Oncologist-led BRCA ‘mainstreaming’ in the ovarian cancer clinic: A study of 255 patients and its impact on their management

Rumford, Megan; Lythgoe, Mark P.; McNeish, Iain A.; Gabra, Hani; Tookman, Laura A.; Rahman, Nazneen; George, Angela; Krell, Jonathan

doi:10.1038/s41598-020-60149-5

Cited by 40 publications

(65 citation statements)

References 22 publications

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“…of included studies (44%) were from North America [34-39, 41, 44-47, 54] (Table 2). The 25 studies [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][51][52][53][54][55] (93%) described interventions to increase access to GC and GT through mainstreaming or UTS initiatives (S4 Table ). The study designs found were retrospective or prospective cohort studies with concurrent or historical controls (44%) [34, 36, 37, 42-47, 54, 55] or case series that reported on intervention outcomes (56%) [29-33, 35, 38-41, 48, 51-53] (Table 2).…”

Section: Plos Onementioning

confidence: 99%

“…Interventions, setting and framework. The majority of studies used complex interventions (Table 1, S4 Table ) to increase access to GC and GT, either in the routine oncology setting [29][30][31][32][33][34][35][36][37][38][39][40][51][52][53][54][55] or optimizing referral to genetic services for GC and GT [45][46][47] for ovarian or breast cancers and through optimizing access to genetic services after UTS in colorectal and endometrial cancer [39,[41][42][43][44]. The 25 studies spanned a variety of health systems (Table 2) with six studies (24%) included either a quality improvement or process model [35-37, 39, 40] or an implementation science framework [42] to guide implementation.…”

Section: Plos Onementioning

confidence: 99%

“…The implementation strategies used were varied and classified under complex intervention type of education, documentation, interdisciplinary practice or electronic systems domains (Table 1). Twenty studies mapped to Proctor's evaluative framework [21] at the service or client level measuring effectiveness through the outcomes outlined above [29][30][31][32][33][34][35][36][37][38][39][40], [43][44][45][46][51][52][53][54][55] (Table 3). CFIR [22] mapped to implementation process factors through the executing and engaging constructs with five studies using a quality PLOS ONE…”

Section: Increasing Access To Genetic Counselling and Genetic Testing In Routine Oncology For Ovarian And Breast Cancermentioning

confidence: 99%

“…Reducing waits and sometimes harmful delays for both those who receive and those who give care [56,57] • Time to GC or GT [32][33][34][35]52] and results [29,[31][32][33]54] 10/25 (40%)…”

Section: Timelinessmentioning

confidence: 99%

“…Nine studies showed a potential positive effect in favour of the intervention having an impact mainly on GC referral [34,36,38,43,44,46,55] and GC and/or GT completion [34,36,38,43,45,46,55]. Thirteen studies revealed an unclear intervention impact in relation to all outcomes with no comparator presented for assessment [29,31,32,33,35,39,40,47,48,[51][52][53][54].…”

Section: Access To Knowledge and Informationmentioning

confidence: 99%

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Health system interventions to integrate genetic testing in routine oncology services: A systematic review

et al. 2021

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Background Integration of genetic testing into routine oncology care could improve access to testing. This systematic review investigated interventions and the tailored implementation strategies aimed at increasing access to genetic counselling and testing and identifying hereditary cancer in oncology. Methods The search strategy results were reported using the PRISMA statement and four electronic databases were searched. Eligible studies included routine genetic testing for breast and ovarian cancer or uptake after universal tumour screening for colorectal or endometrial cancer. The titles and abstracts were reviewed and the full text articles screened for eligibility. Data extraction was preformed using a designed template and study appraisal was assessed using an adapted Newcastle Ottawa Scale. Extracted data were mapped to Proctor’s et al outcomes and the Consolidated Framework for Implementation Research and qualitatively synthesised. Results Twenty-seven studies, published up to May 2020, met the inclusion criteria. Twenty-five studies ranged from poor (72%), fair to good (28%) quality. Most interventions identified were complex (multiple components) such as; patient or health professional education, interdisciplinary practice and a documentation or system change. Forty-eight percent of studies with complex interventions demonstrated on average a 35% increase in access to genetic counselling and a 15% increase in testing completion. Mapping of study outcomes showed that 70% and 32% of the studies aligned with either the service and client or the implementation level outcome and 96% to the process or inner setting domains of the Consolidated Framework for Implementation Research. Conclusion Existing evidence suggests that complex interventions have a potentially positive effect towards genetic counselling and testing completion rates in oncology services. Studies of sound methodological quality that explore a greater breadth of pre and post implementation outcomes and informed by theory are needed. Such research could inform future service delivery models for the integration of genetics into oncology services.

