Rates of appropriate genetic testing referral for breast cancer patients treated in a multidisciplinary cancer care setting.

2014 ◽  
Vol 32 (26_suppl) ◽  
pp. 45-45 ◽  
Author(s):  
Caitlin Laurel Gomez ◽  
Nicole Ann Dawson ◽  
Robyn Lynn Dvorak ◽  
Nova Foster ◽  
Anne Hoyt ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Genetic Testing ◽  
Family History ◽  
Genetic Counselor ◽  
Newly Diagnosed ◽  
Breast Cancer Patients ◽  
Breast Clinic ◽  
Jewish Ancestry ◽  
The Impact ◽  
Genetics Referral

45 Background: Approximately 5% to 10% of women diagnosed with breast cancer have a genetic predisposition, which can affect management recommendations. The National Comprehensive Cancer Network (NCCN) has established guidelines for genetics referral and testing, however recent publications have indicated low rates of family history documentation and appropriate genetics referral. We sought to assess the impact of standardized family history documentation on rates of appropriate genetics referral in a multidisciplinary breast clinic (MDC) setting. Methods: In advance of MDC consultation, women with newly diagnosed breast cancer complete an intake questionnaire which includes documentation of Ashkenazi Jewish ancestry along with a thorough family history. We retrospectively analyzed family history documentation to inform eligibility for genetic testing and rates of appropriate genetics referral. Results: Between June 2012 and April 2014, 202 women with newly diagnosed, nonmetastatic breast cancer were seen in MDC. We noted 100% compliance with family history documentation. Per NCCN Guidelines, genetic testing was indicated in 52% (106 patients), of which 77% were appropriately referred to a genetic counselor for evaluation. All patients who met criteria based on personal history factors including age ≤ 45, triple-negative disease under age 60, or two or more breast primaries under age 50 were appropriately referred. Patients who were eligible but not referred ranged in age from 46 to 93 and were eligible for testing based on Ashkenzi Jewish ancestry (3 patients) or family history factors including a relative with ovarian cancer (3 patients), ≥2 relatives with breast cancer (5 patients), or a relative with breast cancer < age 50 (7 patients). Conclusions: Compared with recently published national averages, rates of appropriate family history documentation and genetic testing referrals are significantly higher in our MDC setting. However, this analysis has identified significant opportunity for improvement via identification of overlooked referral indications. Initiatives are underway to improve future compliance.

Barriers to genetic testing in newly diagnosed breast cancer patients: Do surgeons limit testing?

2017 ◽  
Vol 214 (1) ◽  
pp. 105-110 ◽  
Author(s):  
Laura Hafertepen ◽  
Alyssa Pastorino ◽  
Nichole Morman ◽  
Jennifer Snow ◽  
Deepa Halaharvi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Genetic Testing ◽  
Cancer Patients ◽  
Newly Diagnosed ◽  
Breast Cancer Patients

Recruiting breast cancer patients for mHealth research: Obstacles to clinic-based recruitment for a mobile phone app intervention study

2020 ◽  
Vol 17 (6) ◽  
pp. 675-683
Author(s):  
Alisha Gupta ◽  
Gabrielle Ocker ◽  
Philip I Chow
Keyword(s):  
Breast Cancer ◽  
Mental Health ◽  
Pilot Study ◽  
Cancer Patients ◽  
Large Scale ◽  
Newly Diagnosed ◽  
Breast Cancer Patients ◽  
Pilot Studies ◽  
Staff Members ◽  
The Impact

