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Bednar EM, Paiz KA, Lu KH, Soares Dias De Souza AP, Oliveira G, Andrade CEEMDC, Gallardo L, Rubio-Cordero J, Cantu-de-León D, Rauh-Hain JA. Delivery of hereditary cancer genetics services to patients newly diagnosed with ovarian and endometrial cancers at three gynecologic oncology clinics in the USA, Brazil, and Mexico. Int J Gynecol Cancer 2024:ijgc-2023-005190. [PMID: 38453180 DOI: 10.1136/ijgc-2023-005190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVE Three gynecologic oncology clinics located in the USA, Brazil, and Mexico collaborated to evaluate their delivery of hereditary cancer genetics services. This descriptive retrospective review study aimed to establish baseline rates and timeliness of guideline-recommended genetics service delivery to patients with ovarian, fallopian tube, primary peritoneal (ovarian), and endometrial cancers at each clinic. METHODS Patients who were newly diagnosed with ovarian and endometrial cancers between September 1, 2018 and December 31, 2020 were identified from the medical records of the clinics. Genetics service delivery metrics included the rates of mismatch repair deficiency tumor testing for patients with endometrial cancer (microsatellite instability/immunohistochemistry, MSI/IHC), referral to genetics services for patients with ovarian cancer, completed genetics consultations, and germline genetic testing for patients with ovarian and endometrial cancers. Timeliness was calculated as the average number of days between diagnosis and the relevant delivery metric. Descriptive statistics were used to analyze data. RESULTS In total, 1195 patients (596 with ovarian cancer, 599 with endometrial cancer) were included in the analysis, and rates of genetics service delivery varied by clinic. For patients with ovarian cancer, referral rates ranged by clinic from 32.6% to 89.5%; 30.4-65.1% of patients completed genetics consultation and 32.6-68.7% completed genetic testing. The timeliness to genetic testing for patients with ovarian cancer ranged by clinic from 107 to 595 days. A smaller proportion of patients with endometrial cancer completed MSI/IHC testing (10.0-69.2%), with the average time to MSI/IHC ranging from 15 to 282 days. Rates of genetics consultation among patients with endometrial cancer ranged by clinic from 10.8% to 26.0% and 12.5-16.6% completed genetic testing. CONCLUSIONS All clinics successfully established baseline rates and timeliness of delivering hereditary cancer genetics services to patients with ovarian and endometrial cancers. Lower rates of delivering genetics services to patients with endometrial cancer warrant additional research and quality improvement efforts.
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Affiliation(s)
- Erica M Bednar
- Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Keiry A Paiz
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Karen H Lu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Gabriela Oliveira
- Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, Brazil
| | | | - Lenny Gallardo
- Clinical Research, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | | | | | - Jose Alejandro Rauh-Hain
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Bednar EM, Rauh-Hain JA, Garcia JJ, de Aguinaga N, Powell MA, Peral SL, Nitecki R, Jorgensen K, Rudy NL, Lu KH, Leath CA, Scarinci IC. Experiences of Family Communication and Cascade Genetic Testing for Hereditary Cancer in Medically Underserved Populations-A Qualitative Study. Cancer Prev Res (Phila) 2024; 17:19-28. [PMID: 37913800 PMCID: PMC10872900 DOI: 10.1158/1940-6207.capr-23-0303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/22/2023] [Accepted: 10/31/2023] [Indexed: 11/03/2023]
Abstract
We sought to explore the intrafamilial communication and cascade genetic testing (CGT) experiences of patients with hereditary cancer from diverse, medically underserved populations and their relatives. Participants included patients receiving oncology care at an urban, safety net hospital in Texas or comprehensive cancer center in Alabama and their first-degree relatives. In-depth semi-structured qualitative interviews were completed wherein patients shared their experiences with genetic counseling (GC), genetic testing (GT), and communicating their results to relatives. Relatives shared their experiences receiving information from the patient and considering CGT. Interviews were transcribed, coded, and themes were identified. Of 25 participating patients, most recalled key aspects of GC and their GT results. Most (80%) patients shared their results with relatives, but only some relatives underwent CGT; patients reported low perceived susceptibility to hereditary cancer as a common barrier to CGT for their relatives. Of 16 participating relatives, most reported feeling distress upon learning the patient's GT results. Relatives were fearful of learning their own CGT results but identified prevention and early detection as CGT benefits. Interviews identified opportunities during family communication to improve relatives' perceived susceptibility to hereditary cancer. Tailored resources may support patients and relatives experiencing distress and fear during GT. PREVENTION RELEVANCE This study of intrafamilial communication and cascade genetic testing experiences of patients with hereditary cancer and their relatives from diverse, medically underserved populations identified relatives' perceived susceptibility to hereditary cancer risks, distress, and fear as frequent reactions and barriers to testing. These results may inform future hereditary cancer prevention efforts.
