable to disentangle the treatment role of TFGT from its preventative function for self and other family members, suggesting that some may undergo TFGT to obtain information for others rather than for self.
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Affiliation(s)
- Sarah Wright
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Rm 3.734, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK.
| | - Mary Porteous
- MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Diane Stirling
- MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Julia Lawton
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Rm 3.734, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Oliver Young
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK
| | - Charlie Gourley
- MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
- Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Nina Hallowell
- Big Data Institute, Ethox Centre, Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Colombo N, Huang G, Scambia G, Chalas E, Pignata S, Fiorica J, Van Le L, Ghamande S, González-Santiago S, Bover I, Graña Suárez B, Green A, Huot-Marchand P, Bourhis Y, Karve S, Blakeley C. Evaluation of a Streamlined Oncologist-Led BRCA Mutation Testing and Counseling Model for Patients With Ovarian Cancer. J Clin Oncol 2018; 36:1300-1307. [PMID: 29558274 PMCID: PMC6804908 DOI: 10.1200/jco.2017.76.2781] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Purpose There is a growing demand for BRCA1/ 2 mutation ( BRCAm) testing in patients with ovarian cancer; however, the limited number of genetic counselors presents a potential barrier. To facilitate more widespread BRCAm testing in ovarian cancer, pretest counseling by the oncology team could shorten testing turnaround times and ease the pressure on genetic counselors. Patients and Methods The prospective, observational Evaluating a Streamlined Onco-genetic BRCA Testing and Counseling Model Among Patients With Ovarian Cancer (ENGAGE) study evaluated a streamlined, oncologist-led BRCAm testing pathway. The analysis population comprised 700 patients with ovarian cancer at 26 sites in the United States, Italy, and Spain. The primary objectives were to assess turnaround time and, using questionnaires, to evaluate stakeholder satisfaction (patients, oncologists, and geneticists or genetic counselors) with the oncologist-led BRCAm testing pathway. Results The median overall turnaround time was 9.1 weeks (range, 0.9 to 37.1 weeks), with median turnaround times in the United States, Italy, and Spain of 4.1 weeks (range, 0.9 to 37.1 weeks), 20.4 weeks (range, 2.9 to 35.4 weeks), and 12.0 weeks (range, 2.0 to 36.7 weeks), respectively. Patient satisfaction with the oncologist-led BRCAm testing pathway was high, with > 99% of patients expressing satisfaction with pre- and post- BRCAm test counseling. Oncologist satisfaction with the BRCAm testing pathway was also high, with > 80% agreeing that the process for performing BRCAm testing worked well and that counseling patients on BRCAm testing was an efficient use of their time. Oncologists expressed higher levels of satisfaction with the BRCAm testing pathway than did geneticists or genetic counselors. Conclusion The results of the ENGAGE study demonstrate that an oncologist-led BRCAm testing process is feasible in ovarian cancer. Development of local BRCAm testing guidelines similar to the one used in this study could allow faster treatment decisions and better use of resources in the management of patients with ovarian cancer.
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Affiliation(s)
- Nicoletta Colombo
- Nicoletta Colombo, University of Milan-Bicocca; Nicoletta Colombo, Istituto Europeo di Oncologia, Milan; Giovanni Scambia, Università Cattolica del Sacro Cuore di Roma, Rome; Sandro Pignata, Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione G Pascale IRCCS, Naples, Italy; Gloria Huang, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx; Eva Chalas, Winthrop University Hospital, Mineola, NY; James Fiorica, Sarasota Memorial Hospital, Sarasota, FL; Linda Van Le, University of North Carolina School of Medicine, Chapel Hill, NC; Sharad Ghamande, The Georgia Cancer Center at Augusta University, Augusta; Andrew Green, Northeast Georgia Medical Center, Gainesville, GA; Santiago González-Santiago, Hospital San Pedro de Alcántara, Cáceres; Isabel Bover, Hospital Son Llàtzer, Palma; Begoña Graña Suárez, University Hospital A Coruña, Sergas, Spain; Philippe Huot-Marchand and Yann Bourhis, Mapi Real World Evidence, Lyon, France; Sudeep Karve, AstraZeneca, Gaithersburg, MD; and Christopher Blakeley, AstraZeneca, Cambridge, United Kingdom
| | - Gloria Huang
- Nicoletta Colombo, University of Milan-Bicocca; Nicoletta Colombo, Istituto Europeo di Oncologia, Milan; Giovanni Scambia, Università Cattolica del Sacro Cuore di Roma, Rome; Sandro Pignata, Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione G Pascale IRCCS, Naples, Italy; Gloria Huang, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx; Eva Chalas, Winthrop University Hospital, Mineola, NY; James Fiorica, Sarasota Memorial Hospital, Sarasota, FL; Linda Van Le, University of North Carolina School of Medicine, Chapel Hill, NC; Sharad Ghamande, The Georgia Cancer Center at Augusta University, Augusta; Andrew Green, Northeast Georgia Medical Center, Gainesville, GA; Santiago González-Santiago, Hospital San Pedro de Alcántara, Cáceres; Isabel Bover, Hospital Son Llàtzer, Palma; Begoña Graña Suárez, University Hospital A Coruña, Sergas, Spain; Philippe Huot-Marchand and Yann Bourhis, Mapi Real World Evidence, Lyon, France; Sudeep Karve, AstraZeneca, Gaithersburg, MD; and Christopher Blakeley, AstraZeneca, Cambridge, United Kingdom
| | - Giovanni Scambia
