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McGill BC, Wakefield CE, Tucker KM, Daly RA, Donoghoe MW, Vetsch J, Warby M, Fuentes‐Bolanos NA, Barlow‐Stewart K, Kirk J, Courtney E, O’Brien TA, Marshall GM, Pinese M, Cowley MJ, Tyrrell V, Deyell RJ, Ziegler DS, Hetherington K. Parents' expectations, preferences, and recall of germline findings in a childhood cancer precision medicine trial. Cancer 2023; 129:3620-3632. [PMID: 37382186 PMCID: PMC10952780 DOI: 10.1002/cncr.34917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 04/17/2023] [Accepted: 05/15/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Germline genome sequencing in childhood cancer precision medicine trials may reveal pathogenic or likely pathogenic variants in cancer predisposition genes in more than 10% of children. These findings can have implications for diagnosis, treatment, and the child's and family's future cancer risk. Understanding parents' perspectives of germline genome sequencing is critical to successful clinical implementation. METHODS A total of 182 parents of 144 children (<18 years of age) with poor-prognosis cancers enrolled in the Precision Medicine for Children with Cancer trial completed a questionnaire at enrollment and after the return of their child's results, including clinically relevant germline findings (received by 13% of parents). Parents' expectations of germline genome sequencing, return of results preferences, and recall of results received were assessed. Forty-five parents (of 43 children) were interviewed in depth. RESULTS At trial enrollment, most parents (63%) believed it was at least "somewhat likely" that their child would receive a clinically relevant germline finding. Almost all expressed a preference to receive a broad range of germline genomic findings, including variants of uncertain significance (88%). Some (29%) inaccurately recalled receiving a clinically relevant germline finding. Qualitatively, parents expressed confusion and uncertainty after the return of their child's genome sequencing results by their child's clinician. CONCLUSIONS Many parents of children with poor-prognosis childhood cancer enrolled in a precision medicine trial expect their child may have an underlying cancer predisposition syndrome. They wish to receive a wide scope of information from germline genome sequencing but may feel confused by the reporting of trial results.
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Wakefield CE, Hetherington K, Robertson EG, Donoghoe MW, Hunter JD, Vetsch J, Marron JM, Tucker KM, Marshall GM, Broom A, Haber M, Tyrrell V, Malkin D, Lau L, Mateos MK, O'Brien TA, Ziegler DS. Hopes, concerns, satisfaction and regret in a precision medicine trial for childhood cancer: a mixed-methods study of parent and patient perspectives. Br J Cancer 2023; 129:1634-1644. [PMID: 37726477 PMCID: PMC10645918 DOI: 10.1038/s41416-023-02429-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Paediatric precision oncology aims to match therapeutic agents to driver gene targets. We investigated whether parents and patients regret participation in precision medicine trials, particularly when their hopes are unfulfilled. METHODS Parents and adolescent patients completed questionnaires at trial enrolment (T0) and after receiving results (T1). Parents opted-in to an interview at T1. Bereaved parents completed a questionnaire 6-months post-bereavement (T1B). We analysed quantitative data with R and qualitative data thematically with NVivo, before integrating all data for interpretation. RESULTS 182 parents and 23 patients completed T0; 108/182 parents and 8/23 patients completed T1; 27/98 bereaved parents completed T1B; and 45/108 parents were interviewed. At enrolment, participants held concurrent hopes that precision medicine would benefit future children and their child. Participants expressed concern regarding wait-times for receipt of results. Most participants found the trial beneficial and not burdensome, including bereaved parents. Participants reported high trial satisfaction (median scores: parents: 93/100; patients: 80/100). Participants expressed few regrets (parent median scores: parents: 10/100; bereaved parents: 15/100; patient regret: 2/8 expressed minimal regret). CONCLUSIONS Even when trial outcomes did not match their hopes, parents and patients rarely regretted participating in a childhood cancer precision medicine trial. These data are critical for integrating participants' views into future precision medicine delivery.
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Affiliation(s)
- Claire E Wakefield
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, NSW, Australia.
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia.
| | - Kate Hetherington
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia
| | - Eden G Robertson
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia
| | - Mark W Donoghoe
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia
- Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, Sydney, NSW, Australia
- Clinical Research Unit, UNSW Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Jacqueline D Hunter
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Janine Vetsch
- Department of Health, Institute of Applied Nursing Science, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland
| | - Jonathan M Marron
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
- Center for Bioethics, Harvard Medical School, Boston, MA, USA
| | - Katherine M Tucker
- Department of Medical Oncology, Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
- Prince of Wales Clinical School, UNSW Sydney, Sydney, 2052, NSW, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia
| | - Glenn M Marshall
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia
- Children's Cancer Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Alexander Broom
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Michelle Haber
- Children's Cancer Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Vanessa Tyrrell
- Children's Cancer Institute, UNSW Sydney, Sydney, NSW, Australia
| | - David Malkin
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
- Departments of Pediatrics and Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Loretta Lau
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia
- Children's Cancer Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Marion K Mateos
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia
- Children's Cancer Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Tracey A O'Brien
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia
- Children's Cancer Institute, UNSW Sydney, Sydney, NSW, Australia
| | - David S Ziegler
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia
- Children's Cancer Institute, UNSW Sydney, Sydney, NSW, Australia
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Davidson AL, Dressel U, Norris S, Canson DM, Glubb DM, Fortuno C, Hollway GE, Parsons MT, Vidgen ME, Holmes O, Koufariotis LT, Lakis V, Leonard C, Wood S, Xu Q, McCart Reed AE, Pickett HA, Al-Shinnag MK, Austin RL, Burke J, Cops EJ, Nichols CB, Goodwin A, Harris MT, Higgins MJ, Ip EL, Kiraly-Borri C, Lau C, Mansour JL, Millward MW, Monnik MJ, Pachter NS, Ragunathan A, Susman RD, Townshend SL, Trainer AH, Troth SL, Tucker KM, Wallis MJ, Walsh M, Williams RA, Winship IM, Newell F, Tudini E, Pearson JV, Poplawski NK, Mar Fan HG, James PA, Spurdle AB, Waddell N, Ward RL. The clinical utility and costs of whole-genome sequencing to detect cancer susceptibility variants-a multi-site prospective cohort study. Genome Med 2023; 15:74. [PMID: 37723522 PMCID: PMC10507925 DOI: 10.1186/s13073-023-01223-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 08/18/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Many families and individuals do not meet criteria for a known hereditary cancer syndrome but display unusual clusters of cancers. These families may carry pathogenic variants in cancer predisposition genes and be at higher risk for developing cancer. METHODS This multi-centre prospective study recruited 195 cancer-affected participants suspected to have a hereditary cancer syndrome for whom previous clinical targeted genetic testing was either not informative or not available. To identify pathogenic disease-causing variants explaining participant presentation, germline whole-genome sequencing (WGS) and a comprehensive cancer virtual gene panel analysis were undertaken. RESULTS Pathogenic variants consistent with the presenting cancer(s) were identified in 5.1% (10/195) of participants and pathogenic variants considered secondary findings with potential risk management implications were identified in another 9.7% (19/195) of participants. Health economic analysis estimated the marginal cost per case with an actionable variant was significantly lower for upfront WGS with virtual panel ($8744AUD) compared to standard testing followed by WGS ($24,894AUD). Financial analysis suggests that national adoption of diagnostic WGS testing would require a ninefold increase in government annual expenditure compared to conventional testing. CONCLUSIONS These findings make a case for replacing conventional testing with WGS to deliver clinically important benefits for cancer patients and families. The uptake of such an approach will depend on the perspectives of different payers on affordability.
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Affiliation(s)
- Aimee L Davidson
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston QLD 4006, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Uwe Dressel
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Sarah Norris
- Faculty of Medicine and Health, University of Sydney, L2.22 The Quadrangle (A14), Sydney, NSW, 2006, Australia
| | - Daffodil M Canson
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston QLD 4006, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Dylan M Glubb
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston QLD 4006, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Cristina Fortuno
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston QLD 4006, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Georgina E Hollway
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston QLD 4006, Brisbane, QLD, Australia
| | - Michael T Parsons
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston QLD 4006, Brisbane, QLD, Australia
| | - Miranda E Vidgen
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston QLD 4006, Brisbane, QLD, Australia
- Australian Genomics, Melbourne, VIC, Australia
| | - Oliver Holmes
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston QLD 4006, Brisbane, QLD, Australia
| | - Lambros T Koufariotis
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston QLD 4006, Brisbane, QLD, Australia
| | - Vanessa Lakis
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston QLD 4006, Brisbane, QLD, Australia
| | - Conrad Leonard
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston QLD 4006, Brisbane, QLD, Australia
| | - Scott Wood
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston QLD 4006, Brisbane, QLD, Australia
| | - Qinying Xu
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston QLD 4006, Brisbane, QLD, Australia
| | - Amy E McCart Reed
- Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia
| | - Hilda A Pickett
- Children's Medical Research Institute, University of Sydney, Westmead, NSW, Australia
| | - Mohammad K Al-Shinnag
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Rachel L Austin
- Australian Genomics, Melbourne, VIC, Australia
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Jo Burke
- Tasmanian Clinical Genetics Service, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Elisa J Cops
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Cassandra B Nichols
- Genetic Services of Western Australia, King Edward Memorial Hospital, Subiaco, WA, Australia
| | - Annabel Goodwin
- Cancer Genetics Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
| | - Marion T Harris
- Monash Health Familial Cancer, Monash Health, Melbourne, VIC, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Megan J Higgins
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Emilia L Ip
- Cancer Genetics, Liverpool Hospital, Sydney, NSW, Australia
| | | | - Chiyan Lau
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Genomics, Pathology Queensland, Brisbane, QLD, Australia
| | - Julia L Mansour
- Tasmanian Clinical Genetics Service, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Michael W Millward
- Tasmanian Clinical Genetics Service, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Melissa J Monnik
- Adult Genetics Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Nicholas S Pachter
- Genetic Services of Western Australia, King Edward Memorial Hospital, Subiaco, WA, Australia
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
| | - Abiramy Ragunathan
- Familial Cancer Services, The Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, NSW, Australia
| | - Rachel D Susman
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Sharron L Townshend
- Genetic Services of Western Australia, King Edward Memorial Hospital, Subiaco, WA, Australia
| | - Alison H Trainer
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Simon L Troth
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Katherine M Tucker
- Prince of Wales Clinical School, UNSW Medicine and Health, The University of New South Wales, Sydney, NSW, Australia
- Hereditary Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Mathew J Wallis
- Tasmanian Clinical Genetics Service, Royal Hobart Hospital, Hobart, TAS, Australia
- School of Medicine and Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Maie Walsh
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Rachel A Williams
- Prince of Wales Clinical School, UNSW Medicine and Health, The University of New South Wales, Sydney, NSW, Australia
- Hereditary Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Ingrid M Winship
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
- Genomic Medicine and Familial Cancer Clinic, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Felicity Newell
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston QLD 4006, Brisbane, QLD, Australia
| | - Emma Tudini
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston QLD 4006, Brisbane, QLD, Australia
- Australian Genomics, Melbourne, VIC, Australia
| | - John V Pearson
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston QLD 4006, Brisbane, QLD, Australia
| | - Nicola K Poplawski
- Adult Genetics Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Helen G Mar Fan
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Paul A James
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Amanda B Spurdle
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston QLD 4006, Brisbane, QLD, Australia.
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
| | - Nicola Waddell
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston QLD 4006, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Robyn L Ward
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
- Faculty of Medicine and Health, University of Sydney, L2.22 The Quadrangle (A14), Sydney, NSW, 2006, Australia.
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4
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Daly R, Hetherington K, Hazell E, Wadling BR, Tyrrell V, Tucker KM, Marshall GM, Ziegler DS, Lau LMS, Trahair TN, O'Brien TA, Collins K, Gifford AJ, Haber M, Pinese M, Malkin D, Cowley MJ, Karpelowsky J, Drew D, Jacobs C, Wakefield CE. Precision Medicine Is Changing the Roles of Healthcare Professionals, Scientists, and Research Staff: Learnings from a Childhood Cancer Precision Medicine Trial. J Pers Med 2023; 13:1033. [PMID: 37511646 PMCID: PMC10381580 DOI: 10.3390/jpm13071033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
Precision medicine programs aim to utilize novel technologies to identify personalized treatments for children with cancer. Delivering these programs requires interdisciplinary efforts, yet the many groups involved are understudied. This study explored the experiences of a broad range of professionals delivering Australia's first precision medicine trial for children with poor-prognosis cancer: the PRecISion Medicine for Children with Cancer (PRISM) national clinical trial of the Zero Childhood Cancer Program. We conducted semi-structured interviews with 85 PRISM professionals from eight professional groups, including oncologists, surgeons, clinical research associates, scientists, genetic professionals, pathologists, animal care technicians, and nurses. We analyzed interviews thematically. Professionals shared that precision medicine can add complexity to their role and result in less certain outcomes for families. Although many participants described experiencing a greater emotional impact from their work, most expressed very positive views about the impact of precision medicine on their profession and its future potential. Most reported navigating precision medicine without formal training. Each group described unique challenges involved in adapting to precision medicine in their profession. Addressing training gaps and meeting the specific needs of many professional groups involved in precision medicine will be essential to ensure the successful implementation of standard care.
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Affiliation(s)
- Rebecca Daly
- Discipline of Pediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW 2031, Australia
| | - Kate Hetherington
- Discipline of Pediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW 2031, Australia
| | - Emily Hazell
- Discipline of Pediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW 2031, Australia
- Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Bethany R Wadling
- Discipline of Pediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW 2031, Australia
- Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Vanessa Tyrrell
- Discipline of Pediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW 2052, Australia
- Children's Cancer Institute, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Katherine M Tucker
- Hereditary Cancer Centre, Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW 2031, Australia
- Prince of Wales Clinical School, UNSW Sydney, Randwick, NSW 2031, Australia
| | - Glenn M Marshall
- Discipline of Pediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW 2052, Australia
- Children's Cancer Institute, UNSW Sydney, Sydney, NSW 2052, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW 2031, Australia
| | - David S Ziegler
- Discipline of Pediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW 2052, Australia
- Children's Cancer Institute, UNSW Sydney, Sydney, NSW 2052, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW 2031, Australia
| | - Loretta M S Lau
- Discipline of Pediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW 2052, Australia
- Children's Cancer Institute, UNSW Sydney, Sydney, NSW 2052, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW 2031, Australia
| | - Toby N Trahair
- Discipline of Pediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW 2052, Australia
- Children's Cancer Institute, UNSW Sydney, Sydney, NSW 2052, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW 2031, Australia
| | - Tracey A O'Brien
- Discipline of Pediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW 2052, Australia
- Children's Cancer Institute, UNSW Sydney, Sydney, NSW 2052, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW 2031, Australia
| | - Kiri Collins
- Children's Cancer Institute, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Andrew J Gifford
- Discipline of Pediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW 2052, Australia
- Children's Cancer Institute, UNSW Sydney, Sydney, NSW 2052, Australia
- Anatomical Pathology, NSW Health Pathology, Prince of Wales Hospital, Randwick, NSW 2031, Australia
| | - Michelle Haber
- Children's Cancer Institute, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Mark Pinese
- Discipline of Pediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW 2052, Australia
- Children's Cancer Institute, UNSW Sydney, Sydney, NSW 2052, Australia
| | - David Malkin
- Division of Haematology/Oncology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Mark J Cowley
- Discipline of Pediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW 2052, Australia
- Children's Cancer Institute, UNSW Sydney, Sydney, NSW 2052, Australia
- Kinghorn Centre for Clinical Genomics, Garvan Institute, Darlinghurst, NSW 2010, Australia
| | - Jonathan Karpelowsky
- Department of Paediatric Surgery, Children's Hospital at Westmead, Westmead, NSW 2145, Australia
- Children's Cancer Research Unit, Kids Research Institute, Children's Hospital at Westmead, Westmead, NSW 2145, Australia
- Division of Child and Adolescent Health, University of Sydney, Sydney, NSW 2145, Australia
| | - Donna Drew
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW 2031, Australia
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Claire E Wakefield
- Discipline of Pediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW 2031, Australia
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O’Shea R, Crook A, Jacobs C, Kentwell M, Gleeson M, Tucker KM, Hampel H, Rahm AK, Taylor N, Lewis S, Rankin NM. A mainstreaming oncogenomics model: improving the identification of Lynch syndrome. Front Oncol 2023; 13:1140135. [PMID: 37305562 PMCID: PMC10256118 DOI: 10.3389/fonc.2023.1140135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/24/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction "Mainstreaming" is a proposed strategy to integrate genomic testing into oncology. The aim of this paper is to develop a mainstreaming oncogenomics model by identifying health system interventions and implementation strategies for mainstreaming Lynch syndrome genomic testing. Methods A rigorous theoretical approach inclusive of conducting a systematic review and qualitative and quantitative studies was undertaken using the Consolidated Framework for Implementation Research. Theory-informed implementation data were mapped to the Genomic Medicine Integrative Research framework to generate potential strategies. Results The systematic review identified a lack of theory-guided health system interventions and evaluation for Lynch syndrome and other mainstreaming programs. The qualitative study phase included 22 participants from 12 health organizations. The quantitative Lynch syndrome survey included 198 responses: 26% and 66% from genetic and oncology health professionals, respectively. Studies identified the relative advantage and clinical utility of mainstreaming to improve genetic test access and to streamline care, and adaptation of current processes was recognized for results delivery and follow-up. Barriers identified included funding, infrastructure and resources, and the need for process and role delineation. The interventions to overcome barriers were as follows: embedded mainstream genetic counselors, electronic medical record genetic test ordering, results tracking, and mainstreaming education resources. Implementation evidence was connected through the Genomic Medicine Integrative Research framework resulting in a mainstreaming oncogenomics model. Discussion The proposed mainstreaming oncogenomics model acts as a complex intervention. It features an adaptable suite of implementation strategies to inform Lynch syndrome and other hereditary cancer service delivery. Implementation and evaluation of the model are required in future research.
