Details

Autor(en) / Beteiligte

• Chittenden, Anu
• Haraldsdottir, Sigurdis
• Ukaegbu, Chinedu
• Underhill-Blazey, Meghan
• Gaonkar, Shraddha
• Uno, Hajime
• Brais, Lauren K
• Perez, Kimberly
• Wolpin, Brian M
• Syngal, Sapna
• Yurgelun, Matthew B

Titel

Implementing Systematic Genetic Counseling and Multigene Germline Testing for Individuals With Pancreatic Cancer

Ist Teil von

• JCO oncology practice, 2021-02, Vol.17 (2), p.e236-e247

Ort / Verlag

United States: American Society of Clinical Oncology

Erscheinungsjahr

2021

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• 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. 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). 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% 38.0%, < .001), including those undergoing multigene germline testing (MGT) ≤ 7 days of initial oncology evaluation (14.7% 60.3%, < .001), with preserved pathogenic variant detection rates (10.0% 11.2%, = 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. 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.