- Nicoletta Colombo, University of Milan-Bicocca; Nicoletta Colombo, Istituto Europeo di Oncologia, Milan; Giovanni Scambia, Università Cattolica del Sacro Cuore di Roma, Rome; Sandro Pignata, Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione G Pascale IRCCS, Naples, Italy; Gloria Huang, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx; Eva Chalas, Winthrop University Hospital, Mineola, NY; James Fiorica, Sarasota Memorial Hospital, Sarasota, FL; Linda Van Le, University of North Carolina School of Medicine, Chapel Hill, NC; Sharad Ghamande, The Georgia Cancer Center at Augusta University, Augusta; Andrew Green, Northeast Georgia Medical Center, Gainesville, GA; Santiago González-Santiago, Hospital San Pedro de Alcántara, Cáceres; Isabel Bover, Hospital Son Llàtzer, Palma; Begoña Graña Suárez, University Hospital A Coruña, Sergas, Spain; Philippe Huot-Marchand and Yann Bourhis, Mapi Real World Evidence, Lyon, France; Sudeep Karve, AstraZeneca, Gaithersburg, MD; and Christopher Blakeley, AstraZeneca, Cambridge, United Kingdom
| | - Eva Chalas
- Nicoletta Colombo, University of Milan-Bicocca; Nicoletta Colombo, Istituto Europeo di Oncologia, Milan; Giovanni Scambia, Università Cattolica del Sacro Cuore di Roma, Rome; Sandro Pignata, Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione G Pascale IRCCS, Naples, Italy; Gloria Huang, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx; Eva Chalas, Winthrop University Hospital, Mineola, NY; James Fiorica, Sarasota Memorial Hospital, Sarasota, FL; Linda Van Le, University of North Carolina School of Medicine, Chapel Hill, NC; Sharad Ghamande, The Georgia Cancer Center at Augusta University, Augusta; Andrew Green, Northeast Georgia Medical Center, Gainesville, GA; Santiago González-Santiago, Hospital San Pedro de Alcántara, Cáceres; Isabel Bover, Hospital Son Llàtzer, Palma; Begoña Graña Suárez, University Hospital A Coruña, Sergas, Spain; Philippe Huot-Marchand and Yann Bourhis, Mapi Real World Evidence, Lyon, France; Sudeep Karve, AstraZeneca, Gaithersburg, MD; and Christopher Blakeley, AstraZeneca, Cambridge, United Kingdom
| | - Sandro Pignata
- Nicoletta Colombo, University of Milan-Bicocca; Nicoletta Colombo, Istituto Europeo di Oncologia, Milan; Giovanni Scambia, Università Cattolica del Sacro Cuore di Roma, Rome; Sandro Pignata, Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione G Pascale IRCCS, Naples, Italy; Gloria Huang, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx; Eva Chalas, Winthrop University Hospital, Mineola, NY; James Fiorica, Sarasota Memorial Hospital, Sarasota, FL; Linda Van Le, University of North Carolina School of Medicine, Chapel Hill, NC; Sharad Ghamande, The Georgia Cancer Center at Augusta University, Augusta; Andrew Green, Northeast Georgia Medical Center, Gainesville, GA; Santiago González-Santiago, Hospital San Pedro de Alcántara, Cáceres; Isabel Bover, Hospital Son Llàtzer, Palma; Begoña Graña Suárez, University Hospital A Coruña, Sergas, Spain; Philippe Huot-Marchand and Yann Bourhis, Mapi Real World Evidence, Lyon, France; Sudeep Karve, AstraZeneca, Gaithersburg, MD; and Christopher Blakeley, AstraZeneca, Cambridge, United Kingdom
| | - James Fiorica
- Nicoletta Colombo, University of Milan-Bicocca; Nicoletta Colombo, Istituto Europeo di Oncologia, Milan; Giovanni Scambia, Università Cattolica del Sacro Cuore di Roma, Rome; Sandro Pignata, Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione G Pascale IRCCS, Naples, Italy; Gloria Huang, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx; Eva Chalas, Winthrop University Hospital, Mineola, NY; James Fiorica, Sarasota Memorial Hospital, Sarasota, FL; Linda Van Le, University of North Carolina School of Medicine, Chapel Hill, NC; Sharad Ghamande, The Georgia Cancer Center at Augusta University, Augusta; Andrew Green, Northeast Georgia Medical Center, Gainesville, GA; Santiago González-Santiago, Hospital San Pedro de Alcántara, Cáceres; Isabel Bover, Hospital Son Llàtzer, Palma; Begoña Graña Suárez, University Hospital A Coruña, Sergas, Spain; Philippe Huot-Marchand and Yann Bourhis, Mapi Real World Evidence, Lyon, France; Sudeep Karve, AstraZeneca, Gaithersburg, MD; and Christopher Blakeley, AstraZeneca, Cambridge, United Kingdom
| | - Linda Van Le
- Nicoletta Colombo, University of Milan-Bicocca; Nicoletta Colombo, Istituto Europeo di Oncologia, Milan; Giovanni Scambia, Università Cattolica del Sacro Cuore di Roma, Rome; Sandro Pignata, Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione G Pascale IRCCS, Naples, Italy; Gloria Huang, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx; Eva Chalas, Winthrop University Hospital, Mineola, NY; James Fiorica, Sarasota Memorial Hospital, Sarasota, FL; Linda Van Le, University of North Carolina School of Medicine, Chapel Hill, NC; Sharad Ghamande, The Georgia Cancer Center at Augusta University, Augusta; Andrew Green, Northeast Georgia Medical Center, Gainesville, GA; Santiago González-Santiago, Hospital San Pedro de Alcántara, Cáceres; Isabel Bover, Hospital Son Llàtzer, Palma; Begoña Graña Suárez, University Hospital A Coruña, Sergas, Spain; Philippe Huot-Marchand and Yann Bourhis, Mapi Real World Evidence, Lyon, France; Sudeep Karve, AstraZeneca, Gaithersburg, MD; and Christopher Blakeley, AstraZeneca, Cambridge, United Kingdom
| | - Sharad Ghamande
- Nicoletta Colombo, University of Milan-Bicocca; Nicoletta Colombo, Istituto Europeo di Oncologia, Milan; Giovanni Scambia, Università Cattolica del Sacro Cuore di Roma, Rome; Sandro Pignata, Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione G Pascale IRCCS, Naples, Italy; Gloria Huang, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx; Eva Chalas, Winthrop University Hospital, Mineola, NY; James Fiorica, Sarasota Memorial Hospital, Sarasota, FL; Linda Van Le, University of North Carolina School of Medicine, Chapel Hill, NC; Sharad Ghamande, The Georgia Cancer Center at Augusta University, Augusta; Andrew Green, Northeast Georgia Medical Center, Gainesville, GA; Santiago González-Santiago, Hospital San Pedro de Alcántara, Cáceres; Isabel Bover, Hospital Son Llàtzer, Palma; Begoña Graña Suárez, University Hospital A Coruña, Sergas, Spain; Philippe Huot-Marchand and Yann Bourhis, Mapi Real World Evidence, Lyon, France; Sudeep Karve, AstraZeneca, Gaithersburg, MD; and Christopher Blakeley, AstraZeneca, Cambridge, United Kingdom