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Affiliation(s)
- Erica M. Bednar
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jose J. Garcia
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Sylvia L. Peral
- The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roni Nitecki
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Natasha L. Rudy
- The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Karen H. Lu
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Bello RS, Walsh MT, Harper B, Amos CE, Oestman K, Nutt S, Galindez M, Block K, Rechis R, Bednar EM, Tektiridis J, Foxhall L, Moreno M, Shete S, Hawk E. Creating and Activating an Implementation Community to Drive HPV Vaccine Uptake in Texas: The Role of an NCI-Designated Cancer Center. Vaccines (Basel) 2023; 11:1128. [PMID: 37376517 DOI: 10.3390/vaccines11061128] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/29/2023] [Revised: 06/09/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
The University of Texas MD Anderson Cancer Center, a comprehensive cancer center designated by the National Cancer Institute (NCI), defines its service population area as the State of Texas (29.1 M), the second most populous state in the country and the state with the greatest number of uninsured residents in the United States. Consistent with a novel and formal commitment to prevention as part of its core mission, alongside clear opportunities in Texas to drive vaccine uptake, MD Anderson assembled a transdisciplinary team to develop an institutional Framework to increase adolescent HPV vaccination and reduce HPV-related cancer burden. The Framework was developed and activated through a four-phase approach aligned with the NCI Cancer Center Support Grant Community Outreach and Engagement component. MD Anderson identified collaborators through data-driven outreach and constructed a portfolio of collaborative multi-sector initiatives through review processes designed to assess readiness, impact and sustainability. The result is an implementation community of 78 institutions collaboratively implementing 12 initiatives within a shared measurement framework impacting 18 counties. This paper describes a structured and rigorous process to set up the implementation of a multi-year investment in evidence-based strategies to increase HPV vaccination that solves challenges preventing implementation of recommended strategies and to encourage similar initiative replication.
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Affiliation(s)
- Rosalind S Bello
- The HPV Vaccination Initiative, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Office of Health Policy, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Michael T Walsh
- The HPV Vaccination Initiative, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Impact Evaluation Core, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Joint Center on Geospatial Analysis & Health, Houston, TX 77030, USA
| | - Blake Harper
- The HPV Vaccination Initiative, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Charles E Amos
- The HPV Vaccination Initiative, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Office of Health Policy, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Katherine Oestman
- Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Stephanie Nutt
- Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Impact Evaluation Core, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Joint Center on Geospatial Analysis & Health, Houston, TX 77030, USA
| | - Marcita Galindez
- Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Impact Evaluation Core, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Joint Center on Geospatial Analysis & Health, Houston, TX 77030, USA
| | - Kaitlyn Block
- Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ruth Rechis
- Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Impact Evaluation Core, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Erica M Bednar
- Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jennifer Tektiridis
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Lewis Foxhall
- Office of Health Policy, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Mark Moreno
- Government Relations, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sanjay Shete
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ernest Hawk
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Bednar EM, Chen M, Walsh MT, Eppolito AL, Klein MH, Teed K, Hodge B, Hunter J, Chao HG, Davis D, Serchion W, Yobbi C, Krukenberg R, Jenkinson SB, Moore JJ, Garcia C, Gonzalez F, Murray T, Nielsen LD, Ho B, Haas M, Greenzweig SB, Anderson A, Johnson C, Morman NA, Bowdish E, Wise E, Cooper JN, Russ PK, Tondo-Steele K, de Gracia BF, Levin B, Mattie K, Zarnawski K, Kalasinski M, Stone J, O'Brien C, Bream A, Kennedy AM, Paul RA, Bilbao M, Romero M, Carr RL, Siettmann JM, Vercruyssen AK, Leon K, Arun BK, Grainger AV, Warshal DP, Bowman E, Goedde TA, Halaharvi D, Rath K, Grana G, Mina L, Lu KH. Outcomes of the "BRCA Quality Improvement Dissemination Program": An initiative to improve patient receipt of cancer genetics services at five health systems. Gynecol Oncol 2023; 172:106-114. [PMID: 37004303 PMCID: PMC10192022 DOI: 10.1016/j.ygyno.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/10/2023] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE A quality improvement initiative (QII) was conducted with five community-based health systems' oncology care centers (sites A-E). The QII aimed to increase referrals, genetic counseling (GC), and germline genetic testing (GT) for patients with ovarian cancer (OC) and triple-negative breast cancer (TNBC). METHODS QII activities occurred at sites over several years, all concluding by December 2020. Medical records of patients with OC and TNBC were reviewed, and rates of referral, GC, and GT of patients diagnosed during the 2 years before the QII were compared to those diagnosed during the QII. Outcomes were analyzed using descriptive statistics, two-sample t-test, chi-squared/Fisher's exact test, and logistic regression. RESULTS For patients with OC, improvement was observed in the rate of referral (from 70% to 79%), GC (from 44% to 61%), GT (from 54% to 62%) and decreased time from diagnosis to GC and GT. For patients with TNBC, increased rates of referral (from 90% to 92%), GC (from 68% to 72%) and GT (81% to 86%) were observed. Effective interventions streamlined GC scheduling and standardized referral processes. CONCLUSION A multi-year QII increased patient referral and uptake of recommended genetics services across five unique community-based oncology care settings.