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Affiliation(s)
- Rosie O’Shea
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Ashley Crook
- Discipline of Genetic Counselling, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Chris Jacobs
- Discipline of Genetic Counselling, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Maira Kentwell
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Oncology, Royal Women’s Hospital, Parkville, VIC, Australia
| | - Margaret Gleeson
- Hunter Genetics, Hunter Family Cancer Service, Newcastle, NSW, Australia
| | | | - Heather Hampel
- Division of Clinical Cancer Genomics, Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | | | - Natalie Taylor
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
| | - Sarah Lewis
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Nicole M. Rankin
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Melbourne School of Population and Global Health, Melbourne University, Melbourne, VIC, Australia
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6
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Young AL, Imran A, Spoelma MJ, Williams R, Tucker KM, Halliday J, Forrest LE, Wakefield CE, Butow PN. Proband-mediated interventions to increase disclosure of genetic risk in families with a BRCA or Lynch syndrome condition: a systematic review. Eur J Hum Genet 2023; 31:18-34. [PMID: 36253533 PMCID: PMC9822896 DOI: 10.1038/s41431-022-01200-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 08/19/2022] [Accepted: 09/20/2022] [Indexed: 02/08/2023] Open
Abstract
Interventions to assist family communication about inherited cancer risk have the potential to improve family cancer outcomes. This review aimed to evaluate the efficacy of proband-mediated interventions employed within genetics clinics to increase disclosure of genetic risk to at-risk relatives. MEDLINE, Embase, CINAHL, PubMed and PsycINFO were searched for publications between 1990-2020. The quality of studies was assessed. From 5605 records reviewed, 9 studies (4 randomised control trials and 5 cohort studies) were included involving families with BRCA1, BRCA2 and Lynch syndrome. Intervention delivery modes included genetic counselling with additional telephone or in-person follow-up, letters, videos, and decision aids. The percentages of at-risk relatives informed by the proband about their risk ranged from 54.0% to 95.5% in the intervention or family-mediated comparison group. Of those who were informed, 24.4-60.0% contacted a genetics clinic and 22.8-76.2% had genetic testing after they were counselled at a genetics clinic. Significant differences between intervention and control group were reported on all three outcomes by one study, and with relatives contacting a genetics clinic by another study. The studies suggest but do not conclusively show, that tailored genetic counselling with additional follow-up can increase both the proportion of informed relatives and relatives who contact the genetics clinic. With the increase in germline testing, interventions are required to consider the family communication process and address post-disclosure variables (e.g., relative's perceptions, emotional reactions) through engagement with probands and relatives to maximise the public health benefit of identifying inherited cancer risk in families.
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Affiliation(s)
- Alison Luk Young
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, Callaghan, NSW Australia
| | - Aalya Imran
- grid.412703.30000 0004 0587 9093Division of Obstetrics and Gynaecology, Royal North Shore Hospital, Sydney, NSW Australia
| | - Michael J. Spoelma
- grid.1005.40000 0004 4902 0432Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW Australia
| | - Rachel Williams
- grid.1005.40000 0004 4902 0432Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Randwick, NSW Australia ,grid.415193.bPrince of Wales Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW Australia
| | - Katherine M. Tucker
- grid.1005.40000 0004 4902 0432Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Randwick, NSW Australia ,grid.415193.bPrince of Wales Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW Australia
| | - Jane Halliday
- grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Parkville, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, University of Melbourne, Parkville, VIC Australia
| | - Laura E. Forrest
- grid.1055.10000000403978434Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC Australia
| | - Claire E. Wakefield
- grid.1005.40000 0004 4902 0432School of Women’s and Children’s Health, Faculty of Medicine and Health, UNSW, Sydney, NSW Australia ,grid.414009.80000 0001 1282 788XBehavioral Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW Australia
| | - Phyllis N. Butow
- grid.1013.30000 0004 1936 834XSchool of Psychology, The University of Sydney, Sydney, NSW Australia
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7
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Gereis J, Hetherington K, Ha L, Robertson EG, Ziegler DS, Barlow-Stewart K, Tucker KM, Marron JM, Wakefield CE. Parents' understanding of genome and exome sequencing for pediatric health conditions: a systematic review. Eur J Hum Genet 2022; 30:1216-1225. [PMID: 35999452 PMCID: PMC9626631 DOI: 10.1038/s41431-022-01170-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 07/13/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023] Open
Abstract
Genome and exome sequencing (GS/ES) are increasingly being used in pediatric contexts. We summarize evidence regarding the actual and perceived understanding of GS/ES of parents of a child offered testing for diagnosis and/or management of a symptomatic health condition. We searched four databases (2008-2021) and identified 1264 unique articles, of which 16 met inclusion criteria. We synthesized data from qualitative and quantitative studies and organized results using Ayuso et al. (2013)'s framework of key elements of information for informed consent to GS/ES. Many of the parents represented had prior experience with genetic testing and accessed a form of genetic counseling. Parents' understanding was varied across the domains evaluated. Parents demonstrated understanding of the various potential direct clinical benefits to their child undergoing GS/ES, including in relation to other genetic tests. We found parents had mixed understanding of the nature of potential secondary findings, and of issues related to data privacy, confidentiality, and usage of sequencing results beyond their child's clinical care. Genetic counseling consultations improved understanding. Our synthesis indicates that ES/GS can be challenging for families to understand and underscores the importance of equipping healthcare professionals to explore parents' understanding of ES/GS and the implications of testing for their child.
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Affiliation(s)
- Jessica Gereis
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia ,grid.414009.80000 0001 1282 788XBehavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW Australia
| | - Kate Hetherington
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia ,grid.414009.80000 0001 1282 788XBehavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW Australia
| | - Lauren Ha
- grid.414009.80000 0001 1282 788XBehavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432School of Health Sciences, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia
| | - Eden G. Robertson
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia
| | - David S. Ziegler
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia ,grid.414009.80000 0001 1282 788XKids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432Children’s Cancer Institute, UNSW Sydney, Sydney, NSW Australia
| | - Kristine Barlow-Stewart
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432Children’s Cancer Institute, UNSW Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XNorthern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Katherine M. Tucker
- grid.1005.40000 0004 4902 0432Prince of Wales Clinical School, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia
| | - Jonathan M. Marron
- grid.65499.370000 0001 2106 9910Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA USA ,grid.2515.30000 0004 0378 8438Division of Hematology/Oncology, Boston Children’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XCenter for Bioethics, Harvard Medical School, Boston, MA USA
| | - Claire E. Wakefield
- grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, NSW Australia ,grid.414009.80000 0001 1282 788XBehavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW Australia
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8
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Hunter JD, Robertson EG, Hetherington K, Ziegler DS, Marshall GM, Kirk J, Marron JM, Denburg AE, Barlow-Stewart K, Warby M, Tucker KM, Lee BM, O’Brien TA, Wakefield CE. What’s in a Name? Parents’ and Healthcare Professionals’ Preferred Terminology for Pathogenic Variants in Childhood Cancer Predisposition Genes. J Pers Med 2022; 12:jpm12081327. [PMID: 36013276 PMCID: PMC9410181 DOI: 10.3390/jpm12081327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
Current literature/guidelines regarding the most appropriate term to communicate a cancer-related disease-causing germline variant in childhood cancer lack consensus. Guidelines also rarely address preferences of patients/families. We aimed to assess preferences of parents of children with cancer, genetics professionals, and pediatric oncologists towards terminology to describe a disease-causing germline variant in childhood cancer. Using semi-structured interviews we asked participants their most/least preferred terms from; ‘faulty gene,’ ‘altered gene,’ ‘gene change,’ and ‘genetic variant,’ analyzing responses with directed content analysis. Twenty-five parents, 6 genetics professionals, and 29 oncologists participated. An equal number of parents most preferred ‘gene change,’ ‘altered gene,’ or ‘genetic variant’ (n = 8/25). Parents least preferred ‘faulty gene’ (n = 18/25). Half the genetics professionals most preferred ‘faulty gene’ (n = 3/6); however this was least preferred by the remaining genetics professionals (n = 3/6). Many oncologists most preferred ‘genetic variant’ (n = 11/29) and least preferred ‘faulty gene’ (n = 19/29). Participants across all groups perceived ‘faulty gene’ as having negative connotations, potentially placing blame/guilt on parents/children. Health professionals described challenges selecting a term that was scientifically accurate, easily understood and not distressing to families. Lack of consensus highlights the need to be guided by families’ preferred terminology, while providing accurate explanations regarding implications of genetic findings.
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Affiliation(s)
- Jacqueline D. Hunter
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
- Correspondence: ; Tel.: +61-4-39-110-680
| | - Eden G. Robertson
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, NSW 2052, Australia
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Kate Hetherington
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - David S. Ziegler
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, NSW 2052, Australia
- Children’s Cancer Institute, UNSW Sydney, Kensington, NSW 2750, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Glenn M. Marshall
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, NSW 2052, Australia
- Children’s Cancer Institute, UNSW Sydney, Kensington, NSW 2750, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Judy Kirk
- The Westmead Institute for Medical Research, Sydney Medical School, University of Sydney, Sydney, NSW 2052, Australia
- Familial Cancer Service, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, NSW 2145, Australia
| | - Jonathan M. Marron
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA 02215, USA
- Center for Bioethics, Harvard Medical School, Boston, MA 02115, USA
| | - Avram E. Denburg
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Kristine Barlow-Stewart
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, NSW 2052, Australia
- Children’s Cancer Institute, UNSW Sydney, Kensington, NSW 2750, Australia
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2052, Australia
| | - Meera Warby
- Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW 2031, Australia
| | - Katherine M. Tucker
- Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW 2031, Australia
| | - Brittany M. Lee
- Seattle Children’s Hospital and Research Institute, Seattle, WA 98101, USA
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Tracey A. O’Brien
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, NSW 2052, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Claire E. Wakefield
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
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9
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Weaver A, Landry C, Zhang A, McQuown L, Hahn J, Harrington M, Tucker KM, Holzworth J, Buys T, Smith FN, Grogan-Kaylor A, Pfeiffer PN, Kilbourne AM, Himle JA. Study protocol: A randomized controlled trial of Raising Our Spirits Together, an entertaining, group-based technology-assisted cognitive behavioral therapy for depression, tailored for rural adults and delivery by clergy. Contemp Clin Trials Commun 2022; 29:100952. [PMID: 35865278 PMCID: PMC9294258 DOI: 10.1016/j.conctc.2022.100952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 03/27/2022] [Accepted: 06/23/2022] [Indexed: 11/25/2022] Open
Abstract
This paper presents a methodological description of a randomized controlled trial (RCT) testing the effect of Raising Our Spirits Together (ROST), a technology-assisted cognitive behavioral therapy (T-CBT) for depression, tailored for the rural context and for delivery by clergy, compared to an enhanced control condition. Depression is among the most common mental health conditions; yet the majority of adults with depression do not receive needed treatment due to limited access to mental health professionals, treatment-associated costs, distance to care, and stigma. These barriers are particularly salient in rural areas of the United States. T-CBT with human support is an accessible and effective treatment for depression; however, currently available T-CBTs have poor completion rates due to the lack of tailoring and other features to support engagement. ROST is a T-CBT specifically tailored for the rural setting and delivery by clergy, who are preferred, informal providers. ROST also presents core CBT content in a simple, jargon-free manner that supports multiple learning preferences. ROST is delivered virtually in a small group format across 8 weekly sessions via videoconferencing software consistent with other clergy-based programs, such as Bible studies or self-help groups. In this study, adults with depressive symptoms recruited from two rural Michigan counties will be randomized to receive ROST versus an enhanced control condition (N = 84). Depressive symptoms post-treatment and at 3 months follow-up according to the Patient Health Questionnaire (PHQ-9) will be the primary outcome. Findings will determine whether ROST is effective for improving depression symptoms in underserved, under resourced rural communities.
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10
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Best MC, Butow P, Savard J, Jacobs C, Bartley N, Davies G, Napier CE, Ballinger ML, Thomas DM, Biesecker B, Tucker KM, Juraskova I, Meiser B, Schlub T, Newson AJ. Preferences for return of germline genome sequencing results for cancer patients and their genetic relatives in a research setting. Eur J Hum Genet 2022; 30:930-937. [PMID: 35277654 PMCID: PMC9349221 DOI: 10.1038/s41431-022-01069-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/14/2021] [Accepted: 02/08/2022] [Indexed: 11/09/2022] Open
Abstract
Germline genome sequencing (GS) holds great promise for cancer prevention by identifying cancer risk and guiding prevention strategies, however research evidence is mixed regarding patient preferences for receiving GS results. The aim of this study was to discern preferences for return of results by cancer patients who have actually undergone GS. We conducted a mixed methods study with a cohort of cancer probands (n = 335) and their genetic relatives (n = 199) undergoing GS in a research setting. Both groups completed surveys when giving consent. A subset of participants (n = 40) completed semi-structured interviews. A significantly higher percentage of probands thought people would like to be informed about genetic conditions for which there is prevention or treatment that can change cancer risk compared to conditions for which there is no prevention or treatment (93% [311] versus 65% [216]; p < 0.001). Similar results were obtained for relatives (91% [180] versus 61% [121]; p < 0.001). Themes identified in the analysis of interviews were: (1) Recognised benefits of GS, (2) Balancing benefits with risks, (3) Uncertain results are perceived as unhelpful and (4) Competing obligations. While utility was an important discriminator in what was seen as valuable for this cohort, there was a variety of responses. In view of varied participant preferences regarding return of results, it is important to ensure patient understanding of test validity and identify individual choices at the time of consent to GS. The nature and value of the information, and a contextual understanding of researcher obligations should guide result return.
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Affiliation(s)
- Megan C Best
- Faculty of Science, University of Sydney, Sydney, NSW, Australia. .,Institute for Ethics and Society, University of Notre Dame Australia, Sydney, WA, Australia.
| | - Phyllis Butow
- Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | | | - Chris Jacobs
- Graduate School of Health, University of Technology, Sydney, NSW, Australia
| | - Nicole Bartley
- Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - Grace Davies
- Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - Christine E Napier
- Cancer Division, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Mandy L Ballinger
- Cancer Division, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - David M Thomas
- Cancer Division, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | | | - Katherine M Tucker
- Hereditary Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Ilona Juraskova
- Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - Bettina Meiser
- Psychosocial Research Group, University of NSW, Sydney, NSW, Australia
| | - Timothy Schlub
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Ainsley J Newson
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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11
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Napier CE, Davies G, Butow PN, Schlub TE, Best MC, Bartley N, Juraskova I, Meiser B, Tucker KM, Biesecker BB, Thomas DM, Ballinger ML. Cancer patient knowledge about and behavioral intentions after germline genome sequencing. Patient Educ Couns 2022; 105:707-718. [PMID: 34247865 DOI: 10.1016/j.pec.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 06/08/2021] [Accepted: 07/03/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Germline genome sequencing (GS) is becoming mainstream in cancer diagnosis and risk management. Identifying knowledge gaps and determinants of health behavior change intentions will enable effective targeting of educational and management strategies to translate genomic findings into improved cancer outcomes. METHODS Probands diagnosed with cancer of likely genetic origin that consented to but not yet undergone GS, and their biological relatives, completed a cross-sectional questionnaire assessing GS knowledge and hypothetical intention to change behaviors. RESULTS Probands (n = 348; 57% university educated) and relatives (n = 213; 38% university educated) had moderate GS knowledge levels, with greater knowledge associated with higher education. Both populations reported high behavioral change intentions, significantly associated with being female (p = 0.01) and greater perceived importance of GS (p < 0.001), and for probands: being from English-speaking households (p = 0.003), higher socio-economic status (p = 0.01) and greater self-efficacy (p = 0.02). CONCLUSIONS Increasing GS knowledge will enable realistic participant expectations surrounding germline GS. Actual behavior change should be monitored to determine whether increased cancer risk knowledge results in altered cancer-related behavior and ultimately, cancer outcomes. PRACTICE IMPLICATIONS Educational resources should target specific populations to ensure informed decision-making and expectation management. Support tools facilitating and maintaining behavioral change may be needed to achieve improved cancer patient outcomes.
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Affiliation(s)
- Christine E Napier
- Cancer Theme, Garvan Institute of Medical Research, Darlinghurst, Australia
| | - Grace Davies
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, Australia
| | - Phyllis N Butow
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, Australia; The University of Sydney, School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney, Australia
| | - Timothy E Schlub
- The University of Sydney, Sydney School of Public Health, Sydney, Australia
| | - Megan C Best
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, Australia; University of Notre Dame Australia, Sydney, Australia
| | - Nicci Bartley
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, Australia
| | - Ilona Juraskova
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, Australia; The University of Sydney, School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney, Australia
| | - Bettina Meiser
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Katherine M Tucker
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, Australia
| | - Barbara B Biesecker
- Newborn Screening, Ethics and Disability Studies, RTI International, Washington, DC, USA
| | - David M Thomas
- Cancer Theme, Garvan Institute of Medical Research, Darlinghurst, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Mandy L Ballinger
- Cancer Theme, Garvan Institute of Medical Research, Darlinghurst, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, Australia.