| | - Santiago González-Santiago
- Nicoletta Colombo, University of Milan-Bicocca; Nicoletta Colombo, Istituto Europeo di Oncologia, Milan; Giovanni Scambia, Università Cattolica del Sacro Cuore di Roma, Rome; Sandro Pignata, Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione G Pascale IRCCS, Naples, Italy; Gloria Huang, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx; Eva Chalas, Winthrop University Hospital, Mineola, NY; James Fiorica, Sarasota Memorial Hospital, Sarasota, FL; Linda Van Le, University of North Carolina School of Medicine, Chapel Hill, NC; Sharad Ghamande, The Georgia Cancer Center at Augusta University, Augusta; Andrew Green, Northeast Georgia Medical Center, Gainesville, GA; Santiago González-Santiago, Hospital San Pedro de Alcántara, Cáceres; Isabel Bover, Hospital Son Llàtzer, Palma; Begoña Graña Suárez, University Hospital A Coruña, Sergas, Spain; Philippe Huot-Marchand and Yann Bourhis, Mapi Real World Evidence, Lyon, France; Sudeep Karve, AstraZeneca, Gaithersburg, MD; and Christopher Blakeley, AstraZeneca, Cambridge, United Kingdom
| | - Isabel Bover
- Nicoletta Colombo, University of Milan-Bicocca; Nicoletta Colombo, Istituto Europeo di Oncologia, Milan; Giovanni Scambia, Università Cattolica del Sacro Cuore di Roma, Rome; Sandro Pignata, Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione G Pascale IRCCS, Naples, Italy; Gloria Huang, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx; Eva Chalas, Winthrop University Hospital, Mineola, NY; James Fiorica, Sarasota Memorial Hospital, Sarasota, FL; Linda Van Le, University of North Carolina School of Medicine, Chapel Hill, NC; Sharad Ghamande, The Georgia Cancer Center at Augusta University, Augusta; Andrew Green, Northeast Georgia Medical Center, Gainesville, GA; Santiago González-Santiago, Hospital San Pedro de Alcántara, Cáceres; Isabel Bover, Hospital Son Llàtzer, Palma; Begoña Graña Suárez, University Hospital A Coruña, Sergas, Spain; Philippe Huot-Marchand and Yann Bourhis, Mapi Real World Evidence, Lyon, France; Sudeep Karve, AstraZeneca, Gaithersburg, MD; and Christopher Blakeley, AstraZeneca, Cambridge, United Kingdom
| | - Begoña Graña Suárez
- Nicoletta Colombo, University of Milan-Bicocca; Nicoletta Colombo, Istituto Europeo di Oncologia, Milan; Giovanni Scambia, Università Cattolica del Sacro Cuore di Roma, Rome; Sandro Pignata, Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione G Pascale IRCCS, Naples, Italy; Gloria Huang, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx; Eva Chalas, Winthrop University Hospital, Mineola, NY; James Fiorica, Sarasota Memorial Hospital, Sarasota, FL; Linda Van Le, University of North Carolina School of Medicine, Chapel Hill, NC; Sharad Ghamande, The Georgia Cancer Center at Augusta University, Augusta; Andrew Green, Northeast Georgia Medical Center, Gainesville, GA; Santiago González-Santiago, Hospital San Pedro de Alcántara, Cáceres; Isabel Bover, Hospital Son Llàtzer, Palma; Begoña Graña Suárez, University Hospital A Coruña, Sergas, Spain; Philippe Huot-Marchand and Yann Bourhis, Mapi Real World Evidence, Lyon, France; Sudeep Karve, AstraZeneca, Gaithersburg, MD; and Christopher Blakeley, AstraZeneca, Cambridge, United Kingdom
| | - Andrew Green
- Nicoletta Colombo, University of Milan-Bicocca; Nicoletta Colombo, Istituto Europeo di Oncologia, Milan; Giovanni Scambia, Università Cattolica del Sacro Cuore di Roma, Rome; Sandro Pignata, Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione G Pascale IRCCS, Naples, Italy; Gloria Huang, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx; Eva Chalas, Winthrop University Hospital, Mineola, NY; James Fiorica, Sarasota Memorial Hospital, Sarasota, FL; Linda Van Le, University of North Carolina School of Medicine, Chapel Hill, NC; Sharad Ghamande, The Georgia Cancer Center at Augusta University, Augusta; Andrew Green, Northeast Georgia Medical Center, Gainesville, GA; Santiago González-Santiago, Hospital San Pedro de Alcántara, Cáceres; Isabel Bover, Hospital Son Llàtzer, Palma; Begoña Graña Suárez, University Hospital A Coruña, Sergas, Spain; Philippe Huot-Marchand and Yann Bourhis, Mapi Real World Evidence, Lyon, France; Sudeep Karve, AstraZeneca, Gaithersburg, MD; and Christopher Blakeley, AstraZeneca, Cambridge, United Kingdom
| | - Philippe Huot-Marchand
- Nicoletta Colombo, University of Milan-Bicocca; Nicoletta Colombo, Istituto Europeo di Oncologia, Milan; Giovanni Scambia, Università Cattolica del Sacro Cuore di Roma, Rome; Sandro Pignata, Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione G Pascale IRCCS, Naples, Italy; Gloria Huang, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx; Eva Chalas, Winthrop University Hospital, Mineola, NY; James Fiorica, Sarasota Memorial Hospital, Sarasota, FL; Linda Van Le, University of North Carolina School of Medicine, Chapel Hill, NC; Sharad Ghamande, The Georgia Cancer Center at Augusta University, Augusta; Andrew Green, Northeast Georgia Medical Center, Gainesville, GA; Santiago González-Santiago, Hospital San Pedro de Alcántara, Cáceres; Isabel Bover, Hospital Son Llàtzer, Palma; Begoña Graña Suárez, University Hospital A Coruña, Sergas, Spain; Philippe Huot-Marchand and Yann Bourhis, Mapi Real World Evidence, Lyon, France; Sudeep Karve, AstraZeneca, Gaithersburg, MD; and Christopher Blakeley, AstraZeneca, Cambridge, United Kingdom
| | - Yann Bourhis