Background Nearly half of newly diagnosed breast cancer patients will report clinically significant symptoms of depression and/or anxiety within the first year of diagnosis. Research on the trajectory of distress in cancer patients suggests that targeting patients early in the diagnostic pathway could be particularly impactful. Given the recent rise of smartphone adoption, apps are a convenient and accessible platform from which to deliver mental health support; however, little research has examined their potential impact among newly diagnosed cancer patients. One reason is likely due to the obstacles associated with in-clinic recruitment of newly diagnosed cancer patients for mHealth pilot studies. Methods This article draws from our experiences of a recently completed pilot study to test a suite of mental health apps in newly diagnosed breast cancer patients. Recruitment strategies included in-clinic pamphlets, flyers, and direct communication with clinicians. Surgical oncologists and research staff members approached eligible patients after a medical appointment. Research team members met with patients to provide informed consent and review the study schedule. Results Four domains of in-clinic recruitment challenges emerged: (a) coordination with clinic staff, (b) perceived burden among breast cancer patients, (c) limitations regarding the adoption and use of technology, and (d) availability of resources. Potential solutions are provided for each challenge. Conclusion Recruitment of newly diagnosed cancer patients is a major challenge to conducting mobile intervention studies for researchers on a pilot-study budget. To realize the impact of mobile interventions for the most vulnerable cancer patient populations, health researchers must address barriers to in-clinic recruitment to provide vital preliminary data in proposals of large-scale research projects.

Outcome of interventions to identify family history and risk management for women with breast cancer in the ambulatory setting

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6121-6121
Author(s):  
N. J. Washburn ◽  
S. Simmons ◽  
V. Sommer ◽  
B. Adkins ◽  
P. Gerken ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Management ◽  
Family History ◽  
Genetic Counselor ◽  
Management Tool ◽  
Ambulatory Setting ◽  
Cancer Center ◽  
Breast Cancer Patients ◽  
Family History Questionnaire ◽  
Level 1

6121 Background: In 2002, Kansas City Cancer Center (KCCC) performed a quality improvement (QI) project to evaluate how breast cancer patients were being assessed for family history and cancer risk management. A self-administered family history questionnaire was developed to improve the thoroughness of family history collected and education of clinicians was completed to improve the recognition of risk factors based on ASCO guidelines. Methods: Chart audits on 210 women with breast cancer at KCCC, were completed in the second quarter of 2005. All patients were under the age of 65, not undergoing chemotherapy. A risk management tool was developed. Scoring criteria for 2002 was replicated in 2005 as listed in the table . Results: In 2002, 171 pts (89%) had level 1 or 2 family history assessed compared to 207 pts (99%) in 2005, p<0.0001. In 2002, 47% had 3 generations assessed compared to 84% in 2005, p<0.0001. In 2002 and 2005, some risk factor management occurred in both groups, and was equal, 78% and 80% respectively (p=ns). Of those that had risk management 33% had level 1 in 2002 compared to 3% in 2005 (p<0.0001) a 91% reduction in identifying risk without subsequent management. In 2002, 58% had level 2, compared to 71% in 2005 (p=0.02) a 23% improvement in identification & management of risk. In 2002, 9% had level 3 compared to 26% in 2005 (p<0.0001) a 183% improvement in patients with a detailed risk assessment and/or genetic referral. Conclusions: By improving the assessment of family history and education of providers, women with breast cancer are receiving more information to reduce their risk for recurrence and complications. Patients who were identified as high risk for BRCA1 or BRCA2 mutations were referred to either a nurse practitioner or genetic counselor. [Table: see text] No significant financial relationships to disclose.

Mutation analysis of PALB2 in high-risk and lower-risk patients negative for BRCA1 and BRCA2 mutations.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 30-30
Author(s):  
Shelly Cummings ◽  
Jenny Peterson ◽  
Elisha Hughes ◽  
Rajesh R. Kaldate ◽  
Sonia Chen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Genetic Testing ◽  
Family History ◽  
High Risk ◽  
Cancer Patients ◽  
Lower Risk ◽  
Risk Group ◽  
Breast Cancer Patients ◽  
Brca1 And Brca2 ◽  
Palb2 Mutation

