Hereditary Cancer Clinics Improve Adherence to NCCN Germline Testing Guidelines for Pancreatic Cancer.

Autor:	Rosso C; School of Medicine, University of California, Irvine, Irvine, CA., Marciano ND; School of Medicine, University of California, Irvine, Irvine, CA., Nathan D; Division of Genetic and Genomic Medicine, Department of Pediatrics, University of California, Irvine, Irvine, CA., Chen WP; Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA., McLaren CE; Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA., Osann KE; School of Medicine, University of California, Irvine, Irvine, CA., Flodman PL; Division of Genetic and Genomic Medicine, Department of Pediatrics, University of California, Irvine, Irvine, CA., Cho MT; Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA.; Division of Hematology/Oncology, Department of Medicine, UCI School of Medicine, Irvine, CA., Lee FC; Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA.; Division of Hematology/Oncology, Department of Medicine, UCI School of Medicine, Irvine, CA., Dayyani F; Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA.; Division of Hematology/Oncology, Department of Medicine, UCI School of Medicine, Irvine, CA., Zell JA; Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA.; Division of Hematology/Oncology, Department of Medicine, UCI School of Medicine, Irvine, CA., Valerin JB; Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA.; Division of Hematology/Oncology, Department of Medicine, UCI School of Medicine, Irvine, CA.
Jazyk:	angličtina
Zdroj:	Journal of the National Comprehensive Cancer Network : JNCCN [J Natl Compr Canc Netw] 2024 Jun 18; Vol. 22 (5), pp. 299-305. Date of Electronic Publication: 2024 Jun 18.
DOI:	10.6004/jnccn.2023.7333
Abstrakt:	Background: Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis, with a 5-year overall survival rate of 10%. In November 2018, NCCN recommended that all patients with PDAC receive genetic counseling (GC) and germline testing regardless of family history. We hypothesized that patients with PDAC were more likely to be referred for testing after this change to the guidelines, regardless of presumed predictive factors, and that compliance would be further improved following the implementation of a hereditary cancer clinic (HCC). Methods: We conducted a single-institution retrospective analysis of patients diagnosed with PDAC from June 2017 through December 2021 at University of California, Irvine. We compared rates of genetics referral among patients in different diagnostic eras: the 18-month period before the NCCN Guideline change (pre-NCCN era: June 2017 through November 2018), 14 months following the change (post-NCCN era: December 2018 through January 2020), and 18 months after the creation of an HCC (HCC era: June 2020 through December 2021). Family and personal cancer history, genetics referral patterns, and results of GC were recorded. Data were compared using chi-square, Fisher exact, and multivariate analyses. Results: A total of 335 patients were treated for PDAC (123 pre-NCCN, 109 post-NCCN, and 103 HCC) at University of California, Irvine. Demographics across groups were comparable. Prior to the guideline changes, 30% were referred to GC compared with 54.7% in the post-NCCN era. After the implementation of the HCC, 77.4% were referred to GC (P<.0001). The odds ratio (OR) for referral to GC among patients with a positive family history of cancer progressively decreased following the change (pre-NCCN era: OR, 11.90 [95% CI, 3.00-80.14]; post-NCCN era: OR, 3.39 [95% CI, 1.13-10.76]; HCC era: OR, 3.11 [95% CI, 0.95-10.16]). Conclusions: The 2018 updates to the NCCN Guidelines for PDAC recommending germline testing for all patients with PDAC significantly increased GC referral rates at our academic medical center. Implementation of an HCC further boosted compliance with guidelines.
Databáze:	MEDLINE
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