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Mallen AR, Conley CC, Fuzzell L, Ketcher D, Augusto BM, McIntyre M, Barton LV, Townsend MK, Fridley BL, Tworoger SS, Wenham RM, Vadaparampil ST. "I think that a brief conversation from their provider can go a very long way": Patient and provider perspectives on barriers and facilitators of genetic testing after ovarian cancer. Support Care Cancer 2021; 29:2663-2677. [PMID: 32975643 PMCID: PMC7981241 DOI: 10.1007/s00520-020-05779-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/11/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Identify predisposing, enabling, and reinforcing factors impacting genetic counseling/testing among ovarian cancer patients guided by Green and Kreuter's PRECEDE-PROCEED model. METHODS Gynecologic oncology providers (N = 4), genetic counselors (N = 4), and ovarian cancer patients (N = 9) completed semi-structured qualitative interviews exploring participants' knowledge of and experiences with genetic counseling/testing. Interviews were audio recorded, transcribed verbatim, and analyzed using inductive content analysis by two independent raters. RESULTS Thematic analysis identified predisposing, enabling, and reinforcing factors impacting referral for and uptake of genetic counseling/testing. Predisposing factors included participant's knowledge, beliefs, and attitudes related to genetic counseling/testing. Both patients and providers also cited that insurance coverage and out-of-pocket cost are major concerns for ovarian cancer patients considering genetic testing. Finally, both patients and providers emphasized that genetic counseling/testing would provide additional information to an ovarian cancer patient. While providers emphasized that genetic testing results were useful for informing a patient's personal treatment plan, patients emphasized that this knowledge would be beneficial for their family members. CONCLUSION Barriers to genetic testing for ovarian cancer patients exist at multiple levels, including the patient (e.g., knowledge, attitudes), the provider (e.g., workload, availability of services), the institution (e.g., difficulty with referrals/scheduling), and the healthcare system (e.g., insurance/cost). Interventions aiming to increase genetic testing among ovarian cancer patients will likely need to target multiple levels of influence. Future quantitative studies are needed to replicate these results. This line of work will inform specific multilevel intervention strategies that are adaptable to different practice settings, ultimately improving guideline concordant care.
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Affiliation(s)
- Adrianne R. Mallen
- Moffitt Cancer Center, Department of Gynecologic Oncology, Tampa, FL
- University of South Florida, Department of Obstetrics and Gynecology, Tampa, FL
| | - Claire C. Conley
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, Tampa, FL
- Georgetown Lombardi Cancer Center, Department of Oncology, Washington, DC
| | - Lindsay Fuzzell
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, Tampa, FL
| | - Dana Ketcher
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, Tampa, FL
| | - Bianca M. Augusto
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, Tampa, FL
| | - McKenzie McIntyre
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, Tampa, FL
| | | | - Mary K. Townsend
- Moffitt Cancer Center, Department of Cancer Epidemiology, Tampa, FL
| | - Brooke L. Fridley
- Moffitt Cancer Center, Department of Biostatistics and Bioinformatics, Tampa, FL
| | | | - Robert M. Wenham
- Moffitt Cancer Center, Department of Gynecologic Oncology, Tampa, FL
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Conley CC, Small BJ, Christie J, Hoogland AI, Augusto BM, Garcia JD, Pal T, Vadaparampil ST. Patterns and covariates of benefit finding in young Black breast cancer survivors: A longitudinal, observational study. Psychooncology 2020; 29:1115-1122. [PMID: 32323400 DOI: 10.1002/pon.5398] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/03/2020] [Accepted: 04/14/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the patterns and covariates of benefit finding over time among young Black breast cancer (BC) survivors. METHODS Black women (N = 305) with invasive BC diagnosed ≤50 years were recruited an average of 1.9 years post-BC diagnosis. Participants completed self-report questionnaires of benefit finding, social support, and illness intrusions at three time points (M time since BC diagnosis: T2 = 3.1 years, T3 = 4.0 years). Relationships between posttraumatic growth constructs (social support, illness intrusions) and benefit finding over time were examined using mixed models. Models controlled for cultural variables (religiosity, time orientation, and collectivism), receipt of chemotherapy, general health status, and partner status. RESULTS Participants reported high levels of benefit finding (M = 2.99, SE = 0.04 on a 0-4 scale). When accounting for covariates, benefit finding did not change over time since BC diagnosis (P = .21). Benefit finding scores at BC diagnosis were associated with more illness intrusions, greater religiosity, and having received chemotherapy (all Ps < .04). Social support was associated with change in benefit finding scores over time, such that a 1-point increase in social support was associated with a 0.05 increase in benefit finding per year (P = .02). CONCLUSIONS This study addresses key gaps in knowledge regarding benefit finding among Black cancer survivors. Consistent with findings from majority White samples, social support and illness intrusions appear to play a key role in benefit finding in Black BC survivors. Cultural constructs-including religiosity-must also be considered in future studies of benefit finding among minority populations.