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Affiliation(s)
- Erica M Bednar
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.
| | - Minxing Chen
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Michael T Walsh
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Amanda L Eppolito
- Piedmont Oncology at Piedmont Healthcare, Atlanta, GA, United States of America
| | - Molly H Klein
- Piedmont Oncology at Piedmont Healthcare, Atlanta, GA, United States of America
| | - Kelly Teed
- Piedmont Oncology at Piedmont Healthcare, Atlanta, GA, United States of America
| | - Brittany Hodge
- Piedmont Oncology at Piedmont Healthcare, Atlanta, GA, United States of America
| | - Jordan Hunter
- Piedmont Oncology at Piedmont Healthcare, Atlanta, GA, United States of America
| | - Han Gill Chao
- Piedmont Oncology at Piedmont Healthcare, Atlanta, GA, United States of America
| | - Dillon Davis
- Piedmont Oncology at Piedmont Healthcare, Atlanta, GA, United States of America
| | - Wilshauna Serchion
- Piedmont Oncology at Piedmont Healthcare, Atlanta, GA, United States of America
| | - Cara Yobbi
- Community Health Network, Indianapolis, IN, United States of America
| | | | | | - Jennifer J Moore
- Community Health Network, Indianapolis, IN, United States of America
| | - Cassandra Garcia
- Community Health Network, Indianapolis, IN, United States of America
| | | | - Towanna Murray
- Community Health Network, Indianapolis, IN, United States of America
| | - Linda D Nielsen
- Community Health Network, Indianapolis, IN, United States of America
| | - Brenda Ho
- Community Health Network, Indianapolis, IN, United States of America
| | - Megan Haas
- Community Health Network, Indianapolis, IN, United States of America
| | | | - Abby Anderson
- Community Health Network, Indianapolis, IN, United States of America
| | - Christina Johnson
- Community Health Network, Indianapolis, IN, United States of America
| | | | | | - Emaline Wise
- OhioHealth, Columbus, OH, United States of America
| | | | | | | | | | - Brooke Levin
- MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ, United States of America
| | - Kristin Mattie
- MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ, United States of America
| | - Kathryn Zarnawski
- MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ, United States of America
| | - Molly Kalasinski
- MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ, United States of America
| | - Jennifer Stone
- MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ, United States of America
| | - Caitlin O'Brien
- MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ, United States of America
| | - Alexa Bream
- MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ, United States of America
| | - Aidan M Kennedy
- MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ, United States of America
| | - Rachel A Paul
- MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ, United States of America
| | - Michelle Bilbao
- MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ, United States of America
| | - Maureen Romero
- MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ, United States of America
| | - Rebecca L Carr
- Banner MD Anderson Cancer Center, Gilbert, AZ, United States of America
| | | | | | - Kaycee Leon
- Banner MD Anderson Cancer Center, Gilbert, AZ, United States of America
| | - Banu K Arun
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | | | - David P Warshal
- MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ, United States of America
| | - Erin Bowman
- Piedmont Oncology at Piedmont Healthcare, Atlanta, GA, United States of America
| | - Timothy A Goedde
- Community Health Network, Indianapolis, IN, United States of America
| | | | - Kellie Rath
- OhioHealth, Columbus, OH, United States of America
| | - Generosa Grana
- MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ, United States of America
| | - Lida Mina
- Banner MD Anderson Cancer Center, Gilbert, AZ, United States of America
| | - Karen H Lu
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
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5
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Bednar EM, Harper B, Walsh MT, Rechis R, Bilbao M, Carr RL, Eppolito AL, Goedde T, Levin B, Mattie K, Morman NA, Rath K, Russ P, Siettmann JM, Warshal D, Wise E, Yobbi C, Lu KH. Implementation and outcome evaluations of a multi-site improvement program in cancer genetics. J Genet Couns 2023; 32:182-196. [PMID: 36117454 DOI: 10.1002/jgc4.1633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/20/2021] [Revised: 08/02/2022] [Accepted: 08/15/2022] [Indexed: 11/09/2022]
Abstract
Program evaluation can identify the successes and challenges of implementing clinical programs, which can inform future dissemination efforts. A cancer genetics improvement program, disseminated from the Lead Team's institution to five health systems (Participating Sites), was genetic counselor led, using virtual implementation facilitation to support Participating Sites' performance of quality improvement (QI) activities over several years. Program implementation and outcome evaluations were performed and included evaluation of program delivery and initial effects of the program on Participating Sites. A logic model guided evaluation of program implementation (inputs, activities, outputs, delivery/fidelity, and coverage/reach) and initial outcomes (short-term and intermediate outcomes). Data were collected from