- Nicoletta Colombo, University of Milan-Bicocca; Nicoletta Colombo, Istituto Europeo di Oncologia, Milan; Giovanni Scambia, Università Cattolica del Sacro Cuore di Roma, Rome; Sandro Pignata, Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione G Pascale IRCCS, Naples, Italy; Gloria Huang, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx; Eva Chalas, Winthrop University Hospital, Mineola, NY; James Fiorica, Sarasota Memorial Hospital, Sarasota, FL; Linda Van Le, University of North Carolina School of Medicine, Chapel Hill, NC; Sharad Ghamande, The Georgia Cancer Center at Augusta University, Augusta; Andrew Green, Northeast Georgia Medical Center, Gainesville, GA; Santiago González-Santiago, Hospital San Pedro de Alcántara, Cáceres; Isabel Bover, Hospital Son Llàtzer, Palma; Begoña Graña Suárez, University Hospital A Coruña, Sergas, Spain; Philippe Huot-Marchand and Yann Bourhis, Mapi Real World Evidence, Lyon, France; Sudeep Karve, AstraZeneca, Gaithersburg, MD; and Christopher Blakeley, AstraZeneca, Cambridge, United Kingdom
| | - Sudeep Karve
- Nicoletta Colombo, University of Milan-Bicocca; Nicoletta Colombo, Istituto Europeo di Oncologia, Milan; Giovanni Scambia, Università Cattolica del Sacro Cuore di Roma, Rome; Sandro Pignata, Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione G Pascale IRCCS, Naples, Italy; Gloria Huang, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx; Eva Chalas, Winthrop University Hospital, Mineola, NY; James Fiorica, Sarasota Memorial Hospital, Sarasota, FL; Linda Van Le, University of North Carolina School of Medicine, Chapel Hill, NC; Sharad Ghamande, The Georgia Cancer Center at Augusta University, Augusta; Andrew Green, Northeast Georgia Medical Center, Gainesville, GA; Santiago González-Santiago, Hospital San Pedro de Alcántara, Cáceres; Isabel Bover, Hospital Son Llàtzer, Palma; Begoña Graña Suárez, University Hospital A Coruña, Sergas, Spain; Philippe Huot-Marchand and Yann Bourhis, Mapi Real World Evidence, Lyon, France; Sudeep Karve, AstraZeneca, Gaithersburg, MD; and Christopher Blakeley, AstraZeneca, Cambridge, United Kingdom
| | - Christopher Blakeley
- Nicoletta Colombo, University of Milan-Bicocca; Nicoletta Colombo, Istituto Europeo di Oncologia, Milan; Giovanni Scambia, Università Cattolica del Sacro Cuore di Roma, Rome; Sandro Pignata, Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione G Pascale IRCCS, Naples, Italy; Gloria Huang, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx; Eva Chalas, Winthrop University Hospital, Mineola, NY; James Fiorica, Sarasota Memorial Hospital, Sarasota, FL; Linda Van Le, University of North Carolina School of Medicine, Chapel Hill, NC; Sharad Ghamande, The Georgia Cancer Center at Augusta University, Augusta; Andrew Green, Northeast Georgia Medical Center, Gainesville, GA; Santiago González-Santiago, Hospital San Pedro de Alcántara, Cáceres; Isabel Bover, Hospital Son Llàtzer, Palma; Begoña Graña Suárez, University Hospital A Coruña, Sergas, Spain; Philippe Huot-Marchand and Yann Bourhis, Mapi Real World Evidence, Lyon, France; Sudeep Karve, AstraZeneca, Gaithersburg, MD; and Christopher Blakeley, AstraZeneca, Cambridge, United Kingdom
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Predictors of next-generation sequencing panel selection using a shared decision-making approach. NPJ Genom Med 2018; 3:11. [PMID: 29736259 PMCID: PMC5923203 DOI: 10.1038/s41525-018-0050-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/02/2018] [Accepted: 04/05/2018] [Indexed: 01/05/2023] Open
Abstract
The introduction of next-generation sequencing panels has transformed the approach for genetic testing in cancer patients, however, established guidelines for their use are lacking. A shared decision-making approach has been adopted by our service, where patients play an active role in panel selection and we sought to identify factors associated with panel selection and report testing outcomes. Demographic and clinical data were gathered for female breast and/or ovarian cancer patients aged 21 and over who underwent panel testing. Panel type was classified as ‘breast cancer panel’ (BCP) or ‘multi-cancer panel’ (MCP). Stepwise multiple logistic regression analysis was used to identify clinical factors most predictive of panel selection. Of the 265 included subjects, the vast majority selected a broader MCP (81.5%). Subjects who chose MCPs were significantly more likely to be ≥50 years of age (49 vs. 31%; p < 0.05), Chinese (76 vs. 47%; p < 0.001) and have a personal history of ovarian cancer (41 vs. 8%; p < 0.001) with the latter two identified as the best predictors of panel selection. Family history of cancer was not significantly associated with panel selection. There were no statistically significant differences in result outcomes between the two groups. In summary, our findings demonstrate that the majority of patients have a preference for interrogating a larger number of genes beyond those with established testing guidelines, despite the additional likelihood of uncertainty. Individual factors, including cancer history and ethnicity, are the best predictors of panel selection. Thanks to next-generation sequencing (NGS) it is possible to test multiple genes for cancer susceptibility quickly and cheaply. At the National Cancer Centre Singapore, shared decision-making is used to actively encourage the involvement of patients in the selection of either a ‘breast cancer panel’ (BCP) or a broader ‘multi-cancer panel’ (MCP) test. Joanne Ngeow at the Centre’s Cancer Genetics Service and colleagues examined the choices made by 265 patients with breast and/or ovarian cancer following detailed pre-test counselling by the genetics team. The majority of patients selected the MCP, potentially highlighting a willingness to accept the additional uncertainty that comes with broader NGS panels. Interestingly, a personal history of ovarian cancer and Chinese ethnicity, but not a family history of cancer, were significantly associated with panel selection.