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12
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Weaver A, Zhang A, Landry C, Hahn J, McQuown L, O’Donnell LA, Harrington MM, Buys T, Tucker KM, Pfeiffer P, Kilbourne AM, Grogan-Kaylor A, Himle JA. Technology-Assisted, Group-Based CBT for Rural Adults' Depression: Open Pilot Trial Results. Res Soc Work Pract 2022; 32:131-145. [PMID: 35665316 PMCID: PMC9165685 DOI: 10.1177/10497315211044835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE This pilot study assesses the association of Raising Our Spirits Together (ROST), a technology-assisted, group-based cognitive behavioral therapy for depression, with rural adults' depressive symptoms and anxiety. METHOD Nine adults from rural Michigan participated in an open pilot of ROST. Clergy facilitated pilot groups. The pilot began in February 2020 in-person. Due to COVID-19, the pilot was completed virtually. RESULTS Mean depressive symptom scores, based on the PHQ-9, significantly decreased from pre-treatment (M = 14.4) to post-treatment (M = 6.33; t (8) = 6.79; P < .001). Symptom reduction was maintained at 3-month follow-up (M = 8.00), with a significant pattern of difference in depressive symptoms over time (F(2) = 17.7; P < .001; eta-squared = .689). Similar patterns occurred for anxiety based on the GAD-7. Participants attended an average of 7.33 of 8 sessions. Fidelity ratings were excellent. DISCUSSION ROST is a potentially feasible intervention for rural adults' depressive symptoms. ROST offers a promising model for increasing treatment access and building capacity in rural areas.
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Affiliation(s)
- Addie Weaver
- University of Michigan School of Social Work, Ann Arbor, MI, USA
| | - Anao Zhang
- University of Michigan School of Social Work, Ann Arbor, MI, USA
| | - Caroline Landry
- University of Michigan School of Social Work, Ann Arbor, MI, USA
| | | | - Lynne McQuown
- Jonesville First Presbyterian Church, Jonesville, MI, USA
| | | | | | - Trevor Buys
- University of Michigan School of Social Work, Ann Arbor, MI, USA
| | | | - Paul Pfeiffer
- Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, MI, USA
- Department of Veterans Affairs, Ann Arbor, MI, USA
| | - Amy M. Kilbourne
- Department of Veterans Affairs, Ann Arbor, MI, USA
- Department of Learning Health Sciences, University of Michigan School of Medicine, Ann Arbor, MI, USA
- Quality Enhancement Research Initiative, U.S. Department of Veterans Affairs, Washington, DC, USA
| | | | - Joseph A. Himle
- University of Michigan School of Social Work, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, MI, USA
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13
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Lau LMS, Mayoh C, Xie J, Barahona P, MacKenzie KL, Wong M, Kamili A, Tsoli M, Failes TW, Kumar A, Mould EVA, Gifford A, Chow SO, Pinese M, Fletcher JI, Arndt GM, Khuong-Quang DA, Wadham C, Eden G, Trebilcock P, Joshi S, Alfred S, Gopalakrishnan A, Khan A, Grebert Wade D, Strong PA, Manouvrier E, Morgan LT, Cadiz R, Ung C, Thomas DM, Tucker KM, Warby M, McCowage GB, Dalla-Pozza L, Byrne JA, Saletta F, Fellowes A, Fox SB, Norris MD, Tyrrell V, Trahair TN, Lock RB, Cowley MJ, Ekert PG, Haber M, Ziegler DS, Marshall GM. In vitro and in vivo drug screens of tumor cells identify novel therapies for high-risk child cancer. EMBO Mol Med 2021; 14:e14608. [PMID: 34927798 PMCID: PMC8988207 DOI: 10.15252/emmm.202114608] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 01/08/2023] Open
Abstract
Biomarkers which better match anticancer drugs with cancer driver genes hold the promise of improved clinical responses and cure rates. We developed a precision medicine platform of rapid high-throughput drug screening (HTS) and patient-derived xenografting (PDX) of primary tumor tissue, and evaluated its potential for treatment identification among 56 consecutively enrolled high-risk pediatric cancer patients, compared with conventional molecular genomics and transcriptomics. Drug hits were seen in the majority of HTS and PDX screens, which identified therapeutic options for 10 patients for whom no targetable molecular lesions could be found. Screens also provided orthogonal proof of drug efficacy suggested by molecular analyses and negative results for some molecular findings. We identified treatment options across the whole testing platform for 70% of patients. Only molecular therapeutic recommendations were provided to treating oncologists and led to a change in therapy in 53% of patients, of whom 29% had clinical benefit. These data indicate that in vitro and in vivo drug screening of tumor cells could increase therapeutic options and improve clinical outcomes for high-risk pediatric cancer patients.
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Affiliation(s)
- Loretta M S Lau
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia.,School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Chelsea Mayoh
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia.,School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, Australia
| | - Jinhan Xie
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia
| | - Paulette Barahona
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia
| | - Karen L MacKenzie
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia
| | - Marie Wong
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia.,School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, Australia
| | - Alvin Kamili
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia.,School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, Australia
| | - Maria Tsoli
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia
| | - Tim W Failes
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia.,ACRF Drug Discovery Centre for Childhood Cancer, Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Amit Kumar
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia.,Children's Cancer Centre, Royal Children's Hospital, Parkville, Vic., Australia
| | - Emily V A Mould
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia
| | - Andrew Gifford
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia.,School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, Australia
| | - Shu-Oi Chow
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia.,ACRF Drug Discovery Centre for Childhood Cancer, Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Mark Pinese
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia.,School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, Australia
| | - Jamie I Fletcher
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia.,School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, Australia
| | - Greg M Arndt
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia.,ACRF Drug Discovery Centre for Childhood Cancer, Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Dong-Anh Khuong-Quang
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Vic., Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Vic., Australia
| | - Carol Wadham
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia
| | - Georgina Eden
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia
| | - Peter Trebilcock
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia
| | - Swapna Joshi
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia
| | - Stephanie Alfred
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia
| | - Anjana Gopalakrishnan
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia
| | - Aaminah Khan
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia
| | - Dylan Grebert Wade
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia
| | - Patrick A Strong
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia
| | - Elodie Manouvrier
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia
| | - Lisa T Morgan
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia
| | - Roxanne Cadiz
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia
| | - Caitlin Ung
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia
| | - David M Thomas
- Kinghorn Cancer Centre, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.,Faculty of Medicine, St Vincent's Clinical School, UNSW Sydney, Kensington, NSW, Australia
| | - Katherine M Tucker
- Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia.,Prince of Wales Hospital Clinical School, UNSW Sydney, Randwick, NSW, Australia
| | - Meera Warby
- Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Geoffrey B McCowage
- Cancer Centre for Children, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Luciano Dalla-Pozza
- Cancer Centre for Children, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Jennifer A Byrne
- Children's Cancer Research Unit, Kids Research, Westmead, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Federica Saletta
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia
| | | | - Stephen B Fox
- Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Department of Medical Oncology, University of Melbourne, Melbourne, Vic., Australia
| | - Murray D Norris
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia.,School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, Australia.,University of New South Wales Centre for Childhood Cancer Research, UNSW Sydney, Kensington, Vic., Australia
| | - Vanessa Tyrrell
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia
| | - Toby N Trahair
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia.,School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Richard B Lock
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia.,School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, Australia
| | - Mark J Cowley
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia.,School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, Australia.,Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Paul G Ekert
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia.,School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, Australia.,Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - Michelle Haber
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia.,School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, Australia
| | - David S Ziegler
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia.,School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Glenn M Marshall
- Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia.,School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
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14
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O'Shea R, Rankin NM, Kentwell M, Gleeson M, Tucker KM, Hampel H, Taylor N, Lewis S. Stakeholders' views of integrating universal tumour screening and genetic testing for colorectal and endometrial cancer into routine oncology. Eur J Hum Genet 2021; 29:1634-1644. [PMID: 33811254 PMCID: PMC8560784 DOI: 10.1038/s41431-021-00871-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/07/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022] Open
Abstract
Mainstream genetic testing in routine oncology care requires implementation research to inform intervention design. In Australia, funding is available for oncology health professionals (OHP) to organise genetic testing (GT) for eligible colorectal and endometrial cancer patients as part of their routine care. To assess the health system ability to incorporate this practice change, we conducted an implementation survey using the Consolidated Framework for Implementation Research (CFIR). The online survey was available from April to September 2020 to OHP and genetic health professional (GHP). In total, 198 respondents attempted the survey, with 158 completed and 27 partial responses: 26% were GHP, 66% OHP and 8% pathologists. Of all responders, 50% were female, mainly practicing in public hospital settings (57%) in an urban location (80%) and with an 18-60 years plus age range. The majority of respondents saw the relative advantage of aligning GT to abnormal universal tumour screening (UTS) results, with 77% of GHP and 78% of OHP agreeing it would streamline care for patients. There was disagreement across healthcare professional groups about knowledge and self-efficacy, with 45% of GHP not viewing oncologists as 'feeling confident' to use genetic test results for treatment management decisions, while 62% of OHP felt confident in their ability. Both OHP and GHP's indicated embedding a genetic counsellor in oncology or having a genetics point of contact to support integrating of GT through UTS as favourable interventions. Implementation research findings allow for the design of targeted interventions and a model for GT integration into oncology.
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Affiliation(s)
- Rosie O'Shea
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
- Discipline of Genetic Counselling, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia.
| | - Nicole M Rankin
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Maira Kentwell
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Oncology, Royal Women's Hospital Parkville, Melbourne, VIC, Australia
| | | | - Katherine M Tucker
- Hereditary Cancer Clinic, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Heather Hampel
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Natalie Taylor
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Cancer Research Division, Cancer Council, Sydney, NSW, Australia
| | - Sarah Lewis
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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15
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Goudie C, Witkowski L, Cullinan N, Reichman L, Schiller I, Tachdjian M, Armstrong L, Blood KA, Brossard J, Brunga L, Cacciotti C, Caswell K, Cellot S, Clark ME, Clinton C, Coltin H, Felton K, Fernandez CV, Fleming AJ, Fuentes-Bolanos N, Gibson P, Grant R, Hammad R, Harrison LW, Irwin MS, Johnston DL, Kane S, Lafay-Cousin L, Lara-Corrales I, Larouche V, Mathews N, Meyn MS, Michaeli O, Perrier R, Pike M, Punnett A, Ramaswamy V, Say J, Somers G, Tabori U, Thibodeau ML, Toupin AK, Tucker KM, van Engelen K, Vairy S, Waespe N, Warby M, Wasserman JD, Whitlock JA, Sinnett D, Jabado N, Nathan PC, Shlien A, Kamihara J, Deyell RJ, Ziegler DS, Nichols KE, Dendukuri N, Malkin D, Villani A, Foulkes WD. Performance of the McGill Interactive Pediatric OncoGenetic Guidelines for Identifying Cancer Predisposition Syndromes. JAMA Oncol 2021; 7:1806-1814. [PMID: 34617981 DOI: 10.1001/jamaoncol.2021.4536] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Importance Prompt recognition of a child with a cancer predisposition syndrome (CPS) has implications for cancer management, surveillance, genetic counseling, and cascade testing of relatives. Diagnosis of CPS requires practitioner expertise, access to genetic testing, and test result interpretation. This diagnostic process is not accessible in all institutions worldwide, leading to missed CPS diagnoses. Advances in electronic health technology can facilitate CPS risk assessment. Objective To evaluate the diagnostic accuracy of a CPS prediction tool (McGill Interactive Pediatric OncoGenetic Guidelines [MIPOGG]) in identifying children with cancer who have a low or high likelihood of having a CPS. Design, Setting, and Participants In this international, multicenter diagnostic accuracy study, 1071 pediatric (<19 years of age) oncology patients who had a confirmed CPS (12 oncology referral centers) or who underwent germline DNA sequencing through precision medicine programs (6 centers) from January 1, 2000, to July 31, 2020, were studied. Exposures Exposures were MIPOGG application in patients with cancer and a confirmed CPS (diagnosed through routine clinical care; n = 413) in phase 1 and MIPOGG application in patients with cancer who underwent germline DNA sequencing (n = 658) in phase 2. Study phases did not overlap. Data analysts were blinded to genetic test results. Main Outcomes and Measures The performance of MIPOGG in CPS recognition was compared with that of routine clinical care, including identifying a CPS earlier than practitioners. The tool's test characteristics were calculated using next-generation germline DNA sequencing as the comparator. Results In phase 1, a total of 413 patients with cancer (median age, 3.0 years; range, 0-18 years) and a confirmed CPS were identified. MIPOGG correctly recognized 410 of 412 patients (99.5%) as requiring referral for CPS evaluation at the time of primary cancer diagnosis. Nine patients diagnosed with a CPS by a practitioner after their second malignant tumor were detected by MIPOGG using information available at the time of the first cancer. In phase 2, of 658 children with cancer (median age, 6.6 years; range, 0-18.8 years) who underwent comprehensive germline DNA sequencing, 636 had sufficient information for MIPOGG application. When compared with germline DNA sequencing for CPS detection, the MIPOGG test characteristics for pediatric-onset CPSs were as follows: sensitivity, 90.7%; specificity, 60.5%; positive predictive value, 17.6%; and negative predictive value, 98.6%. Tumor DNA sequencing data confirmed the MIPOGG recommendation for CPS evaluation in 20 of 22 patients with established cancer-CPS associations. Conclusions and Relevance In this diagnostic study, MIPOGG exhibited a favorable accuracy profile for CPS screening and reduced time to CPS recognition. These findings suggest that MIPOGG implementation could standardize and rationalize recommendations for CPS evaluation in children with cancer.