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Affiliation(s)
- Claire C Conley
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Brent J Small
- School of Aging Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Juliette Christie
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Aasha I Hoogland
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Bianca M Augusto
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Jennifer D Garcia
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Tuya Pal
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
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Conley CC, Niell BL, Augusto BM, McIntyre M, Roetzheim R, Funaro K, Vadaparampil ST. Uptake of Risk Appropriate Behaviors After Breast Cancer Risk Stratification in the Mammography Screening Population. J Am Coll Radiol 2020; 17:1285-1288. [PMID: 32229274 DOI: 10.1016/j.jacr.2020.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 02/28/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Claire C Conley
- Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, Florida. Section Chief of Breast Imaging at H. Lee Moffitt Cancer Center and Research Institute; Associate Member of the Moffitt Medical Group, Tampa, Florida; Joint appointment as an Associate Professor at the University of South Florida, Tampa, Florida
| | - Bethany L Niell
- Health Outcomes & Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Bianca M Augusto
- Health Outcomes & Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - McKenzie McIntyre
- Health Outcomes & Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Richard Roetzheim
- Chair of Family Medicine at the University of South Florida Morsani School of Medicine, Tampa, Florida; Breast Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Kimberly Funaro
- Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Susan T Vadaparampil
- Associate Center Director of Community Outreach, Engagement, and Equity at H. Lee Moffitt Cancer Center, Tampa, Florida.
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Mallen AR, Conley CC, Townsend MK, Wells A, Boac BM, Todd S, Gandhi A, Kuznicki M, Augusto BM, McIntyre M, Fridley BL, Tworoger SS, Wenham RM, Vadaparampil ST. Patterns and predictors of genetic referral among ovarian cancer patients at a National Cancer Institute-Comprehensive Cancer Center. Clin Genet 2020; 97:370-375. [PMID: 31600840 PMCID: PMC7322721 DOI: 10.1111/cge.13654] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/26/2019] [Accepted: 09/18/2019] [Indexed: 12/23/2022]
Abstract
Germline mutations (eg, BRCA1/2) have prognostic and treatment implications for ovarian cancer (OVCA) patients. Thus, national guidelines recommend genetic testing for OVCA patients. The present study examines patterns and predictors of genetics referral in OVCA patients. Electronic medical record data were abstracted retrospectively from 557 OVCA patients treated from 1 January 2001 to 31 December 2015. Logistic regression models identified sociodemographic characteristics, disease/treatment characteristics, family history data, provider characteristics, and survival data that predicted genetics referral. Overall, 27.5% of patients received referral. Eleven variables predicting referral were selected during stepwise regression: younger age, White race, not having private insurance, professional school education, year of OVCA diagnosis, platinum sensitivity, female gynecologic oncologist, chemotherapy administered by a gynecologic oncologist, clinical trial enrollment, longer overall survival, and family history of OVCA. Genetics referral among OVCA patients was similar to rates reported nationwide. Unique predictive factors will contribute to quality improvement and should be validated at a multi-institutional level to ensure guideline concordant care is provided to all OVCA patients. Future research should identify both patient-level and provider-level factors associated with genetics referral.