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Vassilakopoulou P, Skorve E, Aanestad M. Enabling openness of valuable information resources: Curbing data subtractability and exclusion. INFORMATION SYSTEMS JOURNAL 2018. [DOI: 10.1111/isj.12191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Stenehjem DD, Au T, Sainski AM, Bauer H, Brown K, Lancaster J, Stevens V, Brixner DI. Impact of a genetic counseling requirement prior to genetic testing. BMC Health Serv Res 2018. [PMID: 29514700 PMCID: PMC5842549 DOI: 10.1186/s12913-018-2957-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background Genetic counseling by a Genetic Counselor (GC) is a requirement prior to genetic testing for cancer susceptibility genes (GC-mandate policy) for some insurers. This study evaluated the impact of this policy from the patient perspective. Methods Surveys were sent to individuals for whom their insurer ordered genetic testing for the cancer susceptibility genes BCRA1 and BRCA2 over a 1 year time period that spanned the introduction of a GC-mandate policy. Responses were assessed by time period (before/after policy introduction) and genetic test completion. Results The surveys were completed by 1247/4950 (25.7%) eligible individuals. After policy introduction, there was no change in the proportion of respondents who completed genetic testing (p = 0.13) or had a mutation (p = 0.55). Overall decisional conflict (uncertainty or feeling uninformed) around genetic testing did not change after policy introduction (p = 0.16), but was significantly higher among respondents who did not complete genetic testing (p < 0.01). Although a larger proportion of respondents saw a GC after policy introduction (p < 0.01), fewer did so to better understand their test results (p < 0.01). The proportion of respondents who did not see a GC due to insurance issues/requirements and time restraints was higher among those tested after policy introduction or who did not complete genetic testing (p < 0.01). In multivariate analysis, respondents with a household income of $25,000 or greater were 3-times more likely to complete testing. Conclusions A GC-mandate policy did not improve decisional conflict or increase the number of deleterious mutations identified and low-income respondents were less likely to complete testing. On the contrary, insurance requirements and time constraints may be preventing individuals at risk from receiving appropriate testing. Electronic supplementary material The online version of this article (10.1186/s12913-018-2957-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David D Stenehjem
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA. .,Huntsman Cancer Institute, Salt Lake City, UT, USA. .,Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota, College of Pharmacy, 1110 Kirby Drive, 232 Life Science, Duluth, MN, 55812, USA.
| | - Trang Au
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Amy M Sainski
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Hillevi Bauer
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Krystal Brown
- Myriad Genetic Laboratories, Inc, Salt Lake City, UT, USA
| | | | - Vanessa Stevens
- Department of Internal Medicine, Division of Epidemiology University of Utah, Salt Lake City, UT, USA
| | - Diana I Brixner
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.,Personalized Health Care Program, University of Utah, Salt Lake City, UT, USA
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24
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Meisel SF, Fraser LSM, Side L, Gessler S, Hann KEJ, Wardle J, Lanceley A. Anticipated health behaviour changes and perceived control in response to disclosure of genetic risk of breast and ovarian cancer: a quantitative survey study among women in the UK. BMJ Open 2017; 7:e017675. [PMID: 29275340 PMCID: PMC5770899 DOI: 10.1136/bmjopen-2017-017675] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Genetic risk assessment for breast cancer and ovarian cancer (BCOC) is expected to make major inroads into mainstream clinical practice. It is important to evaluate the potential impact on women ahead of its implementation in order to maximise health benefits, as predictive genetic testing without adequate support could lead to adverse psychological and behavioural responses to risk disclosure. OBJECTIVE To examine anticipated health behaviour changes and perceived control to disclosure of genetic risk for BCOC and establish demographic and person-specific correlates of adverse anticipated responses in a population-based sample of women. DESIGN Cross-sectional quantitative survey study carried out by the UK Office for National Statistics in January and March 2014. SETTING Face-to-face computer-assisted interviews conducted by trained researchers in participants' homes. PARTICIPANTS 837 women randomly chosen from households across the UK identified from the Royal Mail's Postcode Address File. OUTCOME MEASURES Anticipated health behaviour change and perceived control to disclosure of BCOC risk. RESULTS In response to a genetic test result, most women (72%) indicated 'I would try harder to have a healthy lifestyle', and over half (55%) felt 'it would give me more control over my life'. These associations were independent of demographic factors or perceived risk of BCOC in Bonferroni-corrected multivariate analyses. However, a minority of women (14%) felt 'it isn't worth making lifestyle changes' and that 'I would feel less free to make choices in my life' (16%) in response to BCOC risk disclosure. The former belief was more likely to be held by women who were educated below university degree level (P<0.001) after adjusting for other demographic and person-specific correlates. CONCLUSION These findings indicate that women in the UK largely anticipate that they would engage in positive health behaviour changes in response to BCOC risk disclosure.