30 Background: PALB2 has been identified as a breast cancer susceptibility gene conferring ~ 2-4 fold increased risk of breast cancer. A number of studies have estimated the PALB2 mutation prevalence to range from 0.5% - 2.9% in populations of breast cancer patients. We performed an analysis to determine the PALB2 mutation prevalence in a large U.S. referral testing population. Methods: DNA samples were anonymized from two subsets of patients: 955 early onset breast cancer patients with severe family history, and 524 patients with later onset of breast cancer and/or less severe family history. All patients were negative for deleterious sequence mutations or large rearrangements in BRCA1 and BRCA2. Results: We identified 10 disease associated PALB2 mutations in the high risk group of 955 patients and 2 deleterious PALB2 mutations in the lower risk group of 524 patients. Identified PALB2 mutations included 8 nonsense, 3 frameshift mutations and a splice site mutation. The mutation prevalence for the high risk population was 1.05% (95% C.I., 0.5 -1.92) whereas that for the lower risk population was 0.38% (95% C.I., 0.05-1.37). The observed rate of PALB2 variants of unknown significance (VUS) identified in this study was ~5% (78 VUS were in 75 of the 1479 patients that were tested). Our variant classification program which successfully decreased the VUS rate in BRCA1 and BRCA2 is similarly expected to enhance mutation classification on an on-going basis for PALB2 genetic testing. Conclusions: Genetic testing for PALB2 may be indicated as a reflex test for breast cancer patients who test negative for BRCA1 and BRCA2.

Multidisciplinary breast clinic: Impact on patient satisfaction, timeliness, and guideline concordant care.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 124-124 ◽  
Author(s):  
Caitlin Laurel Gomez ◽  
Nicole Ann Dawson ◽  
Robyn Lynn Dvorak ◽  
Nova Foster ◽  
Anne Hoyt ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Patient Satisfaction ◽  
Adjuvant Chemotherapy ◽  
Metastatic Breast ◽  
Team Approach ◽  
Adjuvant Radiation ◽  
Newly Diagnosed ◽  
Care Coordinator ◽  
Breast Clinic ◽  
The Impact

124 Background: After recent implementation of a multidisciplinary breast clinic (MDC) for newly diagnosed women at our institution, we sought to examine the impact of MDC on patient satisfaction, timeliness and guideline concordant care. Methods: Women with newly diagnosed breast cancer at our institution are referred to MDC where they are seen by a team of breast specialists for initial consultation. The MDC model is further facilitated by a patient navigator/coordinator who serves as a single point of contact across disciplines and through the continuum of care. We deployed patient satisfaction surveys querying helpfulness of the care coordinator and satisfaction with seeing breast cancer specialty physicians together in one visit. We further retrospectively analyzed timeliness of care and guideline concordant care since MDC implementation. Results: Patient satisfaction survey response rate was 42% (n=133).On a scale of 1 (very poor) – 5 (excellent), 93% of respondents rated helpfulness of care coordinator as excellent and seeing specialty physicians together in one visit as excellent. 99% of respondents rated these factors as either excellent (5) or good (4). Regarding timeliness, among 202 women with newly diagnosed, non-metastatic breast cancer seen in MDC between June 2012 and April 2014, mean time from neoadjuvant chemotherapy to surgery was 43.1 days (range 26-78 days), from surgery to adjuvant radiation was 39.2 days (range 22-79 days), from surgery to adjuvant chemotherapy was 40.6 days (range 19-89 days), and from adjuvant chemotherapy to radiation was 34.9 days (range 13-67 days). All timeliness metrics well exceeded established national standards of 60-90 days. Regarding guideline concordant care, 94% and 90% respectively received indicated radiation therapy and chemotherapy in accordance with National Comprehensive Cancer Network (NCCN) Guidelines. Those not receiving guideline concordant care either declined, were of advanced age, or had prohibitive co-morbidities. Conclusions: The MDC model, which emphasizes care coordination via a team approach and patient navigation, is associated with excellent patient satisfaction and timely, guideline concordant breast cancer care.