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Affiliation(s)
- Catherine Goudie
- Division of Hematology-Oncology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada.,Department of Child Health and Human Development, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Leora Witkowski
- McGill University Health Centre, Department of Human Genetics, Montreal, Quebec, Canada
| | - Noelle Cullinan
- Department of Haematology-Oncology, Children's Health Ireland, Crumlin, Dublin, Ireland.,Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lara Reichman
- Department of Child Health and Human Development, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,McGill University Health Centre, Department of Human Genetics, Montreal, Quebec, Canada
| | - Ian Schiller
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Melissa Tachdjian
- Department of Child Health and Human Development, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Linlea Armstrong
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine A Blood
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada.,Hereditary Cancer Program, BC Cancer, Vancouver, British Columbia, Canada
| | - Josée Brossard
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, CIUSSS de l'Estrie - CHUS, Sherbrooke, Quebec, Canada
| | - Ledia Brunga
- Department of Genetics and Genome Biology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Chantel Cacciotti
- Department of Pediatric Oncology-Hematology, Children's Hospital-London Health Sciences Centre, London, Ontario, Canada
| | - Kimberly Caswell
- Department of Genetics and Genome Biology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Sonia Cellot
- Charles-Bruneau Cancer Centre, Pediatric Hematology-Oncology Division, Centre Hospitalier Universitaire (CHU) Sainte-Justine Research Centre, Montreal, Quebec, Canada
| | - Mary Egan Clark
- Cancer Predisposition Division, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Catherine Clinton
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Hallie Coltin
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kathleen Felton
- Pediatric Hematology/Oncology, Jim Pattison Children's Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Conrad V Fernandez
- Division of Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Adam J Fleming
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Noemi Fuentes-Bolanos
- Children's Cancer Institute, Lowy Cancer Centre, University of New South Wales Sydney, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Paul Gibson
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Ronald Grant
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rawan Hammad
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Haematology, King Abdulaziz University, Jeddah, Makkah, Saudi Arabia
| | - Lynn W Harrison
- Cancer Predisposition Division, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Meredith S Irwin
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Donna L Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Sarah Kane
- Division of Clinical Genetics, Department of Hereditary Cancer and Genetics, Memorial Sloan-Kettering Cancer Center, Basking Ridge, New Jersey
| | - Lucie Lafay-Cousin
- Section of Pediatric Hematology Oncology and Bone Marrow Transplantation, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Irene Lara-Corrales
- Section of Dermatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Valerie Larouche
- Department of Pediatrics, Centre mère-enfant Soleil du CHU de Québec-Université Laval, Québec City, Quebec, Canada
| | - Natalie Mathews
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - M Stephen Meyn
- Center for Human Genomics and Precision Medicine, University of Wisconsin School of Medicine and Public Health, Madison.,Division of Clinical and Metabolic Genetics, Department of Pediatrics, and Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Orli Michaeli
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Renée Perrier
- Department of Medical Genetics, Alberta Children's Hospital and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Meghan Pike
- Division of Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Angela Punnett
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vijay Ramaswamy
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jemma Say
- Paediatric Haematology/Oncology Programme, Bristol Children's Hospital, Bristol, United Kingdom
| | - Gino Somers
- Division of Pathology, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Uri Tabori
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - My Linh Thibodeau
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Genetics and Genome Biology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Annie-Kim Toupin
- Faculty of Medicine, Université Laval, Quebec, Canada.,Northern Ontario School of Medicine Residency Program, Sudbury, Ontario, Canada
| | - Katherine M Tucker
- Hereditary Cancer Centre, Department of Oncology and Haematology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Kalene van Engelen
- Medical Genetics Program of Southwestern Ontario, London Health Sciences Centre, London, Ontario, Canada
| | - Stephanie Vairy
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, CIUSSS de l'Estrie - CHUS, Sherbrooke, Quebec, Canada.,Charles-Bruneau Cancer Centre, Pediatric Hematology-Oncology Division, Centre Hospitalier Universitaire (CHU) Sainte-Justine Research Centre, Montreal, Quebec, Canada
| | - Nicolas Waespe
- CANSEARCH Research Platform in Pediatric Oncology and Hematology of the University of Geneva, Geneva, Switzerland.,Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Meera Warby
- Hereditary Cancer Centre, Department of Oncology and Haematology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Jonathan D Wasserman
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - James A Whitlock
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daniel Sinnett
- Charles-Bruneau Cancer Centre, Pediatric Hematology-Oncology Division, Centre Hospitalier Universitaire (CHU) Sainte-Justine Research Centre, Montreal, Quebec, Canada
| | - Nada Jabado
- Division of Hematology-Oncology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada.,Department of Child Health and Human Development, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Paul C Nathan
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adam Shlien
- Department of Genetics and Genome Biology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Junne Kamihara
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Rebecca J Deyell
- Division of Pediatric Hematology/Oncology/BMT, University of British Columbia, British Columbia Children's Hospital and Research Institute, Vancouver, British Columbia, Canada
| | - David S Ziegler
- Children's Cancer Institute, Lowy Cancer Centre, University of New South Wales Sydney, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Kim E Nichols
- Cancer Predisposition Division, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Nandini Dendukuri
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - David Malkin
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anita Villani
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - William D Foulkes
- Department of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,Department of Oncology, McGill University, Montreal, Quebec, Canada
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16
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Murali K, Dwarte TM, Nikfarjam M, Tucker KM, Vaughan RB, Efthymiou M, Collins A, Spigelman AD, Salmon L, Johns AL, Williams DB, Delatycki MB, John T, Stoita A. Correction to: Significant detection of new germline pathogenic variants in Australian Pancreatic Cancer Screening Program participants. Hered Cancer Clin Pract 2021; 19:37. [PMID: 34496934 PMCID: PMC8427826 DOI: 10.1186/s13053-021-00195-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Krithika Murali
- Department of Clinical Genetics, Austin Health, Heidelberg, VIC, 3084, Australia
| | - Tanya M Dwarte
- Australian Pancreatic Cancer Genome Initiative, Garvan Institute of Medical Research, Darlinghurst, NSW, 2010, Australia.,Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW, 2031, Australia.,Department of Gastroenterology, St Vincent's Hospital, Darlinghurst, NSW, 2010, Australia
| | - Mehrdad Nikfarjam
- Division of Surgery, Austin Health, Heidelberg, VIC, 3084, Australia
| | - Katherine M Tucker
- Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW, 2031, Australia.,University of New South Wales, St Vincent's Clinical School and Prince of Wales Clinical School, Randwick, NSW, 2031, Australia
| | - Rhys B Vaughan
- Department of Gastroenterology, Austin Health, Heidelberg, VIC, 3084, Australia
| | - Marios Efthymiou
- Department of Gastroenterology, Austin Health, Heidelberg, VIC, 3084, Australia
| | - Allison Collins
- Clinical Trials Unit, Olivia Newton John Cancer and Wellness Centre, Austin Health, Heidelberg, VIC, 3084, Australia
| | - Allan D Spigelman
- University of New South Wales, St Vincent's Clinical School and Prince of Wales Clinical School, Randwick, NSW, 2031, Australia.,Cancer Genetics Unit, The Kinghorn Cancer Centre, St Vincent's Hospital, Darlinghurst, NSW, 2010, Australia
| | - Lucinda Salmon
- Department of Clinical Genetics, Austin Health, Heidelberg, VIC, 3084, Australia
| | - Amber L Johns
- Australian Pancreatic Cancer Genome Initiative, Garvan Institute of Medical Research, Darlinghurst, NSW, 2010, Australia
| | - David B Williams
- Department of Gastroenterology, St Vincent's Hospital, Darlinghurst, NSW, 2010, Australia
| | - Martin B Delatycki
- Department of Clinical Genetics, Austin Health, Heidelberg, VIC, 3084, Australia
| | - Thomas John
- Peter MacCallum Cancer Centre, Parkville, VIC, 3000, Australia
| | - Alina Stoita
- Department of Gastroenterology, St Vincent's Hospital, Darlinghurst, NSW, 2010, Australia. .,University of New South Wales, St Vincent's Clinical School and Prince of Wales Clinical School, Randwick, NSW, 2031, Australia.
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17
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Morrow A, Chan P, Tucker KM, Taylor N. The design, implementation, and effectiveness of intervention strategies aimed at improving genetic referral practices: a systematic review of the literature. Genet Med 2021; 23:2239-2249. [PMID: 34426665 PMCID: PMC8629749 DOI: 10.1038/s41436-021-01272-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose Despite rapid advancements in genetics and genomics, referral practices remain suboptimal. This systematic review assesses the extent to which approaches from implementation science have been applied to address suboptimal genetic referral practices. Methods A search of MEDLINE, EMBASE, and PsycINFO generated 7,794 articles, of which 28 were included. Lay barriers were mapped to the Theoretical Domains Framework (TDF) and interventions mapped to behavior change techniques. Use of implementation and behavior change frameworks was assessed, and the Theory and Techniques Tool used to determine theoretical alignment. Results Knowledge was the most frequent retrospectively TDF-coded barrier, followed by environmental context and resources, and skills. Significant referral improvements occurred in 56% of studies. Among these, the most frequent interventions were clinical data review systems, family history collection and referral tools, and embedding genetics staff into nongenetic specialties. Few studies used implementation frameworks or reported implementation outcomes, though some deployed intuitive strategies that aligned with theory. Conclusion Genetic referral interventions are rarely informed by implementation and/or behavior change theories, limiting opportunities for learning across contexts. Retrospective coding has provided a suite of theoretically linked strategies, which may be useful for informing future efforts. Incorporating these strategies into clinical guidelines may facilitate operationalization within the system.
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Affiliation(s)
- April Morrow
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia. .,Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.
| | - Priscilla Chan
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Katherine M Tucker
- Hereditary Cancer Clinic, Prince of Wales Hospital and Community Health Services, Randwick, NSW, Australia.,UNSW Prince of Wales Clinical School, Randwick, NSW, Australia
| | - Natalie Taylor
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
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18
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Murali K, Dwarte TM, Nikfarjam M, Tucker KM, Vaughan RB, Efthymiou M, Collins A, Spigelman AD, Salmon L, Johns AL, Williams DB, Delatycki MB, John T, Stoita A. Significant detection of new germline pathogenic variants in Australian Pancreatic Cancer Screening Program participants. Hered Cancer Clin Pract 2021; 19:33. [PMID: 34399810 PMCID: PMC8365963 DOI: 10.1186/s13053-021-00190-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/09/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Australian Pancreatic Cancer Screening Program (APCSP) offers endoscopic ultrasound surveillance for individuals at increased risk of pancreatic ductal adenocarcinoma (PDAC) with all participants requiring assessment by a Familial Cancer Service before or after study enrolment. METHODS Individuals aged 40-80 years (or 10 years younger than the earliest PDAC diagnosis) were eligible for APCSP study entry if they had 1) ≥ two blood relatives with PDAC (at least one of first-degree association); 2) a clinical or genetic diagnosis of Hereditary Pancreatitis or Peutz-Jeghers syndrome irrespective of PDAC family history; or 3) a known PDAC predisposition germline pathogenic variant (BRCA2, PALB2, CDKN2A, or Lynch syndrome) with ≥one PDAC-affected first- or second-degree relative. Retrospective medical record review was conducted for APCSP participants enrolled at the participating Australian hospitals from January 2011 to December 2019. We audited the genetic investigations offered by multiple Familial Cancer Services who assessed APCSP participants according to national guidelines, local clinical protocol and/or the availability of external research-funded testing, and the subsequent findings. Descriptive statistical analysis was performed using Microsoft Excel. RESULTS Of 189 kindreds (285 participants), 50 kindreds (71 participants) had a known germline pathogenic variant at enrolment (BRCA2 n = 35, PALB2 n = 6, CDKN2A n = 3, STK11 n = 3, PRSS1 n = 2, MLH1 n = 1). Forty-eight of 136 (35%) kindreds with no known germline pathogenic variant were offered mutation analysis; 89% was clinic-funded, with increasing self-funded testing since 2016. The relatively low rates of genetic testing performed reflects initial strict criteria for clinic-funded genetic testing. New germline pathogenic variants were detected in five kindreds (10.4%) after study enrolment (BRCA2 n = 3 kindreds, PALB2 n = 1, CDKN2A n = 1). Of note, only eight kindreds were reassessed by a Familial Cancer Service since enrolment, with a further 21 kindreds identified as being suitable for reassessment. CONCLUSION Germline pathogenic variants associated with PDAC were seen in 29.1% of our high-risk cohort (55/189 kindreds; 82/285 participants). Importantly, 10.4% of kindreds offered genetic testing were newly identified as having germline pathogenic variants, with majority being BRCA2. As genetic testing standards evolve rapidly in PDAC, 5-yearly reassessment of high-risk individuals by Familial Cancer Services is warranted.
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Affiliation(s)
- Krithika Murali
- Department of Clinical Genetics, Austin Health, Heidelberg, VIC, 3084, Australia
| | - Tanya M Dwarte
- Australian Pancreatic Cancer Genome Initiative, Garvan Institute of Medical Research, Darlinghurst, NSW, 2010, Australia
- Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW, 2031, Australia
- Department of Gastroenterology, St Vincent's Hospital, Darlinghurst, NSW, 2010, Australia
| | - Mehrdad Nikfarjam
- Division of Surgery, Austin Health, Heidelberg, VIC, 3084, Australia
| | - Katherine M Tucker
- Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW, 2031, Australia
- University of New South Wales, St Vincent's Clinical School and Prince of Wales Clinical School, Randwick, NSW, 2031, Australia
| | - Rhys B Vaughan
- Department of Gastroenterology, Austin Health, Heidelberg, VIC, 3084, Australia
| | - Marios Efthymiou
- Department of Gastroenterology, Austin Health, Heidelberg, VIC, 3084, Australia
| | - Allison Collins
- Clinical Trials Unit, Olivia Newton John Cancer and Wellness Centre, Austin Health, Heidelberg, VIC, 3084, Australia
| | - Allan D Spigelman
- University of New South Wales, St Vincent's Clinical School and Prince of Wales Clinical School, Randwick, NSW, 2031, Australia
- Cancer Genetics Unit, The Kinghorn Cancer Centre, St Vincent's Hospital, Darlinghurst, NSW, 2010, Australia
| | - Lucinda Salmon
- Department of Clinical Genetics, Austin Health, Heidelberg, VIC, 3084, Australia
| | - Amber L Johns
- Australian Pancreatic Cancer Genome Initiative, Garvan Institute of Medical Research, Darlinghurst, NSW, 2010, Australia
| | - David B Williams
- Department of Gastroenterology, St Vincent's Hospital, Darlinghurst, NSW, 2010, Australia
| | - Martin B Delatycki
- Department of Clinical Genetics, Austin Health, Heidelberg, VIC, 3084, Australia
| | - Thomas John
- Peter MacCallum Cancer Centre, Parkville, VIC, 3000, Australia
| | - Alina Stoita
- Department of Gastroenterology, St Vincent's Hospital, Darlinghurst, NSW, 2010, Australia.
- University of New South Wales, St Vincent's Clinical School and Prince of Wales Clinical School, Randwick, NSW, 2031, Australia.
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Morrow A, Chan P, Tiernan G, Steinberg J, Debono D, Wolfenden L, Tucker KM, Hogden E, Taylor N. Building capacity from within: qualitative evaluation of a training program aimed at upskilling healthcare workers in delivering an evidence-based implementation approach. Transl Behav Med 2021; 12:6320108. [PMID: 34255088 PMCID: PMC8765000 DOI: 10.1093/tbm/ibab094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Translating evidence into complex health systems is an ongoing challenge. Building the capacity of healthcare workers in behavioral and implementation science methods may facilitate the use of evidence-based implementation approaches, leading to sustainable and effective translation. The aim was to describe the development, contents and evaluation of a training workshop aimed at upskilling hospital-embedded staff to deliver an evidence-based implementation approach. The Hide and Seek Project (HaSP) is a cluster randomized controlled trial testing two implementation approaches for improving hereditary cancer referral at eight Australian hospitals. Healthcare workers were recruited as “Implementation Leads” and trained via a one-day workshop—TRAining in evideNce-baSed ImpLementATion for hEalth (TRANSLATE). The purpose of TRANSLATE was to upskill Implementation Leads in the delivery of HaSP, as well as implementation science methods more broadly. Implementation Leads participated in semi-structured evaluation interviews, which were analyzed using inductive thematic analysis. Nine Implementation Leads from various professional backgrounds completed the training. Four key themes were identified: (i) training day reactions, (ii) learning, (iii) implementation barriers and facilitators, and (iv) building health system capacity for implementation. Participants reported high levels of satisfaction, and anticipated that the knowledge and skills may be useful in the future. We describe a novel training program focused on the delivery of evidence-based implementation within health systems. Guided by insights from this study, methods to deliver the training on a larger scale and across different contexts are being explored. The prolonged impact of TRANSLATE will be further evaluated at trial completion. Trial registration: ANZCTR, ACTRN12618001072202. Registered on June 27, 2018
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Affiliation(s)
- April Morrow
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Camperdown New South Wales, Australia
| | - Priscilla Chan
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
| | - Gabriella Tiernan
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
| | - Julia Steinberg
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Camperdown New South Wales, Australia
| | - Deborah Debono
- Centre for Health Services Management, School of Public Health, University of Technology Sydney, New South Wales, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Katherine M Tucker
- Hereditary Cancer Centre, Prince of Wales Hospital, New South Wales, Australia.,Prince of Wales Clinical School, UNSW Sydney, New South Wales, Australia
| | - Emily Hogden
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
| | - Natalie Taylor
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Camperdown New South Wales, Australia
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20
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Kee D, Parker C, Bae S, Tucker KM, Harrison M, Tohidi-Esfahani I, Black M, Delahunty R, Ananda S, Friedlander M, Cunliffe HE, Gibbs P, Desai J, Trotman J, Scott CL. CART-WHEEL.org: An Ethically Approved Online Database for Patient-Entered Data to Facilitate Rare Cancer Research. JCO Clin Cancer Inform 2021; 4:136-146. [PMID: 32083956 PMCID: PMC7049250 DOI: 10.1200/cci.19.00085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Rare cancers are challenging for researchers, as clinicians and scientists have difficulty recruiting sufficient patient cases to power studies appropriately. Likewise, patients often are frustrated by a lack of specific information or evidence base for their cancer and, although eager to participate in research, have limited opportunities. We established CART-WHEEL.org, an online patient-entered database, to directly engage patients in the research process, collect rare cancer data, and facilitate their entry into additional research. PATIENTS AND METHODS Patients access CART-WHEEL.org directly online. Clinical information is collected from users via a streamlined questionnaire developed collaboratively with consumer groups to ensure accessibility and relevance. Data collected include the following: patient demographics, comorbidities, and risk factors and tumor diagnostic, biomarker, and treatment history. Patients can download a medical summary for personal use; consent for research use of data; and indicate willingness to be contacted about other research or clinical trials. We describe data collected to date and its validation, and we provide examples of how CART-WHEEL.org can facilitate rare cancer research. RESULTS From January 2010 to March 2018, 558 patients provided consent and entered their rare cancer data. One hundred distinct rare tumor types and patients from 22 countries were included. Validation of data entered by 21 patients with sarcoma against a hospital database demonstrated accuracy sufficient to facilitate future research in key fields, such as tumor site (95%) and histopathologic diagnosis (90%). Examples of CART-WHEEL–based disease-specific projects, subsequent recruitment to other rare cancer projects, and rare cancer patient cases of interest are described. CONCLUSIONS Online platforms like CART-WHEEL.org can engage consumers directly, facilitating collection of patient-entered rare cancer data for hypothesis generation, and connect patients with researchers to enable specific rare cancer research and clinical trials.