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Affiliation(s)
- Susanne F Meisel
- Dept of Psychology, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, UK
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | | | - Lucy Side
- Clinical Genetics, University Hospital Southampton NHS Trust, Southampton, UK
| | - Sue Gessler
- Dept of Women’s Cancer, UCL EGA Institute for Women’s Health, University College London, London, UK
- Gynaecological Cancer Centre, University College London Hospitals (UCLH), London, UK
| | - Katie E J Hann
- Dept of Women’s Cancer, UCL EGA Institute for Women’s Health, University College London, London, UK
| | - Jane Wardle
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Anne Lanceley
- Dept of Women’s Cancer, UCL EGA Institute for Women’s Health, University College London, London, UK
- Gynaecological Cancer Centre, University College London Hospitals (UCLH), London, UK
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25
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Hann KEJ, Fraser L, Side L, Gessler S, Waller J, Sanderson SC, Freeman M, Jacobs I, Lanceley A. Health care professionals' attitudes towards population-based genetic testing and risk-stratification for ovarian cancer: a cross-sectional survey. BMC WOMENS HEALTH 2017; 17:132. [PMID: 29246147 PMCID: PMC5732525 DOI: 10.1186/s12905-017-0488-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 11/30/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Ovarian cancer is usually diagnosed at a late stage when outcomes are poor. Personalised ovarian cancer risk prediction, based on genetic and epidemiological information and risk stratified management in adult women could improve outcomes. Examining health care professionals' (HCP) attitudes to ovarian cancer risk stratified management, willingness to support women, self-efficacy (belief in one's own ability to successfully complete a task), and knowledge about ovarian cancer will help identify training needs in anticipation of personalised ovarian cancer risk prediction being introduced. METHODS An anonymous survey was distributed online to HCPs via relevant professional organisations in the UK. Kruskal-Wallis tests and pairwise comparisons were used to compare knowledge and self-efficacy scores between different types of HCPs, and attitudes toward population-based genetic testing and risk stratified management were described. Content analysis was undertaken of free text responses concerning HCPs willingness to discuss risk management options with women. RESULTS One hundred forty-six eligible HCPs completed the survey: oncologists (31%); genetics clinicians (30%); general practitioners (22%); gynaecologists (10%); nurses (4%); and 'others'. Scores for knowledge of ovarian cancer and genetics, and self-efficacy in conducting a cancer risk consultation were generally high but significantly lower for general practitioners compared to genetics clinicians, oncologists, and gynaecologists. Support for population-based genetic testing was not high (<50%). Attitudes towards ovarian cancer risk stratification were mixed, although the majority of participants indicated a willingness to discuss management options with patients. CONCLUSIONS Larger samples are required to investigate attitudes to population-based genetic testing for ovarian cancer risk and to establish why some HCPs are hesitant to offer testing to all adult female patients. If ovarian cancer risk assessment using genetic testing and non-genetic information including epidemiological information is rolled out on a population basis, training will be needed for HCPs in primary care to enable them to provide appropriate support to women at each stage of the process.
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Affiliation(s)
- Katie E J Hann
- Department of Women's Cancer, EGA UCL Institute for Women's Health, University College London, 74 Huntley Street, London, WC1E 6AU, UK
| | - Lindsay Fraser
- Department of Women's Cancer, EGA UCL Institute for Women's Health, University College London, 74 Huntley Street, London, WC1E 6AU, UK
| | - Lucy Side
- Department of Women's Cancer, EGA UCL Institute for Women's Health, University College London, 74 Huntley Street, London, WC1E 6AU, UK.,University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sue Gessler
- Department of Women's Cancer, EGA UCL Institute for Women's Health, University College London, 74 Huntley Street, London, WC1E 6AU, UK
| | - Jo Waller
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Saskia C Sanderson
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK.,Great Ormond Street Hospital, London, UK
| | - Madeleine Freeman
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Ian Jacobs
- Department of Women's Cancer, EGA UCL Institute for Women's Health, University College London, 74 Huntley Street, London, WC1E 6AU, UK.,The University of New South Wales, Sydney, NSW, Australia
| | - Anne Lanceley
- Department of Women's Cancer, EGA UCL Institute for Women's Health, University College London, 74 Huntley Street, London, WC1E 6AU, UK.
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Abstract
Identifying germline BRCA pathogenic mutations in patients with ovarian or breast cancer is a crucial component in the medical management of affected patients. Furthermore, the relatives of affected patients can be offered genetic testing. Relatives who test positive for a germline BRCA pathogenic mutation can take appropriate action to prevent cancer or have cancer diagnosed as early as possible for better treatment options. The recent discovery that BRCA pathogenic mutation status can inform treatment decisions in patients with ovarian cancer has led to an increased demand for BRCA testing, with testing taking place earlier in the patient care pathway. New approaches to genetic counselling may be required to meet this greater demand for BRCA testing. This review discusses the need for best practices for genetic counselling and BRCA testing; it examines the challenges facing current practice and looks at adapted models of genetic counselling.
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27
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Bouhnik AD, N’Diaye K, Evans DG, Harris H, Tibben A, van Asperen C, Schmidtke J, Nippert I, Mancini J, Julian-Reynier C. Validation of a scale for assessing attitudes towards outcomes of genetic cancer testing among primary care providers and breast specialists. PLoS One 2017; 12:e0178447. [PMID: 28570656 PMCID: PMC5453525 DOI: 10.1371/journal.pone.0178447] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 05/12/2017] [Indexed: 01/31/2023] Open
Abstract
Objective To develop a generic scale for assessing attitudes towards genetic testing and to psychometrically assess these attitudes in the context of BRCA1/2 among a sample of French general practitioners, breast specialists and gyneco-obstetricians. Study design and setting Nested within the questionnaire developed for the European InCRisC (International Cancer Risk Communication Study) project were 14 items assessing expected benefits (8 items) and drawbacks (6 items) of the process of breast/ovarian genetic cancer testing (BRCA1/2). Another item assessed agreement with the statement that, overall, the expected health benefits of BRCA1/2 testing exceeded its drawbacks, thereby justifying its prescription. The questionnaire was mailed to a sample of 1,852 French doctors. Of these, 182 breast specialists, 275 general practitioners and 294 gyneco-obstetricians completed and returned the questionnaire to the research team. Principal Component Analysis, Cronbach’s α coefficient, and Pearson’s correlation coefficients were used in the statistical analyses of collected data. Results Three dimensions emerged from the respondents’ responses, and were classified under the headings: “Anxiety, Conflict and Discrimination”, “Risk Information”, and “Prevention and Surveillance”. Cronbach’s α coefficient for the 3 dimensions was 0.79, 0.76 and 0.62, respectively, and each dimension exhibited strong correlation with the overall indicator of agreement (criterion validity). Conclusions The validation process of the 15 items regarding BRCA1/2 testing revealed satisfactory psychometric properties for the creation of a new scale entitled the Attitudes Towards Genetic Testing for BRCA1/2 (ATGT-BRCA1/2) Scale. Further testing is required to confirm the validity of this tool which could be used generically in other genetic contexts.