program documents and an Evaluation Survey of Participating Site team members (21 respondents), compared against the Lead Team's expectations of participation, and analyzed using descriptive statistics. All program inputs, outputs, and activities were available and delivered as expected across the five Participating Sites. The most frequently used activities and inputs were facilitation-associated meetings and meeting resources, which were rated as useful/helpful by the majority of respondents. Nearly all respondents noted improvement in short-term outcomes following participation: 82.4% reported increased awareness of clinical processes, 94.1% increased knowledge of QI methods, 100% reported increased perceived importance of QI, 94.1% increased perceived feasibility of QI, and 76.5% reported increased problem-solving skills and self-efficacy to use QI at their site. Intermediate outcomes (identifying barriers, developing interventions, improved teamwork, and capacity) were achieved following program participation as indicated by the results of the program document review and Evaluation Survey responses. Implementation challenges at Participating Sites included staffing constraints, difficulties obtaining buy-in and participation, and developing interventions over time. The multi-site improvement program was delivered and implemented with high levels of fidelity and resulted in improved short and intermediate outcomes. Future research will evaluate long-term, patient-level outcomes associated with site-specific QI interventions.
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Affiliation(s)
- Erica M Bednar
- Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Blake Harper
- Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Impact Evaluation Core, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael T Walsh
- Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Impact Evaluation Core, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ruth Rechis
- Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Impact Evaluation Core, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michelle Bilbao
- Department of Gynecologic Oncology, MD Anderson Cancer Center at Cooper University Health Care, Camden, New Jersey, USA
| | - Rebecca L Carr
- Cancer Genetics Program, Banner MD Anderson Cancer Center, Gilbert, Arizona, USA
| | - Amanda L Eppolito
- Cancer Genetics Program, Piedmont Oncology at Piedmont Healthcare, Atlanta, Georgia, USA
| | - Timothy Goedde
- Cancer Genetics Program, Community Health Network, Indianapolis, Indiana, USA
| | - Brooke Levin
- William G. Rohrer Cancer Genetics Program, MD Anderson Cancer Center at Cooper University Health Care, Camden, New Jersey, USA
| | - Kristin Mattie
- William G. Rohrer Cancer Genetics Program, MD Anderson Cancer Center at Cooper University Health Care, Camden, New Jersey, USA
| | | | - Kellie Rath
- Department of Gynecologic Oncology, OhioHealth, Columbus, Ohio, USA
| | - Pauline Russ
- Genetic Counseling Program, OhioHealth, Columbus, Ohio, USA.,Department of Surgical Oncology, OhioHealth Cancer Care, Columbus, Ohio, USA
| | - Jennifer M Siettmann
- Cancer Genetics Program, Banner MD Anderson Cancer Center, Gilbert, Arizona, USA
| | - David Warshal
- Department of Gynecologic Oncology, MD Anderson Cancer Center at Cooper University Health Care, Camden, New Jersey, USA
| | - Emaline Wise
- Genetic Counseling Program, OhioHealth, Columbus, Ohio, USA
| | - Cara Yobbi
- Cancer Genetics Program, Community Health Network, Indianapolis, Indiana, USA
| | - Karen H Lu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Bednar EM, Nitecki R, Krause KJ, Rauh-Hain JA. Interventions to improve delivery of cancer genetics services in the United States: A scoping review. Genet Med 2022; 24:1176-1186. [PMID: 35389342 DOI: 10.1016/j.gim.2022.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 12/06/2021] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Interventions that decrease barriers and improve clinical processes can increase patient access to guideline-recommended cancer genetics services. We sought to identify and describe interventions to improve patient receipt of guideline-recommended cancer genetics services in the United States. METHODS We performed a comprehensive search in Ovid MEDLINE and Embase, Scopus, and Web of Science from January 1, 2000 to February 12, 2020. Eligible articles reported interventions to improve the identification, referral, genetic counseling (GC), and genetic testing (GT) of patients in the United States. We independently screened titles and abstracts and reviewed full-text articles. Data were synthesized by grouping articles by clinical process. RESULTS Of 44 included articles, 17 targeted identification of eligible patients, 14 targeted referral, 15 targeted GC, and 16 targeted GT. Patient identification interventions included universal tumor testing and screening of medical/family history. Referral interventions included medical record system adaptations, standardizing processes, and provider notifications. GC interventions included supplemental patient education, integrated GC within oncology clinics, appointment coordination, and alternative service delivery models. One article directly targeted the GT process by implementing provider-coordinated testing. CONCLUSION This scoping review identified and described interventions to improve US patients' access to and receipt of guideline-recommended cancer genetics services.
