Implementing Systematic Genetic Counseling and Multigene Germline Testing for Individuals With Pancreatic Cancer
| Autor: | Lauren K. Brais, Shraddha Gaonkar, Brian M. Wolpin, Chinedu Ukaegbu, Hajime Uno, Sapna Syngal, Kimberly Perez, Matthew B. Yurgelun, Meghan Underhill-Blazey, Anu Chittenden, Sigurdis Haraldsdottir |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
Oncology medicine.medical_specialty Pancreatic ductal adenocarcinoma endocrine system diseases Genetic counseling MEDLINE Genetic Counseling ORIGINAL CONTRIBUTIONS Germline 03 medical and health sciences 0302 clinical medicine Internal medicine Pancreatic cancer medicine Humans Genetic Predisposition to Disease Genetic Testing Oncology (nursing) business.industry Health Policy medicine.disease Pancreatic Neoplasms 030104 developmental biology Germ Cells 030220 oncology & carcinogenesis business |
| Zdroj: | JCO Oncol Pract |
| Popis: | PURPOSE: National guidelines recommend genetic counseling and multigene germline testing (GC/MGT) for all patients with pancreatic ductal adenocarcinoma (PDAC). This study's aim was to assess real-world effectiveness of implementing systematic GC/MGT for all patients with PDAC at a high-volume academic institution. METHODS: An iterative process for systematizing GC/MGT was developed in which gastrointestinal oncology providers at the Dana-Farber Cancer Institute were recommended to refer all patients with PDAC for GC/MGT (clinician-directed referral). Workflows were subsequently changed such that patients with PDAC were automatically offered GC/MGT when scheduling their initial oncology consultation (automated referral). Clinical and germline data were collected on a consecutive cohort of patients with PDAC undergoing GC/MGT during a 25-month enrollment period (19-month clinician-directed referrals; 6-month automated referrals). RESULTS: One thousand two hundred fourteen patients with PDAC were seen for initial oncologic evaluation, 266 (21.9%) of whom underwent GC/MGT. Compared with baseline clinician-directed referrals, implementation of automated referrals led to a significant increase in patients with PDAC undergoing GC/MGT (16.5% v 38.0%, P < .001), including those undergoing multigene germline testing (MGT) ≤ 7 days of initial oncology evaluation (14.7% v 60.3%, P < .001), with preserved pathogenic variant detection rates (10.0% v 11.2%, P = 0.84). 16 of 28 (57.1%) pathogenic variant carriers had relatives who pursued cascade germline testing, and 13 of 26 (50.0%) carriers with incurable disease received targeted therapy based on MGT results. CONCLUSION: Implementation of systematic GC/MGT in patients with PDAC is feasible and leads to management changes for patients with PDAC and their families. GC/MGT workflows that bypass the need for clinician referral result in superior uptake and time to testing. Further investigation is needed to identify other barriers and facilitators of universal GC/MGT. |
| Databáze: | OpenAIRE |
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