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Affiliation(s)
- Anne-Deborah Bouhnik
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- * E-mail:
| | - Khadim N’Diaye
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
| | - D. Gareth Evans
- Department of Genomic Medicine, The University of Manchester, Manchester, United Kingdom
| | - Hilary Harris
- GenEd Coordinating Centre, University of Manchester, Manchester, United Kingdom
| | - Aad Tibben
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Christi van Asperen
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Joerg Schmidtke
- Institute of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Irmgard Nippert
- Women’s Health Research, Münster Medical School, Münster, Germany
| | - Julien Mancini
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- APHM, Hôpital de la Timone, Service Biostatistique et Technologies de l’Information et de la Communication, Marseille, France
| | - Claire Julian-Reynier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- Institut Paoli-Calmettes, UMR_S 912, Marseille, France
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28
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Jacobs C, Pichert G, Harris J, Tucker K, Michie S. Key messages for communicating information about BRCA1 and BRCA2 to women with breast or ovarian cancer: Consensus across health professionals and service users. Psychooncology 2017; 26:1818-1824. [PMID: 28101941 DOI: 10.1002/pon.4379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 12/26/2016] [Accepted: 01/15/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Genetic testing of cancer predisposing genes will increasingly be needed in oncology clinics to target cancer treatment. This Delphi study aimed to identify areas of agreement and disagreement between genetics and oncology health professionals and service users about the key messages required by women with breast/ovarian cancer who undergo BRCA1/BRCA2 genetic testing and the optimal timing of communicating key messages. METHODS Participants were 16 expert health professionals specialising in oncology/genetics and 16 service users with breast/ovarian cancer and a pathogenic BRCA1/BRCA2 variant. Online questionnaires containing 53 inductively developed information messages were circulated to the groups separately. Participants rated each message as key/not key on a Likert scale and suggested additional messages. Questionnaires were modified according to the feedback and up to 3 rounds were circulated. Consensus was reached when there was ≥75% agreement. RESULTS Thirty key messages were agreed by both groups with 7 of the key messages agreed by ≥95% of participants: dominant inheritance, the availability of predictive testing, the importance of pretest discussion, increased risk of breast and ovarian cancer, and the option of risk-reducing mastectomy and bilateral salpingo-oophorectomy. Both groups agreed that key messages should be communicated before genetic testing and once a pathogenic variant has been identified. CONCLUSIONS There was a high level of agreement within and between the groups about the information requirements of women with breast/ovarian cancer about BRCA1/BRCA2. These key messages will be helpful in developing new approaches to the delivery of information as genetic testing becomes further integrated into mainstream oncology services.
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Affiliation(s)
- Chris Jacobs
- Research Department of Clinical, Education and Health Psychology, University College London, London, UK
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29
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Kulkarni A, Carley H. Advances in the recognition and management of hereditary cancer. Br Med Bull 2016; 120:123-138. [PMID: 27941041 DOI: 10.1093/bmb/ldw046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/02/2016] [Accepted: 10/12/2016] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Constitutional mutations in genes controlling DNA repair, cell-cycle regulation and cell apoptosis can determine an individual's tendency to develop cancer. Hereditary cancer predisposition syndromes present with multiple cancers at a young age and underlie a significant burden of morbidity and mortality. Recent advances in the recognition and management of hereditary cancer will be illustrated with specific examples of developments in diagnosis and treatment. SOURCES OF DATA Key recent published literature. AREAS OF AGREEMENT The identification of individuals with hereditary cancer offers important opportunities for cancer prevention, early intervention and personalized management. AREAS OF CONTROVERSY Individuals at risk of hereditary cancer remain under-recognized. There is a need to develop evidence-based guidelines for the recognition and management of hereditary cancer predisposition conditions. GROWING POINTS The study of Mendelian cancer susceptibility syndromes has added to our understanding of hereditary and sporadic cancers and facilitated the development of targeted agents directed against cancer-driving mutations. Increasingly, cancer patients with constitutional gene mutations treated with targeted therapies have improved clinical outcomes. AREAS FOR TIMELY RESEARCH Building the infrastructure to enable constitutional gene mutation testing to become integrated into routine cancer care, including the parallel development of robust referral pathways alongside genomic sequencing technologies.
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Affiliation(s)
- Anju Kulkarni
- Guy's Regional Genetics Service, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Helena Carley
- Guy's Regional Genetics Service, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
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30
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Lee AJ, Cunningham AP, Tischkowitz M, Simard J, Pharoah PD, Easton DF, Antoniou AC. Incorporating truncating variants in PALB2, CHEK2, and ATM into the BOADICEA breast cancer risk model. Genet Med 2016; 18:1190-1198. [PMID: 27464310 PMCID: PMC5086091 DOI: 10.1038/gim.2016.31] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 02/01/2016] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The proliferation of gene panel testing precipitates the need for a breast cancer (BC) risk model that incorporates the effects of mutations in several genes and family history (FH). We extended the BOADICEA model to incorporate the effects of truncating variants in PALB2, CHEK2, and ATM. METHODS The BC incidence was modeled via the explicit effects of truncating variants in BRCA1/2, PALB2, CHEK2, and ATM and other unobserved genetic effects using segregation analysis methods. RESULTS The predicted average BC risk by age 80 for an ATM mutation carrier is 28%, 30% for CHEK2, 50% for PALB2, and 74% for BRCA1 and BRCA2. However, the BC risks are predicted to increase with FH burden. In families with mutations, predicted risks for mutation-negative members depend on both FH and the specific mutation. The reduction in BC risk after negative predictive testing is greatest when a BRCA1 mutation is identified in the family, but for women whose relatives carry a CHEK2 or ATM mutation, the risks decrease slightly. CONCLUSIONS The model may be a valuable tool for counseling women who have undergone gene panel testing for providing consistent risks and harmonizing their clinical management. A Web application can be used to obtain BC risks in clinical practice (http://ccge.medschl.cam.ac.uk/boadicea/).Genet Med 18 12, 1190-1198.