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Affiliation(s)
- Erica M Bednar
- Cancer Prevention and Control Platform, Moon Shots Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Roni Nitecki
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kate J Krause
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jose Alejandro Rauh-Hain
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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7
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Bednar EM, Chen M, Walsh MT, Eppolito AL, Teed KB, Klein MH, Chao H, Berg J, Bowman E, Yobbi CS, Krukenberg RC, Jenkinson S, Moore J, Garcia C, Goedde T, Morman NA, Bowdish EC, Wise E, Rath KS, Lu KH. Outcomes of the BRCA quality improvement dissemination program in three health systems. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.10603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10603 Background: The BRCA Quality Improvement Dissemination Program (BQIDP) was disseminated to 3 community-based health systems’ oncology clinics in 2017. The BQIDP occurred over 3 years and aimed to increase rates of guideline-recommended referral (ref), genetic counseling (GC), and germline genetic testing (GT) for patients diagnosed with invasive epithelial ovarian, fallopian tube, and primary peritoneal cancer (OC) and triple-negative breast cancer diagnosed at age 60 or younger (TNBC). The BQIDP applied virtual implementation facilitation to support sites’ development, implementation, and tracking of quality improvement (QI) interventions. Interventions were adapted from prior QI initiatives and published interventions. Methods: Baseline metrics (patients diagnosed 1/1/2015 to site’s BQIDP launch date Autumn 2017) were compared to metrics of patients diagnosed during BQIDP implementation (site launch dates Autumn 2017 to Autumn 2020). Two-sample test of proportions was used to assess for statistically significant change in rates pre and post BQIDP implementation at each site. QI interventions targeted provider and patient education, retrospective and prospective case finding with alerts to providers and patients, case finding by review of somatic test results and genetic counselor tumor board attendance, streamlined ref and scheduling processes, and infusion-suite based GC. Results: All clinics increased rates compared to baseline (Table). Statistically significant improvement was noted for patients with OC in receipt of GC at Site A, ref and receipt of GC at site B, and receipt of GC at site C. Statistically significant improvement was noted for patients with TNBC in ref and GT at sites A and B. Conclusions: Improved rates of ref, GC and GT for patients with OC and TNBC were observed at all 3 sites compared to baseline. Baseline ref, GC, and GT metrics for patients with TNBC were higher than for patients with OC at all sites. Tailored and facilitated QI efforts can promote patients’ receipt of guideline-recommended cancer genetics services in health system oncology clinics. [Table: see text]
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Affiliation(s)
- Erica M. Bednar
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Minxing Chen
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | - Han Chao
- Emory University School of Medicine, Atlanta, GA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Karen H. Lu
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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8
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Makhnoon S, Bednar EM, Krause KJ, Peterson SK, Lopez-Olivo MA. Clinical management among individuals with variant of uncertain significance in hereditary cancer: A systematic review and meta-analysis. Clin Genet 2021; 100:119-131. [PMID: 33843052 DOI: 10.1111/cge.13966] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 02/10/2021] [Revised: 04/05/2021] [Accepted: 04/09/2021] [Indexed: 12/01/2022]
Abstract
Improper medical use of variant of uncertain significance (VUS) remains a concern in hereditary cancer genetic testing. The goal of this study was to assess the association between pathogenic and likely pathogenic (P/LP), VUS, and benign and likely benign (B/LB) genetic test results and cancer-related surgical and screening management. Systematic searches of Medline, Embase, EBSCO CINAHL Plus, and PsycINFO were conducted from 1946 to August 26, 2020. Eligible studies included individuals with cancer genetic test result and surgical or screening management outcomes. We reviewed 885 abstracts and 22 studies that reported relevant surgical and screening outcomes were included. Meta-analysis revealed significantly higher surgical rates among individuals with P/LP than among those with VUS for therapeutic mastectomy with contralateral prophylactic mastectomy (OR = 7.35, 95% CI, 4.14-13.64), prophylactic mastectomy (OR = 3.05, 95% CI, 1.5-6.19), and oophorectomy (OR = 6.46, 95% CI, 3.64-11.44). There were no significant differences in therapeutic mastectomy, or breast conservation or lumpectomy rates between individuals with P/LP and VUS, or in any outcomes between patients with VUS and B/LB. Studies evaluating screening outcomes were limited, and results were conflicting. Comprehensive analysis do not indicate that a significant number of individuals with VUS results undergo inappropriate clinical management.