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Affiliation(s)
- Adrianne R Mallen
- Department of Gynecologic Oncology, Moffitt Cancer Center, Tampa, Florida
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida
| | - Claire C Conley
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Mary K Townsend
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida
| | - Ali Wells
- University of South Florida, Morsani School of Medicine, Tampa, Florida
| | - Bernadette M Boac
- Department of Pathology, University of South Florida & Moffitt Cancer Center, Tampa, Florida
| | - Sarah Todd
- Department of Gynecologic Oncology, Moffitt Cancer Center, Tampa, Florida
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida
| | - Anjalika Gandhi
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida
| | - Michelle Kuznicki
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida
| | - Bianca M Augusto
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - McKenzie McIntyre
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Brooke L Fridley
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Shelley S Tworoger
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida
| | - Robert M Wenham
- Department of Gynecologic Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
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Conley CC, Kasting ML, Augusto BM, Garcia JD, Cragun D, Gonzalez BD, Kim J, Ashing KT, Knott CL, Hughes-Halbert C, Pal T, Vadaparampil ST. Impact of Genetic Testing on Risk-Management Behavior of Black Breast Cancer Survivors: A Longitudinal, Observational Study. Ann Surg Oncol 2019; 27:1659-1670. [PMID: 31677107 DOI: 10.1245/s10434-019-07982-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Black women are overrepresented among premenopausal breast cancer (BC) survivors. These patients warrant genetic testing (GT) followed by risk-reducing behaviors. This study documented patterns and predictors of cancer risk-management behaviors among young black BC survivors after GT. METHODS Black women (n = 143) with a diagnosis of BC at the age of 50 years or younger received GT. At 1 year after GT, participants reported receipt of risk-reducing mastectomy, risk-reducing salpingo-oophorectomy, mammogram, breast magnetic resonance imaging (MRI), CA125 test, and transvaginal/pelvic ultrasound. Logistic regression was used to examine predictors of BC risk management (risk-reducing mastectomy or breast MRI) and ovarian cancer risk management (risk-reducing salpingo-oophorectomy, CA125 test, or transvaginal/pelvic ultrasound). RESULTS Of the study participants, 16 (11%) were BRCA1/2-positive, 43 (30%) had a variant of uncertain significance, and 84 (59%) were negative. During the 12 months after GT, no women received risk-reducing mastectomy. The majority (93%) received a mammogram, and a smaller proportion received breast MRI (33%), risk-reducing salpingo-oophorectomy (10%), CA125 test (11%), or transvaginal/pelvic ultrasound (34%). Longer time since the BC diagnosis predicted lower likelihood of BC risk management (odds ratio [OR] 0.54). BRCA1/2 carrier status (OR 4.57), greater perceived risk of recurrence (OR 8.03), and more hereditary breast and ovarian cancer knowledge (OR 1.37) predicted greater likelihood of ovarian cancer risk management. CONCLUSIONS Young black BC survivors appropriately received mammograms and ovarian cancer risk management based on their BRCA1/2 test result. However, the low usage of MRI among BRCA1/2 carriers contrasts with national guidelines. Future research should examine barriers to MRI among black BC survivors. Finally, modifiable variables predicting risk management after GT were identified, providing implications for future interventions.
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Affiliation(s)
- Claire C Conley
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Monica L Kasting
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA
| | - Bianca M Augusto
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Jennifer D Garcia
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Deborah Cragun
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Jongphil Kim
- Division of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Kimlin Tam Ashing
- Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, USA
| | - Cheryl L Knott
- School of Public Health, University of Maryland, College Park, MD, USA
| | - Chanita Hughes-Halbert
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Tuya Pal
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
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