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Cacioppo CN, Egleston BL, Fetzer D, Burke Sands C, Raza SA, Reddy Malleda N, McCarty Wood E, Rittenburg I, Childs J, Cho D, Hosford M, Khair T, Khatri J, Komarnicky L, Poretta T, Rahman F, Shah S, Patrick-Miller LJ, Domchek SM, Bradbury AR. Randomized study of remote telehealth genetic services versus usual care in oncology practices without genetic counselors. Cancer Med 2021; 10:4532-4541. [PMID: 34102012 PMCID: PMC8267134 DOI: 10.1002/cam4.3968] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose To examine the benefit of telehealth over current delivery options in oncology practices without genetic counselors. Methods Participants meeting cancer genetic testing guidelines were recruited to this multi‐center, randomized trial comparing uptake of genetic services with remote services (telephone or videoconference) to usual care in six predominantly community practices without genetic counselors. The primary outcome was the composite uptake of genetic counseling or testing. Secondary outcomes compare telephone versus videoconference services. Results 147 participants enrolled and 119 were randomized. Eighty percent of participants in the telehealth arm had genetic services as compared to 16% in the usual care arm (OR 30.52, p < 0.001). Five genetic mutation carriers (6.7%) were identified in the telehealth arm, compared to none in the usual care arm. In secondary analyses, factors associated with uptake were lower anxiety (6.77 vs. 8.07, p = 0.04) and lower depression (3.38 vs. 5.06, p = 0.04) among those who had genetic services. There were no significant differences in change in cognitive or affective outcomes immediately post‐counseling and at 6 and 12 months between telephone and videoconference arms. Conclusion Telehealth increases uptake of genetic counseling and testing at oncology practices without genetic counselors and could significantly improve identification of genetic carriers and cancer prevention outcomes.
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Affiliation(s)
- Cara N Cacioppo
- Penn Telegenetics Program, University of Pennsylvania, Philadelphia, PA, USA
| | - Brian L Egleston
- Fox Chase Cancer Center, Biostatistics and Bioinformatics Facility, Temple University Health System, Philadelphia, PA, USA
| | - Dominique Fetzer
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Colleen Burke Sands
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Syeda A Raza
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - India Rittenburg
- Penn Telegenetics Program, University of Pennsylvania, Philadelphia, PA, USA
| | | | - David Cho
- Cape Regional Medical Center, Cape May Court House, NJ, USA
| | | | - Tina Khair
- Gettysburg Cancer Center, Gettysburg, PA, USA
| | | | | | | | | | - Satish Shah
- Gettysburg Cancer Center, Gettysburg, PA, USA
| | - Linda J Patrick-Miller
- Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL, USA
| | - Susan M Domchek
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Angela R Bradbury
- Penn Telegenetics Program, University of Pennsylvania, Philadelphia, PA, USA.,Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.,Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA
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