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Affiliation(s)
- Sukh Makhnoon
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Erica M Bednar
- Clinical Cancer Genetics and the Cancer Prevention and Control Platform, Moon Shots Program, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kate J Krause
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maria A Lopez-Olivo
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Bednar EM, Sun CC, McCurdy S, Vernon SW. Assessing relatives’ readiness for hereditary cancer cascade genetic testing. Genet Med 2019; 22:719-726. [DOI: 10.1038/s41436-019-0735-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 12/31/2022] Open
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10
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Clifford M, Bannon S, Bednar EM, Czerwinski J, Davis J, Dunnington L, Shahrukh Hashmi S, DiNardo CD. Clinical applicability of proposed algorithm for identifying individuals at risk for hereditary hematologic malignancies. Leuk Lymphoma 2019; 60:3020-3027. [PMID: 31274040 DOI: 10.1080/10428194.2019.1630618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Multiple genes have been identified to cause hereditary predispositions to hematologic malignancies, and characterized by an increased risk to develop myelodysplastic syndromes (MDS), acute myeloid leukemia (AML), and/or aplastic anemia (AA). Referral algorithms for patients who may be at higher risk have been proposed, with limited data regarding applicability. Our study aimed to evaluate referral criteria on a population of MDS/AML/AA patients. Demographic information and medical history were obtained from 608 patients referred over a 9-month period. Median age at diagnosis was 67 years (56-73), 387 (64%) were male, and the majority of individuals (54.9%) had AML. Overall, 406 individuals (66.8%) had insufficient documentation to determine whether certain criteria were met. Two hundred and two (33.2%) individuals met at least one criteria for genetic counseling referral; however, only nine (4.5%) were referred. Increased documentation of personal and family history is necessary to better assess and validate the applicability of these criteria.
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Affiliation(s)
- Maggie Clifford
- Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, TX, USA.,The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Sarah Bannon
- Department of Clinical Cancer Genetics, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Erica M Bednar
- Department of Clinical Cancer Genetics, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Jennifer Czerwinski
- Department of Obstetrics and Gynecology, McGovern Medical School at the University of Texas at Houston, Houston, TX, USA
| | | | - Leslie Dunnington
- Department of Pediatrics, McGovern Medical School at the University of Texas at Houston, Houston, TX, USA
| | - S Shahrukh Hashmi
- Pediatric Research Center, Department of Pediatrics, McGovern Medical School at the University of Texas at Houston, Houston, TX, USA
| | - Courtney D DiNardo
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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Hinchcliff EM, Bednar EM, Lu KH, Rauh-Hain JA. Disparities in gynecologic cancer genetics evaluation. Gynecol Oncol 2019; 153:184-191. [PMID: 30711300 PMCID: PMC6430691 DOI: 10.1016/j.ygyno.2019.01.024] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [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: 11/07/2018] [Revised: 01/22/2019] [Accepted: 01/25/2019] [Indexed: 01/14/2023]
Abstract
An estimated 2-5% of endometrial cancers and 15-20% of high-grade, non-mucinous epithelial ovarian cancers have an underlying hereditary cause. Appropriate risk assessment, genetic counseling, and germline genetic testing for cancer predisposition genes in both gynecologic cancer patients and their at-risk relatives is essential for effective delivery of tailored cancer treatment and cancer prevention. However, significant disparities exist within medically underserved and minority populations in the United States regarding awareness of, access to, and use of genetic services. The objectives of this review are to summarize the literature on genetic counseling and genetic testing of gynecologic cancer patients, the cascade genetic testing of their families following the identification of a germline mutation associated with susceptibility to cancer, to highlight disparities between populations, and to present some potential remedies.
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Affiliation(s)
- Emily M Hinchcliff
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Erica M Bednar
- The Department of Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; The Cancer Prevention and Control Platform, Moon Shots™ Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karen H Lu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - J Alejandro Rauh-Hain
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA; Department of Health Services Research, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
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12
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Bednar EM, Walsh MT, Baker E, Muse KI, Oakley HD, Krukenberg RC, Dresbold CS, Jenkinson SB, Eppolito AL, Teed KB, Klein MH, Morman NA, Bowdish EC, Russ P, Wise EE, Cooper JN, Method MW, Henson JW, Grainger AV, Arun BK, Lu KH. Creation and Implementation of an Environmental Scan to Assess Cancer Genetics Services at Three Oncology Care Settings. J Genet Couns 2018; 27:10.1007/s10897-018-0262-4. [PMID: 29770910 PMCID: PMC6240000 DOI: 10.1007/s10897-018-0262-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 05/06/2018] [Indexed: 02/03/2023]
Abstract
An environmental scan (ES) is an efficient mixed-methods approach to collect and interpret relevant data for strategic planning and project design. To date, the ES has not been used nor evaluated in the clinical cancer genetics setting. We created and implemented an ES to inform the design of a quality improvement (QI) project to increase the rates of adherence to national guidelines for cancer genetic counseling and genetic testing at three unique oncology care settings (OCS). The ES collected qualitative and quantitative data from reviews of internal processes, past QI efforts, the literature, and each OCS. The ES used a data collection form and semi-structured interviews to aid in data collection. The ES was completed within 6 months, and sufficient data were captured to identify opportunities and threats to the QI project's success, as well as potential barriers to, and facilitators of guideline-based cancer genetics services at each OCS. Previously unreported barriers were identified, including inefficient genetic counseling appointment scheduling processes and the inability to track referrals, genetics appointments, and genetic test results within electronic medical record systems. The ES was a valuable process for QI project planning at three OCS and may be used to evaluate genetics services in other settings.