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Affiliation(s)
- Damien Kee
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Clare Parker
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Susie Bae
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Katherine M Tucker
- Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, VIC, Australia
| | - Michelle Harrison
- Chris O'Brien Lifehouse, Camperdown, NSW, Australia.,Liverpool Hospital, Liverpool, NSW, Australia
| | - Ibrahim Tohidi-Esfahani
- School of Medicine, University of Sydney, Sydney, NSW, Australia.,Hematology department, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Marita Black
- CART-WHEEL (BioGrid Australia), Royal Melbourne Hospital, Parkville, VIC, Australia
| | | | - Sumitra Ananda
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.,Royal Women's Hospital, Parkville, VIC, Australia
| | - Michael Friedlander
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | | | - Peter Gibbs
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Jayesh Desai
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Judith Trotman
- School of Medicine, University of Sydney, Sydney, NSW, Australia.,Hematology department, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Clare L Scott
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.,Royal Women's Hospital, Parkville, VIC, Australia.,Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, VIC, Australia
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21
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Tudini E, Davidson AL, Dressel U, Andrews L, Antill Y, Crook A, Field M, Gattas M, Harris R, Kirk J, Pachter N, Salmon L, Susman R, Townshend S, Trainer AH, Tucker KM, Mitchell G, James PA, Ward RL, Mar Fan H, Poplawski NK, Spurdle AB. Implementing gene curation for hereditary cancer susceptibility in Australia: achieving consensus on genes with clinical utility. J Med Genet 2020; 58:853-858. [PMID: 33168572 DOI: 10.1136/jmedgenet-2020-107140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/08/2020] [Accepted: 09/12/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND The strength of evidence supporting the validity of gene-disease relationships is variable. Hereditary cancer has the additional complexity of low or moderate penetrance for some confirmed disease-associated alleles. METHODS To promote national consistency in interpretation of hereditary cancer/tumour gene test results, we requested opinions of representatives from Australian Family Cancer Clinics regarding the clinical utility of 157 genes initially collated for a national research project. Viewpoints were sought by initial survey, face-to-face workshop and follow-up survey. Subsequent review was undertaken by the eviQ Cancer Genetics Reference Committee, a national resource providing evidence-based and consensus-driven cancer treatment protocols. RESULTS Genes were categorised by clinical actionability as: relevant for testing on presentation of common cancer/tumour types (n=45); relevant for testing in the context of specific rare phenotypes (n=74); insufficient clinical utility (n=34) or contentious clinical utility (n=3). Opinions for several genes altered during the study time frame, due to new information. CONCLUSION Through an iterative process, consensus was achieved on genes with clinical utility for hereditary cancer/tumour conditions in the Australian setting. This study highlighted need for regular review of gene-disease lists, a role assumed in Australia for hereditary cancer/tumour predisposition genes by the eviQ Cancer Genetics Reference Committee.
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Affiliation(s)
- Emma Tudini
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Australian Genomics Health Alliance, Melbourne, Victoria, Australia
| | - Aimee L Davidson
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Uwe Dressel
- Australian Genomics Health Alliance, Melbourne, Victoria, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Lesley Andrews
- Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Prince of Wales Medical School, University of New South Wales, Randwick, New South Wales, Australia
| | - Yoland Antill
- Cabrini Family Cancer Clinic, Cabrini Hospital, Malvern, Victoria, Australia
| | - Ashley Crook
- Familial Cancer Service, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Michael Field
- Familial Cancer Service, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Michael Gattas
- Brisbane Genetics, Nicholson St Specialist Centre, Greenslopes, Queensland, Australia
| | - Rebecca Harris
- Familial Cancer Service, Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia
| | - Judy Kirk
- Familial Cancer Service, Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia.,Sydney Medical School, University of Sydney, Centre for Cancer Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Nicholas Pachter
- Genetic Services of Western Australia, King Edward Memorial Hospital, Perth, Western Australia, Australia.,Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Lucinda Salmon
- Department of Clinical Genetics, Austin Health, Melbourne, Victoria, Australia
| | - Rachel Susman
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Sharron Townshend
- Genetic Services of Western Australia, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Alison H Trainer
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Katherine M Tucker
- Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Prince of Wales Medical School, University of New South Wales, Randwick, New South Wales, Australia
| | - Gillian Mitchell
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Paul A James
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Robyn L Ward
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Helen Mar Fan
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Nicola K Poplawski
- Adult Genetics Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Amanda B Spurdle
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
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22
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Morrow A, Tucker KM, Shaw TJ, Parkinson B, Abraham C, Wolfenden L, Taylor N. Understanding implementation success: protocol for an in-depth, mixed-methods process evaluation of a cluster randomised controlled trial testing methods to improve detection of Lynch syndrome in Australian hospitals. BMJ Open 2020; 10:e033552. [PMID: 32540886 PMCID: PMC7299044 DOI: 10.1136/bmjopen-2019-033552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION In multisite intervention trials, implementation success often varies widely across settings. Process evaluations are crucial to interpreting trial outcomes and understanding contextual factors and causal chains necessary for successful implementation. Lynch syndrome is a hereditary cancer predisposition conferring an increased risk of colorectal, endometrial and other cancer types. Despite systematic screening protocols to identify Lynch syndrome, the condition remains largely underdiagnosed. The Hide and Seek Project ('HaSP') is a cluster randomised controlled trial determining the effectiveness of two approaches to improving Lynch syndrome detection at eight Australian hospital networks. To enhance widespread implementation of optimal Lynch syndrome identification, there is a need to understand not only what works, but also why, in what contexts, and at what costs. Here we describe an in-depth investigation of factors influencing successful implementation of procedures evaluated in the HaSP trial. METHODS AND ANALYSIS A mixed-methods, theory-driven process evaluation will be undertaken in parallel to the HaSP trial. Data will include: interviews of Implementation Leads and Lynch syndrome stakeholders, pre-post implementation questionnaires, audio analysis of meetings and focus groups, observation of multidisciplinary team meetings, fidelity checklists and project log analysis. Results will be triangulated and coded, drawing on the Theoretical Domains Framework, Consolidated Framework for Implementation Research and Proctor's implementation outcomes. ETHICS AND DISSEMINATION Use of a theory-based process evaluation will enhance interpretation and generalisability of HaSP trial findings, and contribute to the implementation research field by furthering understanding of the conditions necessary for implementation success. Ethical approval has been granted and results will be disseminated via publications in peer-reviewed journals and conference presentations. At trial completion, key findings will be fed back to sites to enable refinement of intervention strategies, both in the context of Lynch syndrome and for the possible generalisability of intervention components in other genetic and broader clinical specialties. HASP TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (Identifier: ACTRN12618001072202). Registered 27 June 2018. http://www.ANZCTR.org.au/ACTRN12618001072202.aspx.
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Affiliation(s)
- April Morrow
- Cancer Council New South Wales, Woolloomooloo, New South Wales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
| | - Katherine M Tucker
- Hereditary Cancer Clinic, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
- UNSW Prince of Wales Clinical School, Randwick, New South Wales, Australia
| | - Tim J Shaw
- Research in Implementation Science and eHealth (RISe), Faculty of Health Sciences, University of Sydney, Camperdown, New South Wales, Australia
| | - Bonny Parkinson
- The Macquarie University Centre for the Health Economy, Macquarie University, Macquarie, New South Wales, Australia
| | - Charles Abraham
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Natalie Taylor
- Cancer Council New South Wales, Woolloomooloo, New South Wales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
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O'Shea R, Rankin NM, Kentwell M, Gleeson M, Salmon L, Tucker KM, Lewis S, Taylor N. How can Australia integrate routine genetic sequencing in oncology: a qualitative study through an implementation science lens. Genet Med 2020; 22:1507-1516. [PMID: 32461668 DOI: 10.1038/s41436-020-0838-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/04/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE This study sought to determine genetics and oncology specialists' views of integrating BRCA1 and BRCA2 testing in epithelial ovarian and breast cancer into routine practice. METHODS Qualitative interviews were designed using the Consolidated Framework for Implementation Research. Questions included experiences or views of the BRCA testing processes, implementation needs of oncology health professionals, perceived challenges, and future ideas for interventions to integrate genetic testing into oncology. RESULTS Twenty-two participants were interviewed from twelve health organizations and four themes were identified: (1) embracing the shift to mainstream genetic testing, with the majority of participants viewing BRCA testing as clinically useful and routine use important for maintaining a patient centered process; (2) the need for communication networks and role delineation to integrate routine genetic testing; (3) factors that influence sustaining routine genetic testing, including ongoing training, resources and funding, real-world adaptation, system complexity, and champions; and (4) variation in system interventions for integrating routine genetic testing align to organizational context. CONCLUSION Findings illustrate the need for integrating genetic testing into routine oncology, and that adaptation of interventions and processes is essential to sustain a feasible model. An understanding of individual and organizational implementation factors will help to prepare for future integration of routine genetic testing in other cancers.
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Affiliation(s)
- Rosie O'Shea
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia. .,Discipline of Genetic Counselling, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia.
| | - Nicole M Rankin
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Maira Kentwell
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of Oncology, Royal Women's Hospital Parkville, Parkville, VIC, Australia
| | | | - Lucinda Salmon
- Department of Clinical Genetics, Austin Health, Melbourne, VIC, Australia
| | - Katherine M Tucker
- Hereditary Cancer Clinic, Prince of Wales Hospital, University of New South Wales, UNSW, Sydney, NSW, Australia
| | - Sarah Lewis
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Natalie Taylor
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
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Gleeson M, Kentwell M, Meiser B, Do J, Nevin S, Taylor N, Barlow-Stewart K, Kirk J, James P, Scott CL, Williams R, Gamet K, Burke J, Murphy M, Antill YC, Pearn A, Pachter N, Ebzery C, Poplawski N, Friedlander M, Tucker KM. The development and evaluation of a nationwide training program for oncology health professionals in the provision of genetic testing for ovarian cancer patients. Gynecol Oncol 2020; 158:431-439. [PMID: 32451123 DOI: 10.1016/j.ygyno.2020.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/03/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND BRCA1/2 mutation status has increasing relevance for ovarian cancer treatments, making traditional coordination of genetic testing by genetic services unsustainable. Consequently alternative models of genetic testing have been developed to improve testing at the initial diagnosis for all eligible women. METHODS A training module to enable mainstreamed genetic testing by oncology healthcare professionals was developed by genetic health professionals. Oncology healthcare professionals completed questionnaires before and 12 months post-training to assess perceived skills, competence and barriers to their coordinating genetic testing for women with high-grade non-mucinous epithelial ovarian cancer. Genetic health professionals were surveyed 12 months post-training to assess perceived barriers to implementation of mainstreaming. RESULTS 185 oncology healthcare professionals were trained in 42 workshops at 35 Australasian hospitals. Of the 273 tests ordered by oncology healthcare professionals post-training, 241 (93.1%) met national testing guidelines. The number of tests ordered by genetic health professionals reduced significantly (z = 45.0, p = 0.008). Oncology healthcare professionals' perceived barriers to mainstreamed testing decreased from baseline to follow-up (t = 2.39, p = 0.023), particularly perceived skills, knowledge and attitudes. However, only 58% reported either 'always' or 'nearly always' having ordered BRCA testing for eligible patients at 12 months, suggesting oncology healthcare professionals' perceived barriers were not systematically addressed through training. CONCLUSIONS Oncology healthcare professionals have demonstrated a willingness to be involved in the provision of genetic testing in a mainstreaming model. If oncology services are to hold responsibility for coordinating genetic testing, their readiness will require understanding of barriers not addressed by training alone to inform future intervention design.
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Affiliation(s)
- M Gleeson
- Hunter Family Cancer Service, Newcastle, Australia.
| | - M Kentwell
- Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia; The Royal Women's Hospital, Oncology and Dysplasia, Melbourne, Australia
| | - B Meiser
- Prince of Wales Clinical School, UNSW Sydney, Australia
| | - J Do
- Prince of Wales Clinical School, UNSW Sydney, Australia
| | - S Nevin
- Prince of Wales Clinical School, UNSW Sydney, Australia
| | - N Taylor
- The Cancer Council New South Wales, Sydney and Faculty of Health Science, University of Sydney, Australia
| | | | - J Kirk
- Familial Cancer Service, Westmead Hospital, Sydney Medical School, University of Sydney and Centre for Cancer Research, The Westmead Institute for Medical Research, Australia
| | - P James
- Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - C L Scott
- Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology and Department of Medical Biology, University of Melbourne, Australia
| | - R Williams
- Prince of Wales Clinical School, UNSW Sydney, Australia; Hereditary Cancer Centre, Prince of Wales Hospital, Sydney, Australia
| | - K Gamet
- Genetic Health Service NZ Northern Hub, Auckland City Hospital, Auckland, New Zealand
| | - J Burke
- Tasmanian Clinical Genetics Service, Royal Hobart Hospital, Hobart, Australia
| | - M Murphy
- Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia; Bendigo Health Cancer Centre, Bendigo, Australia
| | - Y C Antill
- Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia; Familial Cancer Centre, Monash Health, Victoria, Australia
| | - A Pearn
- Genetic Services of Western Australia, King Edward Memorial Hospital, Perth, Australia
| | - N Pachter
- Genetic Services of Western Australia, King Edward Memorial Hospital, Perth, Australia; School of Medicine, University of Western Australia, Perth, Australia
| | - C Ebzery
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - N Poplawski
- Adult Genetics Unit, Royal Adelaide Hospital, Adelaide and School of Medicine, University of Adelaide, Australia
| | - M Friedlander
- Dept Medical Oncology, Prince of Wales Hospital, Sydney, Australia
| | - K M Tucker
- Prince of Wales Clinical School, UNSW Sydney, Australia; Hereditary Cancer Centre, Prince of Wales Hospital, Sydney, Australia
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Young AL, Butow PN, Tucker KM, Wakefield CE, Healey E, Williams R. When to break the news and whose responsibility is it? A cross-sectional qualitative study of health professionals' views regarding disclosure of BRCA genetic cancer risk. BMJ Open 2020; 10:e033127. [PMID: 32102811 PMCID: PMC7045026 DOI: 10.1136/bmjopen-2019-033127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Disclosure of a hereditary condition in the family poses notable challenges for patients who often seek the assistance of genetic health professionals (GHPs). This study aimed to investigate GHPs' opinions about the ideal time for disclosure to offspring and their responsibility to at-risk relatives. DESIGN Cross-sectional qualitative study. SETTING Genetic familial cancer clinics related to mostly secondary and tertiary care hospitals and centres in urban, regional and rural areas across all states of Australia. PARTICIPANTS GHPs (N=73) including clinical geneticists, genetic counsellors, medical specialists, nurses, surgeons and mental health specialists (eg, psychiatrists, psychologists) who had worked with BRCA1 and BRCA2 families for an average of 9 years. RESULTS Focus groups and interviews were transcribed and analysed thematically. GHPs perceived that life stage, maturity, parents' knowledge and capacity to disseminate information influenced parent-offspring disclosure. In general, GHPs recommended early informal conversations with offspring about a family illness. GHPs considered that facilitation of disclosure to relatives using counselling strategies was their responsibility, yet there were limitations to their role (eg, legal and resource constraints). Variability exists in the extent to which genetic clinics overcome challenges to disclosure. CONCLUSIONS GHPs' views on the ideal time for the disclosure of genetic risk are generally dependent on the patient's age and relative's ability to disclose information. A responsibility towards the patient and their at-risk relative was widely accepted as a role of a GHP but views vary depending on legislative and specialty differences. Greater uniformity is needed in genetic procedural guidelines and the role of each discipline (eg, geneticists, genetic counsellors, oncologists, nurses and mental health specialists) in genetic clinics to manage disclosure challenges.
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Affiliation(s)
- Alison Luk Young
- The University of Sydney, Faculty of Science, School of Psychology, Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), Sydney, New South Wales, Australia
- Kids Cancer Centre, Sydney Children's Hospital Randwick, Sydney, New South Wales, Australia
| | - Phyllis N Butow
- The University of Sydney, Faculty of Science, School of Psychology, Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), Sydney, New South Wales, Australia
| | - Katherine M Tucker
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Prince of Wales Hereditary Cancer Centre, Prince of Wales Hospital and Community Health Services, Sydney, New South Wales, Australia
| | - Claire E Wakefield
- Kids Cancer Centre, Sydney Children's Hospital Randwick, Sydney, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Emma Healey
- Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Rachel Williams
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Prince of Wales Hereditary Cancer Centre, Prince of Wales Hospital and Community Health Services, Sydney, New South Wales, Australia
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McGill BC, Wakefield CE, Hetherington K, Munro LJ, Warby M, Lau L, Tyrrell V, Ziegler DS, O’Brien TA, Marshall GM, Malkin D, Hansford JR, Tucker KM, Vetsch J. "Balancing Expectations with Actual Realities": Conversations with Clinicians and Scientists in the First Year of a High-Risk Childhood Cancer Precision Medicine Trial. J Pers Med 2020; 10:E9. [PMID: 32075154 PMCID: PMC7151613 DOI: 10.3390/jpm10010009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/10/2020] [Accepted: 02/13/2020] [Indexed: 12/11/2022] Open
Abstract
Precision medicine is changing cancer care and placing new demands on oncology professionals. Precision medicine trials for high-risk childhood cancer exemplify these complexities. We assessed clinicians' (n = 39) and scientists' (n = 15) experiences in the first year of the PRecISion Medicine for Children with Cancer (PRISM) trial for children and adolescents with high-risk cancers, through an in-depth semi-structured interview. We thematically analysed participants' responses regarding their professional challenges, and measured oncologists' knowledge of genetics and confidence with somatic and germline molecular test results. Both groups described positive early experiences with PRISM but were cognisant of managing parents' expectations. Key challenges for clinicians included understanding and communicating genomic results, balancing biopsy risks, and drug access. Most oncologists rated 'good' knowledge of genetics, but a minority were 'very confident' in interpreting (25%), explaining (34.4%) and making treatment recommendations (18.8%) based on somatic genetic test results. Challenges for scientists included greater emotional impact of their work and balancing translational outputs with academic productivity. Continued tracking of these challenges across the course of the trial, while assessing the perspectives of a wider range of stakeholders, is critical to drive the ongoing development of a workforce equipped to manage the demands of paediatric precision medicine.