Gaps in integrating genetic testing into management of breast cancer.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 160-160 ◽  
Author(s):  
Steven J. Katz ◽  
Sarah T. Hawley ◽  
Reshma Jagsi ◽  
Allison W. Kurian
Keyword(s):  
Breast Cancer ◽  
Genetic Testing ◽  
Los Angeles ◽  
Genetic Counselor ◽  
Private Insurance ◽  
Pathogenic Mutation ◽  
Average Risk ◽  
Breast Cancer Patients ◽  
Unilateral Breast Cancer ◽  
Wide Variability

160 Background: Genetic testing for breast cancer risk is evolving rapidly, with surging use of multiple-gene panels. However, little is known about the extent to which testing is effectively integrated into management after diagnosis of breast cancer. Methods: A population-based sample of 3930 patients diagnosed with breast cancer in 2014-15 and identified by two SEER registries (Georgia and Los Angeles) were sent surveys 2 months after surgery and responses merged to SEER data. A subgroup at higher pre-test risk of pathogenic mutation carriage (vs average risk) was defined according to testing guidelines. Results: Among 2502 eligible patients with unilateral breast cancer (response rate 70%), 666 (27%) reported genetic testing. The Table shows wide variability in patient report of which professional ordered the test and discussed the results. Few (18-21%) patients had testing ordered by a genetic counselor and approximately half (57% high-risk, 42% average-risk) discussed results with one. One third of patient received testing after they had surgery. In a multivariable model adjusted for age, race, education, pre-test risk of mutation carriage, stage, co-morbidities and study site, the only factor significantly associated with delayed testing was insurance status: Compared to private insurance, patients were more likely to be tested after surgery if they had Medicare (OR 2.1, 95% CI 1.1-4.2) or no insurance (OR 3.0, CI 1.6-5.3). Conclusions: There is wide variability in which professionals order genetic testing and discuss results. Many breast cancer patients who receive genetic testing never see a genetic counselor. Many patients do not get tested early enough to consider the results in surgery management. These findings suggest enormous challenges in personalizing communication about genetic testing after diagnosis of breast cancer. [Table: see text]

scholarly journals Gaps in Incorporating Germline Genetic Testing Into Treatment Decision-Making for Early-Stage Breast Cancer

2017 ◽  
Vol 35 (20) ◽  
pp. 2232-2239 ◽  
Author(s):  
Allison W. Kurian ◽  
Yun Li ◽  
Ann S. Hamilton ◽  
Kevin C. Ward ◽  
Sarah T. Hawley ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Genetic Testing ◽  
Los Angeles ◽  
Early Stage ◽  
Genetic Counselor ◽  
Private Insurance ◽  
Bilateral Mastectomy ◽  
Average Risk ◽  
Pathogenic Mutations ◽  
The Impact

Purpose Genetic testing for breast cancer risk is evolving rapidly, with growing use of multiple-gene panels that can yield uncertain results. However, little is known about the context of such testing or its impact on treatment. Methods A population-based sample of patients with breast cancer diagnosed in 2014 to 2015 and identified by two SEER registries (Georgia and Los Angeles) were surveyed about genetic testing experiences (N = 3,672; response rate, 68%). Responses were merged with SEER data. A patient subgroup at higher pretest risk of pathogenic mutation carriage was defined according to genetic testing guidelines. Patients’ attending surgeons were surveyed about genetic testing and results management. We examined patterns and correlates of genetic counseling and testing and the impact of results on bilateral mastectomy (BLM) use. Results Six hundred sixty-six patients reported genetic testing. Although two thirds of patients were tested before surgical treatment, patients without private insurance more often experienced delays. Approximately half of patients (57% at higher pretest risk, 42% at average risk) discussed results with a genetic counselor. Patients with pathogenic mutations in BRCA1/2 or another gene had the highest rates of BLM (higher risk, 80%; average risk, 85%); however, BLM was also common among patients with genetic variants of uncertain significance (VUS; higher risk, 43%; average risk, 51%). Surgeons’ confidence in discussing testing increased with volume of patients with breast cancer, but many surgeons (higher volume, 24%; lower volume, 50%) managed patients with BRCA1/2 VUS the same as patients with BRCA1/2 pathogenic mutations. Conclusion Many patients with breast cancer are tested without ever seeing a genetic counselor. Half of average-risk patients with VUS undergo BLM, suggesting a limited understanding of results that some surgeons share. These findings emphasize the need to address challenges in personalized communication about genetic testing.