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Affiliation(s)
- Erica M Bednar
- The Department of Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Unit 1362 P.O. Box 301439, Houston, TX, 77230-1439, USA.
- The Cancer Prevention and Control Platform, Moon Shots Program™, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Michael T Walsh
- The Cancer Prevention and Control Platform, Moon Shots Program™, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ellen Baker
- The Cancer Prevention and Control Platform, Moon Shots Program™, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kimberly I Muse
- The Department of Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Unit 1362 P.O. Box 301439, Houston, TX, 77230-1439, USA
| | - Holly D Oakley
- The Department of Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Unit 1362 P.O. Box 301439, Houston, TX, 77230-1439, USA
| | | | - Cara S Dresbold
- Oncology Genetic Counseling, Community Health Network, Indianapolis, IN, USA
| | - Sandra B Jenkinson
- Oncology Genetic Counseling, Community Health Network, Indianapolis, IN, USA
| | | | - Kelly B Teed
- Piedmont Cancer, Piedmont Healthcare, Atlanta, GA, USA
| | - Molly H Klein
- Piedmont Cancer, Piedmont Healthcare, Atlanta, GA, USA
| | | | | | - Pauline Russ
- Genetic Counseling Program, OhioHealth, Columbus, OH, USA
| | - Emaline E Wise
- Genetic Counseling Program, OhioHealth, Columbus, OH, USA
| | - Julia N Cooper
- Genetic Counseling Program, OhioHealth, Columbus, OH, USA
| | - Michael W Method
- Gynecologic Cancer Care, Community Health Network, Indianapolis, IN, USA
| | - John W Henson
- Piedmont Cancer, Piedmont Healthcare, Atlanta, GA, USA
| | | | - Banu K Arun
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karen H Lu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Roberts MC, Dotson WD, DeVore CS, Bednar EM, Bowen DJ, Ganiats TG, Green RF, Hurst GM, Philp AR, Ricker CN, Sturm AC, Trepanier AM, Williams JL, Zierhut HA, Wilemon KA, Hampel H. Delivery Of Cascade Screening For Hereditary Conditions: A Scoping Review Of The Literature. Health Aff (Millwood) 2018; 37:801-808. [PMID: 29733730 PMCID: PMC11022644 DOI: 10.1377/hlthaff.2017.1630] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [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] [Indexed: 11/05/2022]
Abstract
Cascade screening is the process of contacting relatives of people who have been diagnosed with certain hereditary conditions. Its purpose is to identify, inform, and manage those who are also at risk. We conducted a scoping review to obtain a broad overview of cascade screening interventions, facilitators and barriers to their use, relevant policy considerations, and future research needs. We searched for relevant peer-reviewed literature in the period 1990-2017 and reviewed 122 studies. Finally, we described 45 statutes and regulations related to the use and release of genetic information across the fifty states. We sought standardized best practices for optimizing cascade screening across various geographic and policy contexts, but we found none. Studies in which trained providers contacted relatives directly, rather than through probands (index patients), showed greater cascade screening uptake; however, policies in some states might limit this approach. Major barriers to cascade screening delivery include suboptimal communication between the proband and family and geographic barriers to obtaining genetic services. Few US studies examined interventions for cascade screening or used rigorous study designs such as randomized controlled trials. Moving forward, there remains an urgent need to conduct rigorous intervention studies on cascade screening in diverse US populations, while accounting for state policy considerations.
