Randomized trial promoting cancer genetic risk assessment when genetic counseling cost removed: 1-year follow-up.

Autor:	An J; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA., McDougall J; Fred Hutchinson Cancer Center, Seattle, WA, USA., Lin Y; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.; Rutgers University School of Public Health, Piscataway, NJ, USA., Lu SE; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.; Rutgers University School of Public Health, Piscataway, NJ, USA., Walters ST; University of North Texas Health Science Center, Fort Worth, TX, USA., Heidt E; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA., Stroup A; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.; Rutgers University School of Public Health, Piscataway, NJ, USA., Paddock L; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.; Rutgers University School of Public Health, Piscataway, NJ, USA., Grumet S; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA., Toppmeyer D; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA., Kinney AY; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.; Rutgers University School of Public Health, Piscataway, NJ, USA.
Jazyk:	angličtina
Zdroj:	JNCI cancer spectrum [JNCI Cancer Spectr] 2024 Feb 29; Vol. 8 (2).
DOI:	10.1093/jncics/pkae018
Abstrakt:	Purpose: Cancer genetic risk assessment (CGRA) is recommended for women with ovarian and high-risk breast cancer. However, the underutilization of CGRA has long been documented, and cost has been a major barrier. In this randomized controlled trial, a tailored counseling and navigation (TCN) intervention significantly improved CGRA uptake at 6-month follow-up, compared with targeted print (TP) and usual care (UC). We aimed to examine the effect of removing genetic counseling costs on CGRA uptake by 12 months. Methods: We recruited racially and geographically diverse women with breast and ovarian cancer from cancer registries in Colorado, New Jersey, and New Mexico. Participants assigned to TCN received telephone-based psychoeducation and navigation. After 6 months, the trial provided free genetic counseling to participants in all arms. Results: At 12 months, more women in TCN obtained CGRA (26.6%) than those in TP (11.0%; odds ratio [OR] = 2.77, 95% confidence interval [CI] = 1.56 to 4.89) and UC (12.2%; OR = 2.46, 95% CI = 1.41 to 4.29). There were no significant differences in CGRA uptake between TP and UC. The Kaplan-Meier curve shows that the divergence of cumulative incidence slopes (TCN vs UC, TCN vs TP) appears primarily within the initial 6 months. Conclusion: TCN significantly increased CGRA uptake at the 12-month follow-up. Directly removing the costs of genetic counseling attenuated the effects of TCN, highlighting the critical enabling role played by cost coverage. Future policies and interventions should address multilevel cost-related barriers to expand patients' access to CGRA. Trial Registration: This trial was registered with the NIH clinical trial registry, clinicaltrials.gov, NCT03326713. https://clinicaltrials.gov/ct2/show/NCT03326713. (© The Author(s) 2024. Published by Oxford University Press.)
Databáze:	MEDLINE
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