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Affiliation(s)
- Brittany C. McGill
- School of Women’s and Children’s Health, UNSW Medicine, UNSW Sydney, Sydney 2052, Australia; (C.E.W.); (K.H.); (L.J.M.); (L.L.); (D.S.Z.); (T.A.O.); (J.V.)
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick 2031, Australia
| | - Claire E. Wakefield
- School of Women’s and Children’s Health, UNSW Medicine, UNSW Sydney, Sydney 2052, Australia; (C.E.W.); (K.H.); (L.J.M.); (L.L.); (D.S.Z.); (T.A.O.); (J.V.)
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick 2031, Australia
| | - Kate Hetherington
- School of Women’s and Children’s Health, UNSW Medicine, UNSW Sydney, Sydney 2052, Australia; (C.E.W.); (K.H.); (L.J.M.); (L.L.); (D.S.Z.); (T.A.O.); (J.V.)
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick 2031, Australia
| | - Lachlan J. Munro
- School of Women’s and Children’s Health, UNSW Medicine, UNSW Sydney, Sydney 2052, Australia; (C.E.W.); (K.H.); (L.J.M.); (L.L.); (D.S.Z.); (T.A.O.); (J.V.)
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick 2031, Australia
| | - Meera Warby
- Hereditary Cancer Centre, Department of Medical Oncology, Prince of Wales Hospital, Randwick 2031, Australia; (M.W.); (K.M.T.)
- Prince of Wales Clinical School, UNSW Sydney, Sydney 2052, Australia
| | - Loretta Lau
- School of Women’s and Children’s Health, UNSW Medicine, UNSW Sydney, Sydney 2052, Australia; (C.E.W.); (K.H.); (L.J.M.); (L.L.); (D.S.Z.); (T.A.O.); (J.V.)
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick 2031, Australia;
- Children’s Cancer Institute, UNSW Sydney, Kensington 2750, Australia;
| | - Vanessa Tyrrell
- Children’s Cancer Institute, UNSW Sydney, Kensington 2750, Australia;
| | - David S. Ziegler
- School of Women’s and Children’s Health, UNSW Medicine, UNSW Sydney, Sydney 2052, Australia; (C.E.W.); (K.H.); (L.J.M.); (L.L.); (D.S.Z.); (T.A.O.); (J.V.)
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick 2031, Australia;
- Children’s Cancer Institute, UNSW Sydney, Kensington 2750, Australia;
| | - Tracey A. O’Brien
- School of Women’s and Children’s Health, UNSW Medicine, UNSW Sydney, Sydney 2052, Australia; (C.E.W.); (K.H.); (L.J.M.); (L.L.); (D.S.Z.); (T.A.O.); (J.V.)
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick 2031, Australia;
| | - Glenn M. Marshall
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick 2031, Australia;
- Children’s Cancer Institute, UNSW Sydney, Kensington 2750, Australia;
| | - David Malkin
- Division of Haematology/Oncology, Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada;
| | - Jordan R. Hansford
- Children’s Cancer Centre, Royal Children’s Hospital, Melbourne 3052, Australia;
- Division of Cancer, Murdoch Children’s Research Institute, Melbourne 3052, Australia
- Department of Paediatrics, University of Melbourne, Melbourne 3010, Australia
- Department of Paediatrics, Monash University, Melbourne 3800, Australia
| | - Katherine M. Tucker
- Hereditary Cancer Centre, Department of Medical Oncology, Prince of Wales Hospital, Randwick 2031, Australia; (M.W.); (K.M.T.)
- Prince of Wales Clinical School, UNSW Sydney, Sydney 2052, Australia
| | - Janine Vetsch
- School of Women’s and Children’s Health, UNSW Medicine, UNSW Sydney, Sydney 2052, Australia; (C.E.W.); (K.H.); (L.J.M.); (L.L.); (D.S.Z.); (T.A.O.); (J.V.)
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick 2031, Australia
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Vetsch J, Wakefield CE, Tucker KM, McCarthy M, Signorelli C, Walwyn T, Alvaro F, Cohn RJ. Genetics-related service and information needs of childhood cancer survivors and parents: a mixed-methods study. Eur J Hum Genet 2020; 28:6-16. [PMID: 31363185 PMCID: PMC6906423 DOI: 10.1038/s41431-019-0481-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/10/2019] [Accepted: 07/16/2019] [Indexed: 01/12/2023] Open
Abstract
Genetics in paediatric oncology is becoming increasingly important in diagnostics, treatment and follow-up care. Genetic testing may offer a possibility to stratify survivors follow-up care. However, survivors' and parents' preferences and needs for genetics-related services are largely unknown. This mixed-methods study assessed genetics-related information and service needs of survivors and parents. Six hundred and twenty-two participants (404 survivors: mean age: 26.27 years; 218 parents of survivors: mean age of child: 13.05 years) completed questionnaires. Eighty-seven participants (52 survivors; 35 parents) also completed in-depth telephone interviews. We analysed data using multivariable logistic regression and qualitative thematic analyses. Thirty-six of 50 families who were offered cancer-related genetic testing chose to undergo testing. Of those not offered testing, 11% of survivors and 7.6% of parents indicated that they believed it was 'likely/very likely' that the survivor had inherited a gene fault. Twenty-nine percent of survivors and 36% of parents endorsed access to a genetics specialist as important in their care. Survivors (40.9%) and parents (43.7%) indicated an unmet need for information about genetics and childhood cancer. Parents indicated a higher unmet need for information related to the survivors' future offspring than survivors (p < 0.001). Many survivors and parents have unmet needs for genetics-related services and information. Greater access to services and information might allow survivors at high risk for late effects to detect and prevent side effects early and improve medical outcomes. Addressing families' needs and preferences during survivorship may increase satisfaction with survivorship care.
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Affiliation(s)
- Janine Vetsch
- School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, 2031, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, 2031, Australia
| | - Claire E Wakefield
- School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, 2031, Australia.
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, 2031, Australia.
| | - Katherine M Tucker
- Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, NSW, 2031, Australia
- Prince of Wales Clinical School, UNSW Sydney, Melbourne, Australia
| | - Maria McCarthy
- Royal Children's Hospital, Melbourne, Australia
- Murdoch Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Christina Signorelli
- School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, 2031, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, 2031, Australia
| | - Thomas Walwyn
- Perth Children's Hospital, Nedlands, Western Australia, Australia
- School of Paediatrics & Child Health, University of Western Australia, Melbourne, Australia
| | - Frank Alvaro
- John Hunter Children's Hospital, Melbourne, Australia
- University of Newcastle, Melbourne, Australia
| | - Richard J Cohn
- School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, 2031, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, 2031, Australia
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28
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Vetsch J, Wakefield CE, Duve E, McGill BC, Warby M, Tucker KM, Malkin D, Lau L, Ziegler DS. Parents', Health Care Professionals', and Scientists' Experiences of a Precision Medicine Pilot Trial for Patients With High-Risk Childhood Cancer: A Qualitative Study. JCO Precis Oncol 2019; 3:1-11. [PMID: 35100729 DOI: 10.1200/po.19.00235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Children with high-risk cancers have low survival rates because current treatment options are limited. Precision medicine trials are designed to offer patients individualized treatment recommendations, potentially improving their clinical outcomes. However, parents' understanding is often limited, and expectations of benefit to their own child can be high. Health care professionals (HCPs) are often not familiar with precision medicine and might find managing families' expectations challenging. Scientists find themselves working with high expectations among different stakeholders to rapidly translate their identification of actionable targets in real time. Therefore, we wanted to gain an in-depth understanding of the experiences of all stakeholders involved in a new precision medicine pilot trial called TARGET, including parents, their child's HCPs, and the scientists who conducted the laboratory research and generated the data used to make treatment recommendations. METHODS We conducted semistructured interviews with all participants and analyzed the interviews thematically. RESULTS We interviewed 15 parents (9 mothers; 66.7% bereaved), 17 HCPs, and 16 scientists. We identified the following themes in parents' interviews: minimal understanding and need for more information, hope as a driver of participation, challenges around biopsies, timing, and drug access, and few regrets. HCP and scientist interviews revealed themes such as embracing new technologies and collaborations and challenges managing families' expectations, timing of testing and test results, and drug access. CONCLUSION Educating families, HCPs, and scientists to better understand the benefits and limitations of precision medicine trials may improve the transparency of the translation of discovery genomics to novel therapies, increase satisfaction with the child's care, and ameliorate the additional long-term psychosocial burden for families already affected by high-risk childhood cancer.
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Affiliation(s)
- Janine Vetsch
- University of New South Wales, Sydney, New South Wales, Australia.,Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Claire E Wakefield
- University of New South Wales, Sydney, New South Wales, Australia.,Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Emily Duve
- University of New South Wales, Sydney, New South Wales, Australia.,Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Brittany C McGill
- University of New South Wales, Sydney, New South Wales, Australia.,Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Meera Warby
- University of New South Wales, Sydney, New South Wales, Australia.,Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Katherine M Tucker
- University of New South Wales, Sydney, New South Wales, Australia.,Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - David Malkin
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Loretta Lau
- University of New South Wales, Sydney, New South Wales, Australia.,Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - David S Ziegler
- University of New South Wales, Sydney, New South Wales, Australia.,Sydney Children's Hospital, Randwick, New South Wales, Australia
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29
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Himle JA, LeBeau RT, Weaver A, Brydon DM, Bybee D, Kilbourne AM, Rose RD, Tucker KM, Kim R, Perez M, Smith FN, Sinco BR, Levine S, Hamameh N, Golenberg Z, McKiver M, Wierzbicki PT, Hasratian AM, Craske MG. Study protocol: A multisite trial of Work-Related Cognitive behavioral therapy for unemployed persons with social anxiety. Contemp Clin Trials Commun 2019; 16:100464. [PMID: 31701038 PMCID: PMC6831710 DOI: 10.1016/j.conctc.2019.100464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 10/01/2019] [Accepted: 10/09/2019] [Indexed: 01/04/2023] Open
Abstract
This paper provides a methodological description of a multi-site, randomized controlled trial (RCT) of a cognitive-behavioral intervention for enhancing employment success among unemployed persons whose employment efforts have been undermined by social anxiety disorder (SAD). SAD is a common and impairing condition, with negative impacts on occupational functioning. In response to these documented employment-related impairments, in a previous project, we produced and tested an eight-session work-related group cognitive-behavioral therapy provided alongside vocational services as usual (WCBT + VSAU). WCBT is delivered by vocational service professionals and is designed in a context and style that overcomes accessibility and stigma-related obstacles with special focus on employment-related targets. Our previous project found that WCBT + VSAU significantly improved social anxiety, depression, and a range of employment-related outcomes compared to a control group of socially anxious job-seekers who received vocational services as usual without WCBT (VSAU-alone). Participants in this study were all homeless, primarily African American job-seekers with high levels of psychiatric comorbidity and limited education and employment histories. The present, two-region study addresses whether WCBT + VSAU enhances job placement, job retention and mental health outcomes in a larger sample assessed over an extended follow-up period. In addition, this trial evaluates whether the effects of WCBT + VSAU generalize to a new population of urban-based, racially diverse job-seekers with vocational and educational histories that differ from our original sample. This study also investigates the system-effects of WCBT + VSAU in a new site that will be informative for broad implementation of WCBT + VSAU. Finally, this project involves a refined, technology-assisted form of WCBT + VSAU designed to be delivered more easily by vocational services professionals.
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Affiliation(s)
- Joseph A Himle
- School of Social Work, University of Michigan, USA.,Department of Psychiatry, Medical School, University of Michigan, USA
| | - Richard T LeBeau
- Department of Psychology, University of California Los Angeles, USA
| | - Addie Weaver
- School of Social Work, University of Michigan, USA
| | | | - Deborah Bybee
- Department of Psychology, Michigan State University, USA
| | - Amy M Kilbourne
- Department of Psychiatry, Medical School, University of Michigan, USA.,Department of Learning Health Sciences, Medical School, University of Michgan, USA
| | - Raphael D Rose
- Department of Psychology, University of California Los Angeles, USA
| | | | - Richard Kim
- Department of Psychology, University of California Los Angeles, USA
| | - Marcelina Perez
- Department of Psychology, University of California Los Angeles, USA
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Young AL, Butow PN, Tucker KM, Wakefield CE, Healey E, Williams R. Challenges and strategies proposed by genetic health professionals to assist with family communication. Eur J Hum Genet 2019; 27:1630-1638. [PMID: 31189929 PMCID: PMC6871519 DOI: 10.1038/s41431-019-0447-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/24/2019] [Accepted: 05/31/2019] [Indexed: 11/09/2022] Open
Abstract
Hereditary genetic conditions have implications for the whole family and therefore genetic health professionals (GHPs) interact with multiple family members, sometimes individually and sometimes in aggregate. Family communication is important to ensure dissemination of genetic information to potentially affected relatives and to facilitate supportive family interactions around genetic testing and risk management decisions. Yet, little is known about how GHPs perceive and manage these interactions. A total of 73 GHPs working across Australian cancer genetic clinics participated in semi-structured focus groups or interviews to elucidate what aspects of family communication they found most challenging, the strategies they used, and whether current academic training provides sufficient guidance to address familial concerns. Patients' lack of understanding about the importance of communicating genetic information to at-risk relatives was the most common challenge reported. GHPs reported that the patients' concern for their families' emotional responses as well as wider family system challenges (e.g. estrangement) affected family communication. Common strategies during consultations included structuring appointments logistically to account for family dynamics and post-consultation use of family letters and follow-up appointments. GHPs generally felt equipped with the skills and training provided to address patient concerns, but also desired upskilling in techniques relating to systemic family issues and behavioural change. Reflective practice strategies were requested by geneticists and nurses to foster therapeutic skill usage. Additional family therapy training while on the job may be beneficial in order to meet current challenges faced in clinical practice and can be provided as further professional development.
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Affiliation(s)
- Alison L Young
- The University of Sydney, Faculty of Science, School of Psychology, Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), Sydney, NSW, Australia.
- Behavioural Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.
| | - Phyllis N Butow
- The University of Sydney, Faculty of Science, School of Psychology, Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), Sydney, NSW, Australia
| | - Katherine M Tucker
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
- Prince of Wales Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Claire E Wakefield
- Behavioural Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Emma Healey
- Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, NSW, Australia
| | - Rachel Williams
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
- Prince of Wales Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
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Young AL, Butow PN, Tucker KM, Williams R, Healey E, Wakefield CE. Health professional and at-risk BRCA young adult perspectives about information needs: What does Gen Y need to know? J Genet Couns 2019; 28:1154-1165. [PMID: 31538377 DOI: 10.1002/jgc4.1167] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 08/23/2019] [Accepted: 08/28/2019] [Indexed: 12/23/2022]
Abstract
Young adults at risk of a hereditary condition require the provision of accurate information to make an informed decision about genetic testing and risk management options. At-risk young adults' (18- to 40-year olds) preferences for information and resources, and genetic-related health professionals' (GHPs) views on young adults' information needs, are largely unknown in the literature. This study aimed to clarify and compare the information needs of emerging (18- to 25-year olds) and early (26- to 40-year olds) adults. Resource preferences of young adults were also explored. Findings are drawn from two datasets: questionnaires and semi-structured interviews with at-risk young adults from BRCA1 or BRCA2 families (N = 32), and focus groups with GHPs (N = 73) working in Australian familial cancer clinics. Both datasets were analyzed using framework analysis. Emerging adults, particularly those who had not attended a clinic, wanted to know the rationale for genetic testing and basic genetic facts. Early adults were concerned about reproductive issues and cancer risk for future or current children. Information needs reported by young adults but not reported by GHPs include male cancer risk, finding reputable information, understanding test results (e.g., negative), and understanding risk terminology (e.g., lifetime cancer risk). Young adults' satisfaction with current information received was suboptimal, yet uptake of genetic-related resources was generally low. Getting information to this cohort remains a challenge for GHPs. Emerging adults showed a preference to obtain information through technologically-based formats (e.g., websites, social media), whereas early adults used a wider range of formats (e.g., websites, booklets). Awareness of and access to genetic information prior to genetic clinic attendance is needed. A review of the utility of current resources available for at-risk young adults would be helpful.