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Affiliation(s)
- Megan C Roberts
- Megan C. Roberts is a Cancer Prevention Fellow in the Division of Cancer Control and Population Sciences, National Cancer Institute, in Rockville, Maryland
| | - W David Dotson
- W. David Dotson is a senior coordinating scientist in the Office of Public Health Genomics, Centers for Disease Control and Prevention (CDC), in Atlanta, Georgia
| | - Christopher S DeVore
- Christopher S. DeVore is a Public Health Fellow in the Office of Public Health Preparedness and Response, CDC, and a master of public health candidate at the Rollins School of Public Health, Emory University, in Atlanta
| | - Erica M Bednar
- Erica M. Bednar is a genetic counselor in the Department of Clinical Cancer Genetics and the Cancer Prevention and Control Platform at the University of Texas MD Anderson Cancer Center, in Houston, Texas
| | - Deborah J Bowen
- Deborah J. Bowen is a professor of bioethics and humanities at the University of Washington, in Seattle
| | - Theodore G Ganiats
- Theodore G. Ganiats is director of the National Center for Excellence in Primary Care Research, Agency for Healthcare Research and Quality, in Rockville, Maryland
| | - Ridgely Fisk Green
- Ridgely Fisk Green is a Carter Consulting, Inc., contractor in the Office of Public Health Genomics, CDC, and at Carter Consulting, in Atlanta
| | - Georgia M Hurst
- Georgia M. Hurst is the director of ihavelynchsyndrome.org, in Evanston, Illinois
| | - Alisdair R Philp
- Alisdair R. Philp is a genetic counselor and a clinical assistant professor at the University of Kansas Hospitals and Clinics, in Westwood
| | - Charité N Ricker
- Charité N. Ricker is a genetic counselor and clinical instructor at the University of Southern California, in Los Angeles
| | - Amy C Sturm
- Amy C. Sturm is a professor at the Genomic Medicine Institute, Geisinger, in Danville, Pennsylvania
| | - Angela M Trepanier
- Angela M. Trepanier is an associate professor (clinician educator) at the Center for Molecular Medicine and Genetics, Wayne State University, in Detroit, Michigan
| | - Janet L Williams
- Janet L. Williams is director, Research Genetic Counselors, at the Genomic Medicine Institute, Geisinger, in Danville, Pennsylvania
| | - Heather A Zierhut
- Heather A. Zierhut is an assistant professor in genetics, cell biology, and development at the College of Biological Sciences, University of Minnesota Twin Cities, in Minneapolis
| | - Katherine A Wilemon
- Katherine A. Wilemon is CEO of the Familial Hypercholesterolemia Foundation, in Pasadena, California
| | - Heather Hampel
- Heather Hampel is associate director of the Division of Human Genetics and of biospecimen research, and a professor of internal medicine, all at the Ohio State University Comprehensive Cancer Center, in Columbus
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Bednar EM, Oakley HD, Sun CC, Burke CC, Munsell MF, Westin SN, Lu KH. A universal genetic testing initiative for patients with high-grade, non-mucinous epithelial ovarian cancer and the implications for cancer treatment. Gynecol Oncol 2017; 146:399-404. [PMID: 28610746 DOI: 10.1016/j.ygyno.2017.05.037] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [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: 05/04/2017] [Revised: 05/26/2017] [Accepted: 05/27/2017] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Genetic counseling (GC) and germline genetic testing (GT) for BRCA1 and BRCA2 are considered standard of care for patients with high-grade, non-mucinous epithelial ovarian, fallopian tube, and primary peritoneal cancers (HGOC). We describe a universal genetic testing initiative to increase the rates of recommendation and acceptance of GC and GT to >80% for patients with HGOC at our institution. METHODS Data from a consecutive cohort of patients seen in our gynecologic oncology clinics between 9/1/2012 and 8/31/2015 for evaluation of HGOC were retrospectively analyzed. Data were abstracted from the tumor registry, medical records, and research databases. Descriptive statistics were used to evaluate patient characteristics and GC, GT, and PARP inhibitor use. Various clinic interventions were developed, influenced by the Plan-Do-Study-Act cycle method, which included physician-coordinated GT, integrated GC, and assisted GC referrals. RESULTS A cohort of 1636 patients presented to the gynecologic oncology clinics for evaluation of HGOC during our study period, and 1423 (87.0%) were recommended to have GC and GT. Of these, 1214 (85.3%) completed GT and 217 (17.9%) were found to have a BRCA1 or BRCA2 mutation. Among BRCA-positive patients, 167 had recurrent or progressive disease, and 56 of those received PARP inhibitor therapy. CONCLUSIONS The rates of GC and GT recommendation and completion among patients with HGOC at our institution exceeded 80% following the implementation of a universal genetic testing initiative. Universal genetic testing of patients with HGOC is one strategy to identify those who may benefit from PARP inhibitor therapy.
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Affiliation(s)
- Erica M Bednar
- The Department of Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, 1155 Herman P. Pressler Dr. Houston, TX 77030, United States
| | - Holly D Oakley
- The Department of Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, 1155 Herman P. Pressler Dr. Houston, TX 77030, United States
| | - Charlotte C Sun
- The Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1155 Herman P. Pressler Dr. Houston, TX 77030, United States
| | - Catherine C Burke
- The Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1155 Herman P. Pressler Dr. Houston, TX 77030, United States
| | - Mark F Munsell
- The Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1155 Herman P. Pressler Dr. Houston, TX 77030, United States
| | - Shannon N Westin
- The Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1155 Herman P. Pressler Dr. Houston, TX 77030, United States
| | - Karen H Lu
- The Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1155 Herman P. Pressler Dr. Houston, TX 77030, United States.
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