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Affiliation(s)
- Andrew J Lee
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, The University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - Alex P Cunningham
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, The University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - Marc Tischkowitz
- Department of Medical Genetics and National Institute for Health Research, Cambridge Biomedical Research Centre, The University of Cambridge, Cambridge, UK
| | - Jacques Simard
- Canada Research Chair in Oncogenetics, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- Genomics Center, Centre Hospitalier Universitaire de Québec Research Center, Quebec City, Quebec, Canada
| | - Paul D Pharoah
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, The University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
- Department of Oncology, Centre for Cancer Genetic Epidemiology, The University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - Douglas F Easton
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, The University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
- Department of Oncology, Centre for Cancer Genetic Epidemiology, The University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - Antonis C Antoniou
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, The University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
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31
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Implementing rapid, robust, cost-effective, patient-centred, routine genetic testing in ovarian cancer patients. Sci Rep 2016; 6:29506. [PMID: 27406733 PMCID: PMC4942815 DOI: 10.1038/srep29506] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/17/2016] [Indexed: 01/09/2023] Open
Abstract
Advances in DNA sequencing have made genetic testing fast and affordable, but limitations of testing processes are impeding realisation of patient benefits. Ovarian cancer exemplifies the potential value of genetic testing and the shortcomings of current pathways to access testing. Approximately 15% of ovarian cancer patients have a germline BRCA1 or BRCA2 mutation which has substantial implications for their personal management and that of their relatives. Unfortunately, in most countries, routine implementation of BRCA testing for ovarian cancer patients has been inconsistent and largely unsuccessful. We developed a rapid, robust, mainstream genetic testing pathway in which testing is undertaken by the trained cancer team with cascade testing to relatives performed by the genetics team. 207 women with ovarian cancer were offered testing through the mainstream pathway. All accepted. 33 (16%) had a BRCA mutation. The result informed management of 79% (121/154) women with active disease. Patient and clinician feedback was very positive. The pathway offers a 4-fold reduction in time and 13-fold reduction in resource requirement compared to the conventional testing pathway. The mainstream genetic testing pathway we present is effective, efficient and patient-centred. It can deliver rapid, robust, large-scale, cost-effective genetic testing of BRCA1 and BRCA2 and may serve as an exemplar for other genes and other diseases.
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32
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Percival N, George A, Gyertson J, Hamill M, Fernandes A, Davies E, Rahman N, Banerjee S. The integration of BRCA testing into oncology clinics. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2016; 25:690-4. [PMID: 27345073 PMCID: PMC5993185 DOI: 10.12968/bjon.2016.25.12.690] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE The PARP inhibitor, Olaparib, is approved for women with BRCA-mutated ovarian cancer. Therefore there is an urgent need to test patients and obtain results in time to influence treatment. Models of BRCA testing, such as the mainstreaming oncogenetic pathway, involving oncology health professionals are being used. The authors report on the establishment of the extended role of the clinical nurse specialist in consenting women for BRCA testing in routine gynaecology-oncology clinics using the mainstreaming model. METHODS Nurses undertook generic consent training and specific counselling training for BRCA testing in the form of a series of online videos, written materials and checklists before obtaining approval to consent patients for germline BRCA1 and BRCA2 mutations. RESULTS Between July 2013 and December 2015, 108 women with ovarian cancer were counselled and consented by nurses in the medical oncology clinics at a single centre (The Royal Marsden, UK). This represented 36% of all ovarian cancer patients offered BRCA testing in the oncology clinics at the centre. Feedback from patients and nurses was encouraging with no significant issues raised in the counselling and consenting process. CONCLUSION The mainstreaming model allows for greater access to BRCA testing for ovarian cancer patients, many of whom may benefit from personalised therapy (PARP inhibitors). This is the first report of oncology nurses in the BRCA testing pathway. Specialist oncology nurses trained in BRCA testing have an important role within a multidisciplinary team counselling and consenting patients to undergo BRCA testing.
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Affiliation(s)
- Natalie Percival
- Advanced Nurse Practitioner, Gynaecology Unit, The Royal Marsden NHS Foundation Trust
| | - Angela George
- Consultant Oncogenetics, Gynaecology Unit, The Royal Marsden NHS Foundation Trust and Division of Genetics and Epidemiology, The Institute of Cancer Research, London
| | - Jennifer Gyertson
- Research Nurse, Gynaecology Unit, The Royal Marsden NHS Foundation Trust
| | - Monica Hamill
- Research Nurse, Gynaecology Unit, The Royal Marsden NHS Foundation Trust
| | - Andreia Fernandes
- Clinical Nurse Specialist, Gynaecology Unit, The Royal Marsden NHS Foundation Trust
| | - Emily Davies
- Clinical Nurse Specialist, Gynaecology Unit, The Royal Marsden NHS Foundation Trust
| | - Nazneen Rahman
- Professor of Genetics, The Royal Marsden NHS Foundation Trust and Division of Genetics and Epidemiology, The Institute of Cancer Research, London
| | - Susana Banerjee
- Consultant Medical Oncologist, Gynaecology Unit, The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, London
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33
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Mitchell G, Schrader KA. Testing for Hereditary Predisposition in Patients with Gynecologic Cancers, Quo Vadis? Surg Pathol Clin 2016; 9:301-6. [PMID: 27241110 DOI: 10.1016/j.path.2016.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Genetic testing for a hereditary predisposition to gynecologic cancers has been available clinically since the 1990s. Since then, knowledge of the hereditary contribution to gynecologic cancers has dramatically increased, especially with respect to ovarian cancer. Although knowledge of the number of gynecologic cancer-predisposing genes has increased, the integration of genetic predisposition testing into routine clinical practice has been much slower. This article summarizes the technical and practical aspects of genetic testing in gynecologic cancers, the potential barriers to more widespread access and practice of genetic testing for hereditary predisposition to gynecologic cancers, and the potential solutions to these barriers.
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Affiliation(s)
- Gillian Mitchell
- Hereditary Cancer Program, BC Cancer Agency, 600 West 10th Ave, Vancouver, British Columbia V5Z 4E6, Canada; Department of Medical Oncology, University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T 1Z4, Canada.
| | - Kasmintan A Schrader
- Hereditary Cancer Program, Department of Molecular Oncology, BC Cancer Agency, 600 Wet 10th Ave, Vancouver, British Columbia V5Z 4E6, Canada; Department of Medical Genetics, University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T 1Z4, Canada
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