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Affiliation(s)
- Alison Luk Young
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,Behavioral Sciences Unit Proudly Supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Phyllis N Butow
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Katherine M Tucker
- Prince of Wales Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia.,Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
| | - Rachel Williams
- Prince of Wales Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia.,Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
| | - Emma Healey
- Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, NSW, Australia
| | - Claire E Wakefield
- Behavioral Sciences Unit Proudly Supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
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Parsons MT, Tudini E, Li H, Hahnen E, Wappenschmidt B, Feliubadaló L, Aalfs CM, Agata S, Aittomäki K, Alducci E, Alonso‐Cerezo MC, Arnold N, Auber B, Austin R, Azzollini J, Balmaña J, Barbieri E, Bartram CR, Blanco A, Blümcke B, Bonache S, Bonanni B, Borg Å, Bortesi B, Brunet J, Bruzzone C, Bucksch K, Cagnoli G, Caldés T, Caliebe A, Caligo MA, Calvello M, Capone GL, Caputo SM, Carnevali I, Carrasco E, Caux‐Moncoutier V, Cavalli P, Cini G, Clarke EM, Concolino P, Cops EJ, Cortesi L, Couch FJ, Darder E, de la Hoya M, Dean M, Debatin I, Del Valle J, Delnatte C, Derive N, Diez O, Ditsch N, Domchek SM, Dutrannoy V, Eccles DM, Ehrencrona H, Enders U, Evans DG, Farra C, Faust U, Felbor U, Feroce I, Fine M, Foulkes WD, Galvao HC, Gambino G, Gehrig A, Gensini F, Gerdes A, Germani A, Giesecke J, Gismondi V, Gómez C, Gómez Garcia EB, González S, Grau E, Grill S, Gross E, Guerrieri‐Gonzaga A, Guillaud‐Bataille M, Gutiérrez‐Enríquez S, Haaf T, Hackmann K, Hansen TV, Harris M, Hauke J, Heinrich T, Hellebrand H, Herold KN, Honisch E, Horvath J, Houdayer C, Hübbel V, Iglesias S, Izquierdo A, James PA, Janssen LA, Jeschke U, Kaulfuß S, Keupp K, Kiechle M, Kölbl A, Krieger S, Kruse TA, Kvist A, Lalloo F, Larsen M, Lattimore VL, Lautrup C, Ledig S, Leinert E, Lewis AL, Lim J, Loeffler M, López‐Fernández A, Lucci‐Cordisco E, Maass N, Manoukian S, Marabelli M, Matricardi L, Meindl A, Michelli RD, Moghadasi S, Moles‐Fernández A, Montagna M, Montalban G, Monteiro AN, Montes E, Mori L, Moserle L, Müller CR, Mundhenke C, Naldi N, Nathanson KL, Navarro M, Nevanlinna H, Nichols CB, Niederacher D, Nielsen HR, Ong K, Pachter N, Palmero EI, Papi L, Pedersen IS, Peissel B, Perez‐Segura P, Pfeifer K, Pineda M, Pohl‐Rescigno E, Poplawski NK, Porfirio B, Quante AS, Ramser J, Reis RM, Revillion F, Rhiem K, Riboli B, Ritter J, Rivera D, Rofes P, Rump A, Salinas M, Sánchez de Abajo AM, Schmidt G, Schoenwiese U, Seggewiß J, Solanes A, Steinemann D, Stiller M, Stoppa‐Lyonnet D, Sullivan KJ, Susman R, Sutter C, Tavtigian SV, Teo SH, Teulé A, Thomassen M, Tibiletti MG, Tischkowitz M, Tognazzo S, Toland AE, Tornero E, Törngren T, Torres‐Esquius S, Toss A, Trainer AH, Tucker KM, van Asperen CJ, van Mackelenbergh MT, Varesco L, Vargas‐Parra G, Varon R, Vega A, Velasco Á, Vesper A, Viel A, Vreeswijk MPG, Wagner SA, Waha A, Walker LC, Walters RJ, Wang‐Gohrke S, Weber BHF, Weichert W, Wieland K, Wiesmüller L, Witzel I, Wöckel A, Woodward ER, Zachariae S, Zampiga V, Zeder‐Göß C, Investigators KC, Lázaro C, De Nicolo A, Radice P, Engel C, Schmutzler RK, Goldgar DE, Spurdle AB. Large scale multifactorial likelihood quantitative analysis of BRCA1 and BRCA2 variants: An ENIGMA resource to support clinical variant classification. Hum Mutat 2019; 40:1557-1578. [PMID: 31131967 PMCID: PMC6772163 DOI: 10.1002/humu.23818] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/08/2019] [Accepted: 05/12/2019] [Indexed: 12/24/2022]
Abstract
The multifactorial likelihood analysis method has demonstrated utility for quantitative assessment of variant pathogenicity for multiple cancer syndrome genes. Independent data types currently incorporated in the model for assessing BRCA1 and BRCA2 variants include clinically calibrated prior probability of pathogenicity based on variant location and bioinformatic prediction of variant effect, co-segregation, family cancer history profile, co-occurrence with a pathogenic variant in the same gene, breast tumor pathology, and case-control information. Research and clinical data for multifactorial likelihood analysis were collated for 1,395 BRCA1/2 predominantly intronic and missense variants, enabling classification based on posterior probability of pathogenicity for 734 variants: 447 variants were classified as (likely) benign, and 94 as (likely) pathogenic; and 248 classifications were new or considerably altered relative to ClinVar submissions. Classifications were compared with information not yet included in the likelihood model, and evidence strengths aligned to those recommended for ACMG/AMP classification codes. Altered mRNA splicing or function relative to known nonpathogenic variant controls were moderately to strongly predictive of variant pathogenicity. Variant absence in population datasets provided supporting evidence for variant pathogenicity. These findings have direct relevance for BRCA1 and BRCA2 variant evaluation, and justify the need for gene-specific calibration of evidence types used for variant classification.
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Affiliation(s)
- Michael T. Parsons
- Department of Genetics and Computational BiologyQIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia
| | - Emma Tudini
- Department of Genetics and Computational BiologyQIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia
| | - Hongyan Li
- Cancer Control and Population Science, Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUtah
| | - Eric Hahnen
- Center for Familial Breast and Ovarian Cancer, Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
- Center for Integrated Oncology (CIO), Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
| | - Barbara Wappenschmidt
- Center for Familial Breast and Ovarian Cancer, Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
- Center for Integrated Oncology (CIO), Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
| | - Lidia Feliubadaló
- Hereditary Cancer Program, ONCOBELL‐IDIBELL‐IDIBGI‐IGTP, Catalan Institute of OncologyCIBERONCBarcelonaSpain
| | - Cora M. Aalfs
- Department of Clinical GeneticsAmsterdam UMCAmsterdamThe Netherlands
| | - Simona Agata
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOVIRCCSPaduaItaly
| | - Kristiina Aittomäki
- Department of Clinical Genetics, Helsinki University HospitalUniversity of HelsinkiHelsinkiFinland
| | - Elisa Alducci
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOVIRCCSPaduaItaly
| | | | - Norbert Arnold
- Department of Gynaecology and Obstetrics, University Hospital of Schleswig‐Holstein, Campus KielChristian‐Albrechts University KielKielGermany
- Institute of Clinical Molecular Biology, University Hospital of Schleswig‐Holstein, Campus KielChristian‐Albrechts University KielKielGermany
| | - Bernd Auber
- Institute of Human GeneticsHannover Medical SchoolHannoverGermany
| | - Rachel Austin
- Genetic Health QueenslandRoyal Brisbane and Women's HospitalBrisbaneAustralia
| | - Jacopo Azzollini
- Unit of Medical Genetics, Department of Medical Oncology and HematologyFondazione IRCCS Istituto Nazionale dei Tumori di MilanoMilanItaly
| | - Judith Balmaña
- High Risk and Cancer Prevention GroupVall d'Hebron Institute of OncologyBarcelonaSpain
- Department of Medical OncologyUniversity Hospital of Vall d'HebronBarcelonaSpain
| | - Elena Barbieri
- Department of Oncology and HaematologyUniversity of Modena and Reggio EmiliaModenaItaly
| | - Claus R. Bartram
- Institute of Human GeneticsUniversity Hospital HeidelbergHeidelbergGermany
| | - Ana Blanco
- Fundación Pública galega Medicina Xenómica‐SERGASGrupo de Medicina Xenómica‐USC, CIBERER, IDISSantiago de CompostelaSpain
| | - Britta Blümcke
- Center for Familial Breast and Ovarian Cancer, Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
- Center for Integrated Oncology (CIO), Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
| | - Sandra Bonache
- Oncogenetics GroupVall d'Hebron Institute of Oncology (VHIO)BarcelonaSpain
| | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, IEOEuropean Institute of Oncology IRCCSMilanItaly
| | - Åke Borg
- Division of Oncology and Pathology, Department of Clinical Sciences LundLund UniversityLundSweden
| | | | - Joan Brunet
- Hereditary Cancer Program, ONCOBELL‐IDIBELL‐IDIBGI‐IGTP, Catalan Institute of OncologyCIBERONCBarcelonaSpain
| | - Carla Bruzzone
- Unit of Hereditary CancerIRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Karolin Bucksch
- Institute for Medical Informatics, Statistics and EpidemiologyUniversity of LeipzigLeipzigGermany
| | - Giulia Cagnoli
- Unit of Medical Genetics, Department of Medical Oncology and HematologyFondazione IRCCS Istituto Nazionale dei Tumori di MilanoMilanItaly
| | - Trinidad Caldés
- Molecular Oncology Laboratory, CIBERONC, Hospital Clinico San CarlosIdISSC (Instituto de Investigación Sanitaria del Hospital Clínico San Carlos)MadridSpain
| | - Almuth Caliebe
- Institute of Human Genetics, University Hospital of Schleswig‐Holstein, Campus KielChristian‐Albrechts University KielKielGermany
| | | | - Mariarosaria Calvello
- Division of Cancer Prevention and Genetics, IEOEuropean Institute of Oncology IRCCSMilanItaly
| | - Gabriele L. Capone
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', Medical Genetics UnitUniversity of FlorenceFlorenceItaly
| | - Sandrine M. Caputo
- Service de GénétiqueInstitut CurieParisFrance
- Paris Sciences Lettres Research UniversityParisFrance
| | - Ileana Carnevali
- UO Anatomia PatologicaOspedale di Circolo ASST SettelaghiVareseItaly
| | - Estela Carrasco
- High Risk and Cancer Prevention GroupVall d'Hebron Institute of OncologyBarcelonaSpain
| | | | | | - Giulia Cini
- Division of Functional Onco‐genomics and Genetics, Centro di Riferimento Oncologico di Aviano (CRO)IRCCSAvianoItaly
| | - Edward M. Clarke
- Department of Genetics and Computational BiologyQIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia
| | - Paola Concolino
- Fondazione Policlinico Universitario A.GemelliIRCCSRomeItaly
| | - Elisa J. Cops
- Parkville Familial Cancer CentrePeter MacCallum Cancer CenterMelbourneVictoriaAustralia
| | - Laura Cortesi
- Department of Oncology and HaematologyUniversity of Modena and Reggio EmiliaModenaItaly
| | - Fergus J. Couch
- Department of Laboratory Medicine and PathologyMayo ClinicRochesterMinnesota
| | - Esther Darder
- Hereditary Cancer Program, ONCOBELL‐IDIBELL‐IDIBGI‐IGTP, Catalan Institute of OncologyCIBERONCBarcelonaSpain
| | - Miguel de la Hoya
- Molecular Oncology Laboratory, CIBERONC, Hospital Clinico San CarlosIdISSC (Instituto de Investigación Sanitaria del Hospital Clínico San Carlos)MadridSpain
| | - Michael Dean
- Laboratory of Translational Genomics, DCEGNational Cancer InstituteGaithersburgMaryland
| | - Irmgard Debatin
- Institute of Human GeneticsUniversity Hospital UlmUlmGermany
| | - Jesús Del Valle
- Hereditary Cancer Program, ONCOBELL‐IDIBELL‐IDIBGI‐IGTP, Catalan Institute of OncologyCIBERONCBarcelonaSpain
| | | | - Nicolas Derive
- Service de GénétiqueInstitut CurieParisFrance
- Paris Sciences Lettres Research UniversityParisFrance
| | - Orland Diez
- Oncogenetics GroupVall d'Hebron Institute of Oncology (VHIO)BarcelonaSpain
- Clinical and Molecular Genetics AreaUniversity Hospital Vall d'HebronBarcelonaSpain
| | - Nina Ditsch
- Department of Gynecology and ObstetricsUniversity of MunichMunichGermany
| | - Susan M. Domchek
- Basser Center for BRCA, Abramson Cancer CenterUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Véronique Dutrannoy
- Institute of Medical and Human GeneticsCharité –Universitätsmedizin BerlinBerlinGermany
| | | | - Hans Ehrencrona
- Department of Clinical Genetics and Pathology, Laboratory MedicineOffice for Medical Services ‐ Region SkåneLundSweden
- Division of Clinical Genetics, Department of Laboratory MedicineLund UniversityLundSweden
| | - Ute Enders
- Institute for Medical Informatics, Statistics and EpidemiologyUniversity of LeipzigLeipzigGermany
| | - D. Gareth Evans
- Genomic Medicine, Division of Evolution and Genomic Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester Universities Foundation TrustSt. Mary's HospitalManchesterUK
- Genomic Medicine, North West Genomics hub, Manchester Academic Health Science Centre, Manchester Universities Foundation TrustSt. Mary's HospitalManchesterUK
| | - Chantal Farra
- Medical GeneticsAmerican University of Beirut Medical CenterBeirutLebanon
| | - Ulrike Faust
- Institute of Medical Genetics and Applied GenomicsUniversity of TübingenTübingenGermany
| | - Ute Felbor
- Institute of Human GeneticsUniversity Medicine GreifswaldGreifswaldGermany
| | - Irene Feroce
- Division of Cancer Prevention and Genetics, IEOEuropean Institute of Oncology IRCCSMilanItaly
| | - Miriam Fine
- Adult Genetics UnitRoyal Adelaide HospitalAdelaideAustralia
| | - William D. Foulkes
- Program in Cancer Genetics, Departments of Human Genetics and OncologyMcGill UniversityMontréalQCCanada
| | | | | | - Andrea Gehrig
- Department of Human GeneticsUniversity of WürzburgWürzburgGermany
| | - Francesca Gensini
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', Medical Genetics UnitUniversity of FlorenceFlorenceItaly
| | - Anne‐Marie Gerdes
- Department of Clinical Genetics, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Aldo Germani
- Department of Clinical and Molecular Medicine, Sant'Andrea University HospitalSapienza UniversityRomeItaly
| | - Jutta Giesecke
- Center for Familial Breast and Ovarian Cancer, Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
- Center for Integrated Oncology (CIO), Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
| | - Viviana Gismondi
- Unit of Hereditary CancerIRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Carolina Gómez
- Hereditary Cancer Program, ONCOBELL‐IDIBELL‐IDIBGI‐IGTP, Catalan Institute of OncologyCIBERONCBarcelonaSpain
| | - Encarna B. Gómez Garcia
- Department of Clinical GeneticsMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Sara González
- Hereditary Cancer Program, ONCOBELL‐IDIBELL‐IDIBGI‐IGTP, Catalan Institute of OncologyCIBERONCBarcelonaSpain
| | - Elia Grau
- Hereditary Cancer Program, ONCOBELL‐IDIBELL‐IDIBGI‐IGTP, Catalan Institute of OncologyCIBERONCBarcelonaSpain
| | - Sabine Grill
- Division of Gynaecology and Obstetrics, Klinikum rechts der Isar der TechnischenUniversität MünchenMunichGermany
| | - Eva Gross
- Department of Gynecology and ObstetricsUniversity of MunichMunichGermany
| | | | | | | | - Thomas Haaf
- Department of Human GeneticsUniversity of WürzburgWürzburgGermany
| | - Karl Hackmann
- Institute for Clinical Genetics, Faculty of Medicine Carl Gustav CarusTU DresdenDresdenGermany
| | - Thomas V.O. Hansen
- Department of Clinical Genetics, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | | | - Jan Hauke
- Center for Familial Breast and Ovarian Cancer, Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
- Center for Integrated Oncology (CIO), Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
| | - Tilman Heinrich
- Institute of Medical Genetics and Applied GenomicsUniversity of TübingenTübingenGermany
| | - Heide Hellebrand
- Division of Gynaecology and Obstetrics, Klinikum rechts der Isar der TechnischenUniversität MünchenMunichGermany
| | | | - Ellen Honisch
- Department of Gynecology and Obstetrics, University Hospital DüsseldorfHeinrich‐Heine University DüsseldorfDüsseldorfGermany
| | - Judit Horvath
- Institute of Human GeneticsUniversity of MünsterMünsterGermany
| | - Claude Houdayer
- Department of Genetics, F76000 and Normandy University, UNIROUEN, Inserm U1245, Normandy Centre for Genomic and Personalized MedicineRouen University HospitalRouenFrance
| | - Verena Hübbel
- Center for Familial Breast and Ovarian Cancer, Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
- Center for Integrated Oncology (CIO), Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
| | - Silvia Iglesias
- Hereditary Cancer Program, ONCOBELL‐IDIBELL‐IDIBGI‐IGTP, Catalan Institute of OncologyCIBERONCBarcelonaSpain
| | - Angel Izquierdo
- Hereditary Cancer Program, ONCOBELL‐IDIBELL‐IDIBGI‐IGTP, Catalan Institute of OncologyCIBERONCBarcelonaSpain
| | - Paul A. James
- Parkville Familial Cancer CentrePeter MacCallum Cancer CenterMelbourneVictoriaAustralia
- Sir Peter MacCallum Department of OncologyThe University of MelbourneMelbourneVictoriaAustralia
| | - Linda A.M. Janssen
- Department of Clinical GeneticsLeiden University Medical CenterLeidenThe Netherlands