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Section: Plos Onementioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

Section: Increasing Access To Genetic Counselling and Genetic Testing In Routine Oncology For Ovarian And Breast Cancermentioning

confidence: 99%

“…Reducing waits and sometimes harmful delays for both those who receive and those who give care [56,57] • Time to GC or GT [32][33][34][35]52] and results [29,[31][32][33]54] 10/25 (40%)…”

Section: Timelinessmentioning

confidence: 99%

Section: Access To Knowledge and Informationmentioning

confidence: 99%

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Health system interventions to integrate genetic testing in routine oncology services: A systematic review

et al. 2021

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Following NCCN guidelines within one hospital system in the United States: Comparison between cancer centers and genetic counselor utilization

Powell

Rakestraw

Gupta

et al. 2021

Journal of Genetic Counseling

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Genetic testing is an instrumental tool used to determine whether an individual has a predisposition to certain cancers. Knowing of a hereditary cancer predisposition may allow a patient and their family to consider high-risk screening or risk-reducing options. Genetic counselors work with physicians to identify patients at increased risk for genetic testing using available guidelines such as those provided by the National Comprehensive Cancer Network (NCCN). Information within one hospital system's cancer registry was used to identify individuals who qualify for genetic testing. This includes patients with a history of cancer of the breast (diagnosis ≤45, triple negative (TN) ≤60, and male), ovaries, colon (diagnosis ≤50), or uterus (diagnosis ≤50). Within this hospital system's registry, there are six cancer centers. Data were collected from cancer centers that utilized genetic counselors (GCs), and cancer centers that did not (non-GC) to determine whether there was a difference in genetic testing rates between GC and non-GC cancer centers. An analysis of 695 patients demonstrated a significantly higher proportion of eligible patients undergoing genetic testing at the GC cancer centers than at the non-GC cancer centers (91.6% versus 68.7%, p < .001).Further analysis of specific cancers showed a significantly higher uptake of genetic testing for eligible patients with colon cancer (90.8% versus 50%, p < .001), breast cancer ≤45 (99.5% versus 86%, p < .001), and ovarian cancer (91.3% versus 62.8%, p < .001) at the GC cancer centers than at the non-GC cancer centers. There was no significant difference in the proportion of testing of TN breast cancer ≤60 or uterine cancer ≤50 between cancer centers. These data suggest that having a GC working within a cancer center increases the ability to identify and offer testing to patients who meet NCCN genetic testing criteria based on their cancer type.

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Prevalence and clinical implications of germline mutations among Jordanian patients with ovarian cancer. The Jordanian exploratory cancer genetics (Jo‐ECAG) ovarian study

Abdel‐Razeq

Al-Azzam

Elemian

et al. 2022

Molec Gen & Gen Med

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Background Ovarian cancer is one of the most common gynecological malignancies. Due to the absence of effective screening methods, ovarian cancer is usually diagnosed at late stages. Patients with pathogenic and likely‐pathogenic germline variants (PGVs) in BRCA1 or BRCA2 harbor elevated risk of developing both ovarian and breast cancers. Identifying PGVs may help in both cancer prevention and active disease treatment. Worldwide prevalence of PGVs varies and the matter is poorly addressed among Arab patients. Methods Patients with epithelial ovarian, fallopian tube or primary peritoneal cancers were offered the universal 20 or 84‐multi‐gene panel testing as per standard guidelines. Cascade family screening was also offered to all first and second‐degree relatives of PGV positive patients. Genetic testing was done at a referral lab using a next generation sequencing (NGS)‐based platform. Results During the study period, 152 patients, median age (range): 50 (18–79) years old, were tested. The majority ( n = 100, 65.8%) had high‐grade serous carcinoma, and 106 patients (69.7%) had metastatic disease at presentation. In total, 38 (25.0%) had PGVs, while 47 (30.9%) others had variants of uncertain significance (VUS). PGVs were mostly in BRCA1 ( n = 21, 13.8%) and in BRCA2 ( n = 12, 7.9%), while 6 (3.9%) others had PGVs in non‐ BRCA1/2 genes . PGV rates were significantly higher among 15 patients with a positive family history of ovarian cancer (60.0%, p = .022) and among 52 patients with a positive family history of breast cancer (40.4%, p = .017). Conclusions PGVs are common among Jordanian women with ovarian cancer, and mostly occur in BRCA1/2 . Given its clinical impact on disease prevention and precision therapy, universal testing should be routinely offered.

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Oncologist-led BRCA ‘mainstreaming’ in the ovarian cancer clinic: A study of 255 patients and its impact on their management

Cited by 40 publications

References 22 publications

Health system interventions to integrate genetic testing in routine oncology services: A systematic review

Health system interventions to integrate genetic testing in routine oncology services: A systematic review

Following NCCN guidelines within one hospital system in the United States: Comparison between cancer centers and genetic counselor utilization

Prevalence and clinical implications of germline mutations among Jordanian patients with ovarian cancer. The Jordanian exploratory cancer genetics (Jo‐ECAG) ovarian study

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