scholarly journals The impact of COVID-19 pandemic on the rate of newly diagnosed gynecological and breast cancers: a tertiary center perspective

2021 ◽  
Author(s):  
Katharina Knoll ◽  
Elisabeth Reiser ◽  
Katharina Leitner ◽  
Johanna Kögl ◽  
Christoph Ebner ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Gynecological Cancer ◽  
Performance Status ◽  
Tumor Stage ◽  
Breast Cancers ◽  
Newly Diagnosed ◽  
Breast Cancer Patients ◽  
Tertiary Center ◽  
The Impact

Abstract Purpose The aim of the present study was to assess the impact of postponed screening examinations and lockdown measures on gynecological and breast cancer diagnoses throughout the year 2020 in a gynecological oncological center in Austria. Methods Data of 889 patients with either newly diagnosed gynecological or breast cancer between January 2019 and December 2020 were collected. Clinical parameters including symptoms, performance status, comorbidities and referral status were compared in patients, who were newly diagnosed with cancer in the period of the first lockdown from March 2020 to April 2020 and the second lockdown from November 2020 to December 2020 and compared to the same period in 2019. Results Our results showed a strong decline in newly diagnosed cancers during the lockdown periods: −45% in gynecological cancer and -52% in breast cancer compared to the same period in 2019. Compared to the analogue period of 2019, breast cancer patients reported significantly more tumor-associated symptoms (55% vs. 31%, p = 0.013) during and in between (48% vs. 32%, p = 0.022) the lockdowns. During the lockdown, periods in the group of breast cancer patients’ tumor stage varied significantly compared to 2019 (T2–T4; p = 0.047). Conclusion Both lockdowns led to a strong decrease in newly diagnosed gynecological and breast cancers. Treatment delays in potentially curable disease could lead to inferior clinical outcomes, with the risk of missing the optimal treatment window. As the COVID-19 pandemic will be a challenge for some time to come, new strategies in patient care are needed to optimize cancer screening and management during the pandemic.

scholarly journals The Impact of COVID-19 Pandemic on Gynecological and Breast Cancer Detection Rate: A Tertiary Center Perspective.

2021 ◽  
Author(s):  
Katharina Knoll ◽  
Elisabeth Reiser ◽  
Katharina Leitner ◽  
Johanna Kögl ◽  
Christoph Ebner ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Cancer Detection ◽  
Detection Rate ◽  
Cancer Detection Rate ◽  
Breast Cancer Detection ◽  
Newly Diagnosed ◽  
Breast Cancer Patients ◽  
Tertiary Center ◽  
The Impact

Abstract Purpose: The aim of the present study was to assess the impact of postponed screening examinations and lockdown measures on gynecological and breast cancer detection rate throughout the year 2020 in a gynecological oncological center in Austria.Methods: Data of 889 patients with either newly diagnosed gynecological or breast cancer between January 2019 and December 2020 were collected. Clinical parameters including symptoms, performance status, comorbidities and referral status were compared in patients, who were newly diagnosed with cancer in the period of the first lockdown from March 2020 – April 2020 and the second lockdown from November 2020 – December 2020 and compared to the same period in 2019.Results: Our results showed a strong decline in newly diagnosed cancers during the lockdown periods: -45% in gynecological cancer and -52% in breast cancer compared to the same period in 2019. Compared to the analogue period of 2019, breast cancer patients reported significantly more tumor-associated symptoms (55% versus 31%, p=0.013) during and in between (48% versus 32%, p=0.022) the lockdowns. During the lockdown periods breast cancer patients were diagnosed with a significantly higher tumor-stage (T2-T4; p=0.047).Conclusion: Both lockdowns led to a strong decrease in newly diagnosed gynecological and breast cancers. Treatment delays in potentially curable disease could lead to inferior clinical outcomes, with the risk of missing the optimal treatment window. As the COVID-19 pandemic will be a challenge for some time to come, new strategies in patient care are needed to optimize cancer screening and management during the pandemic.

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