| | - Udo Jeschke
- Department of Gynecology and ObstetricsUniversity of MunichMunichGermany
| | - Silke Kaulfuß
- Institute of Human GeneticsUniversity Medical Center GöttingenGöttingenGermany
| | - Katharina Keupp
- Center for Familial Breast and Ovarian Cancer, Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
- Center for Integrated Oncology (CIO), Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
| | - Marion Kiechle
- Division of Gynaecology and Obstetrics, Klinikum rechts der Isar der TechnischenUniversität MünchenMunichGermany
| | - Alexandra Kölbl
- Department of Gynecology and ObstetricsUniversity of MunichMunichGermany
| | - Sophie Krieger
- Laboratoire de Biologie Clinique et OncologiqueCentre Francois BaclesseCaenFrance
- Genomics and Personalized Medecine in Cancer and Neurological DisordersNormandy Centre for Genomic and Personalized MedicineRouenFrance
- Normandie UniversitéUNICAENCaenFrance
| | - Torben A. Kruse
- Department of Clinical GeneticsOdense University HospitalOdense CDenmark
| | - Anders Kvist
- Division of Oncology and Pathology, Department of Clinical Sciences LundLund UniversityLundSweden
| | - Fiona Lalloo
- Genomic Medicine, North West Genomics hub, Manchester Academic Health Science Centre, Manchester Universities Foundation TrustSt. Mary's HospitalManchesterUK
| | - Mirjam Larsen
- Center for Familial Breast and Ovarian Cancer, Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
- Center for Integrated Oncology (CIO), Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
| | - Vanessa L. Lattimore
- Department of Pathology and Biomedical ScienceUniversity of OtagoChristchurchNew Zealand
| | - Charlotte Lautrup
- Department of Clinical GeneticsAalborg University HospitalAalborgDenmark
- Clinical Cancer Research CenterAalborg University HospitalAalborgDenmark
| | - Susanne Ledig
- Institute of Human GeneticsUniversity of MünsterMünsterGermany
| | - Elena Leinert
- Department of Gynaecology and ObstetricsUniversity Hospital UlmUlmGermany
| | | | - Joanna Lim
- Breast Cancer Research ProgrammeCancer Research MalaysiaSubang JayaSelangorMalaysia
| | - Markus Loeffler
- Institute for Medical Informatics, Statistics and EpidemiologyUniversity of LeipzigLeipzigGermany
| | - Adrià López‐Fernández
- High Risk and Cancer Prevention GroupVall d'Hebron Institute of OncologyBarcelonaSpain
| | - Emanuela Lucci‐Cordisco
- UOC Genetica Medica, Fondazione Policlinico Universitario A.Gemelli IRCCS and Istituto di Medicina GenomicaUniversità Cattolica del Sacro CuoreRomeItaly
| | - Nicolai Maass
- Department of Gynaecology and Obstetrics, University Hospital of Schleswig‐Holstein, Campus KielChristian‐Albrechts University KielKielGermany
| | - Siranoush Manoukian
- Unit of Medical Genetics, Department of Medical Oncology and HematologyFondazione IRCCS Istituto Nazionale dei Tumori di MilanoMilanItaly
| | - Monica Marabelli
- Division of Cancer Prevention and Genetics, IEOEuropean Institute of Oncology IRCCSMilanItaly
| | - Laura Matricardi
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOVIRCCSPaduaItaly
| | - Alfons Meindl
- Department of Gynecology and ObstetricsUniversity of MunichMunichGermany
| | | | - Setareh Moghadasi
- Department of Clinical GeneticsLeiden University Medical CenterLeidenThe Netherlands
| | | | - Marco Montagna
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOVIRCCSPaduaItaly
| | - Gemma Montalban
- Oncogenetics GroupVall d'Hebron Institute of Oncology (VHIO)BarcelonaSpain
| | | | - Eva Montes
- Hereditary Cancer Program, ONCOBELL‐IDIBELL‐IDIBGI‐IGTP, Catalan Institute of OncologyCIBERONCBarcelonaSpain
| | - Luigi Mori
- Department of Clinical and Experimental Science, University of Brescia c/o 2nd Internal MedicineHospital of BresciaBresciaItaly
| | - Lidia Moserle
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOVIRCCSPaduaItaly
| | | | - Christoph Mundhenke
- Department of Gynaecology and Obstetrics, University Hospital of Schleswig‐Holstein, Campus KielChristian‐Albrechts University KielKielGermany
| | - Nadia Naldi
- Division of OncologyUniversity Hospital of ParmaParmaItaly
| | - Katherine L. Nathanson
- Basser Center for BRCA, Abramson Cancer CenterUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Matilde Navarro
- Hereditary Cancer Program, ONCOBELL‐IDIBELL‐IDIBGI‐IGTP, Catalan Institute of OncologyCIBERONCBarcelonaSpain
| | - Heli Nevanlinna
- Department of Obstetrics and Gynecology, Helsinki University HospitalUniversity of HelsinkiHelsinkiFinland
| | - Cassandra B. Nichols
- Genetic Services of Western AustraliaKing Edward Memorial HospitalPerthAustralia
| | - Dieter Niederacher
- Department of Gynecology and Obstetrics, University Hospital DüsseldorfHeinrich‐Heine University DüsseldorfDüsseldorfGermany
| | | | - Kai‐ren Ong
- West Midlands Regional Genetics ServiceBirmingham Women's Hospital Healthcare NHS TrustBirminghamUK
| | - Nicholas Pachter
- Genetic Services of Western AustraliaKing Edward Memorial HospitalPerthAustralia
- Faculty of Health and Medical SciencesUniversity of Western AustraliaPerthAustralia
| | - Edenir I. Palmero
- Molecular Oncology Research CenterBarretos Cancer HospitalSão PauloBrazil
- Barretos School of Health SciencesDr. Paulo Prata ‐ FACISBSão PauloBrazil
| | - Laura Papi
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', Medical Genetics UnitUniversity of FlorenceFlorenceItaly
| | - Inge Sokilde Pedersen
- Clinical Cancer Research CenterAalborg University HospitalAalborgDenmark
- Molecular DiagnosticsAalborg University HospitalAalborgDenmark
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | - Bernard Peissel
- Unit of Medical Genetics, Department of Medical Oncology and HematologyFondazione IRCCS Istituto Nazionale dei Tumori di MilanoMilanItaly
| | - Pedro Perez‐Segura
- Molecular Oncology Laboratory, CIBERONC, Hospital Clinico San CarlosIdISSC (Instituto de Investigación Sanitaria del Hospital Clínico San Carlos)MadridSpain
| | - Katharina Pfeifer
- Division of Gynaecology and Obstetrics, Klinikum rechts der Isar der TechnischenUniversität MünchenMunichGermany
| | - Marta Pineda
- Hereditary Cancer Program, ONCOBELL‐IDIBELL‐IDIBGI‐IGTP, Catalan Institute of OncologyCIBERONCBarcelonaSpain
| | - Esther Pohl‐Rescigno
- Center for Familial Breast and Ovarian Cancer, Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
- Center for Integrated Oncology (CIO), Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
| | - Nicola K. Poplawski
- Adult Genetics UnitRoyal Adelaide HospitalAdelaideAustralia
- School of Paediatrics and Reproductive HealthUniversity of AdelaideAdelaideAustralia
| | - Berardino Porfirio
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', Medical Genetics UnitUniversity of FlorenceFlorenceItaly
| | - Anne S. Quante
- Division of Gynaecology and Obstetrics, Klinikum rechts der Isar der TechnischenUniversität MünchenMunichGermany
| | - Juliane Ramser
- Division of Gynaecology and Obstetrics, Klinikum rechts der Isar der TechnischenUniversität MünchenMunichGermany
| | - Rui M. Reis
- Molecular Oncology Research CenterBarretos Cancer HospitalSão PauloBrazil
- Health Sciences SchoolUniversity of MinhoBragaPortugal
- ICVS/3B's‐PT Government Associate LaboratoryBragaPortugal
| | - Françoise Revillion
- Laboratoire d'Oncogenetique Moleculaire HumaineCentre Oscar LambretLilleFrance
| | - Kerstin Rhiem
- Center for Familial Breast and Ovarian Cancer, Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
- Center for Integrated Oncology (CIO), Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
| | | | - Julia Ritter
- Institute of Medical and Human GeneticsCharité –Universitätsmedizin BerlinBerlinGermany
| | - Daniela Rivera
- Unit of Hereditary CancerIRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Paula Rofes
- Hereditary Cancer Program, ONCOBELL‐IDIBELL‐IDIBGI‐IGTP, Catalan Institute of OncologyCIBERONCBarcelonaSpain
| | - Andreas Rump
- Institute for Clinical Genetics, Faculty of Medicine Carl Gustav CarusTU DresdenDresdenGermany
| | - Monica Salinas
- Hereditary Cancer Program, ONCOBELL‐IDIBELL‐IDIBGI‐IGTP, Catalan Institute of OncologyCIBERONCBarcelonaSpain
| | - Ana María Sánchez de Abajo
- Servicio de Análisis Clínicos y Bioquímica Clínica, Complejo HospitalarioUniversitario Insular Materno‐Infantil de Gran CanariaLas Palmas de Gran CanaríaSpain
| | - Gunnar Schmidt
- Institute of Human GeneticsHannover Medical SchoolHannoverGermany
| | - Ulrike Schoenwiese
- Institute for Medical Informatics, Statistics and EpidemiologyUniversity of LeipzigLeipzigGermany
| | - Jochen Seggewiß
- Institute of Human GeneticsUniversity of MünsterMünsterGermany
| | - Ares Solanes
- Hereditary Cancer Program, ONCOBELL‐IDIBELL‐IDIBGI‐IGTP, Catalan Institute of OncologyCIBERONCBarcelonaSpain
| | - Doris Steinemann
- Institute of Human GeneticsHannover Medical SchoolHannoverGermany
| | - Mathias Stiller
- Institute of Human GeneticsUniversity Hospital LeipzigLeipzigGermany
| | - Dominique Stoppa‐Lyonnet
- Service de GénétiqueInstitut CurieParisFrance
- Department of Tumour BiologyINSERM U830ParisFrance
- Université Paris DescartesParisFrance
| | - Kelly J. Sullivan
- Genetic Health Service NZ‐ Northern HubAuckland District Health BoardAucklandNew Zealand
| | - Rachel Susman
- Genetic Health QueenslandRoyal Brisbane and Women's HospitalBrisbaneAustralia
| | - Christian Sutter
- Institute of Human GeneticsUniversity Hospital HeidelbergHeidelbergGermany
| | - Sean V. Tavtigian
- Department of Oncological ServicesUniversity of Utah School of MedicineSalt Lake CityUtah
- Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUtah
| | - Soo H. Teo
- Breast Cancer Research ProgrammeCancer Research MalaysiaSubang JayaSelangorMalaysia
- Department of Surgery, Faculty of MedicineUniversity MalayaKuala LumpurMalaysia
| | - Alex Teulé
- Hereditary Cancer Program, ONCOBELL‐IDIBELL‐IDIBGI‐IGTP, Catalan Institute of OncologyCIBERONCBarcelonaSpain
| | - Mads Thomassen
- Department of Clinical GeneticsOdense University HospitalOdense CDenmark
| | | | - Marc Tischkowitz
- Department of Medical GeneticsUniversity of CambridgeCambridgeUK
| | - Silvia Tognazzo
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOVIRCCSPaduaItaly
| | - Amanda E. Toland
- Department of Cancer Biology and GeneticsThe Ohio State UniversityColumbusOhio
| | - Eva Tornero
- Hereditary Cancer Program, ONCOBELL‐IDIBELL‐IDIBGI‐IGTP, Catalan Institute of OncologyCIBERONCBarcelonaSpain
| | - Therese Törngren
- Division of Oncology and Pathology, Department of Clinical Sciences LundLund UniversityLundSweden
| | - Sara Torres‐Esquius
- High Risk and Cancer Prevention GroupVall d'Hebron Institute of OncologyBarcelonaSpain
| | - Angela Toss
- Department of Oncology and HaematologyUniversity of Modena and Reggio EmiliaModenaItaly
| | - Alison H. Trainer
- Parkville Familial Cancer CentrePeter MacCallum Cancer CenterMelbourneVictoriaAustralia
- Department of medicineUniversity of MelbourneMelbourneVictoriaAustralia
| | - Katherine M. Tucker
- Prince of Wales Clinical SchoolUniversity of NSWSydneyNew South WalesAustralia
- Hereditary Cancer Clinic, Department of Medical OncologyPrince of Wales HospitalRandwickNew South WalesAustralia
| | | | - Marion T. van Mackelenbergh
- Department of Gynaecology and Obstetrics, University Hospital of Schleswig‐Holstein, Campus KielChristian‐Albrechts University KielKielGermany
| | - Liliana Varesco
- Unit of Hereditary CancerIRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Gardenia Vargas‐Parra
- Hereditary Cancer Program, ONCOBELL‐IDIBELL‐IDIBGI‐IGTP, Catalan Institute of OncologyCIBERONCBarcelonaSpain
| | - Raymonda Varon
- Institute of Medical and Human GeneticsCharité –Universitätsmedizin BerlinBerlinGermany
| | - Ana Vega
- Fundación Pública galega Medicina Xenómica‐SERGASGrupo de Medicina Xenómica‐USC, CIBERER, IDISSantiago de CompostelaSpain
| | - Ángela Velasco
- Hereditary Cancer Program, ONCOBELL‐IDIBELL‐IDIBGI‐IGTP, Catalan Institute of OncologyCIBERONCBarcelonaSpain
| | - Anne‐Sophie Vesper
- Department of Gynecology and Obstetrics, University Hospital DüsseldorfHeinrich‐Heine University DüsseldorfDüsseldorfGermany
| | - Alessandra Viel
- Division of Functional Onco‐genomics and Genetics, Centro di Riferimento Oncologico di Aviano (CRO)IRCCSAvianoItaly
| | | | - Sebastian A. Wagner
- Department of MedicineHematology/Oncology, Goethe‐University FrankfurtFrankfurtGermany
| | - Anke Waha
- Center for Familial Breast and Ovarian Cancer, Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
- Center for Integrated Oncology (CIO), Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
| | - Logan C. Walker
- Department of Pathology and Biomedical ScienceUniversity of OtagoChristchurchNew Zealand
| | - Rhiannon J. Walters
- Department of Genetics and Computational BiologyQIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia
| | - Shan Wang‐Gohrke
- Department of Gynaecology and ObstetricsUniversity Hospital UlmUlmGermany
| | | | - Wilko Weichert
- Institute of PathologyTechnische Universität MünchenMunichGermany
| | - Kerstin Wieland
- Institute for Medical Informatics, Statistics and EpidemiologyUniversity of LeipzigLeipzigGermany
| | - Lisa Wiesmüller
- Department of Gynaecology and ObstetricsUniversity Hospital UlmUlmGermany
| | - Isabell Witzel
- Department of GynecologyUniversity Medical Center HamburgHamburgGermany
| | - Achim Wöckel
- Department of Gynecology and ObstetricsUniversity Hospital WürzburgWürzburgGermany
| | - Emma R. Woodward
- Genomic Medicine, Division of Evolution and Genomic Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester Universities Foundation TrustSt. Mary's HospitalManchesterUK
- Genomic Medicine, North West Genomics hub, Manchester Academic Health Science Centre, Manchester Universities Foundation TrustSt. Mary's HospitalManchesterUK
| | - Silke Zachariae
- Institute for Medical Informatics, Statistics and EpidemiologyUniversity of LeipzigLeipzigGermany
| | - Valentina Zampiga
- Biosciences LaboratoryIstituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCSMeldolaItaly
| | | | - KConFab Investigators
- Sir Peter MacCallum Department of OncologyThe University of MelbourneMelbourneVictoriaAustralia
- Research DepartmentPeter MacCallum Cancer CenterMelbourneVictoriaAustralia
| | - Conxi Lázaro
- Hereditary Cancer Program, ONCOBELL‐IDIBELL‐IDIBGI‐IGTP, Catalan Institute of OncologyCIBERONCBarcelonaSpain
| | | | - Paolo Radice
- Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of ResearchFondazione IRCCS Istituto Nazionale dei Tumori (INT)MilanItaly
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and EpidemiologyUniversity of LeipzigLeipzigGermany
| | - Rita K. Schmutzler
- Center for Familial Breast and Ovarian Cancer, Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
- Center for Integrated Oncology (CIO), Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
| | - David E. Goldgar
- Department of Dermatology, Huntsman Cancer InstituteUniversity of Utah School of MedicineSalt Lake CityUtah
| | - Amanda B. Spurdle
- Department of Genetics and Computational BiologyQIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia
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McGill BC, Wakefield CE, Vetsch J, Lim Q, Warby M, Metcalfe A, Byrne JA, Cohn RJ, Tucker KM. "I remember how I felt, but I don't remember the gene": Families' experiences of cancer-related genetic testing in childhood. Pediatr Blood Cancer 2019; 66:e27762. [PMID: 31006986 DOI: 10.1002/pbc.27762] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 04/02/2019] [Accepted: 04/04/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Genetic testing in children for hereditary cancer predisposition syndromes (CPSs) involves unique psychosocial and family-systems considerations. This retrospective study explored the perspectives and emotional reactions of parents and young adults about cancer-related genetic counseling and testing offered to children in the family. METHODS Families were eligible if they had considered genetic testing for a child (≤18 years) within the family. Parents and young adults ≥16 years participated in semistructured interviews that we coded and identified key themes. We also quantitively assessed emotional distress, quality of life, impact of receiving genetic cancer risk information, and service-related satisfaction. RESULTS From 35 interviews (26 parents, nine young adults), we identified themes spanning families' experiences from referral to genetic services to the longer term impact of receiving information about family cancer risk from testing of children. Supported by quantitative data, families generally described positive experiences of genetic services and reported benefits to genetic testing. Nevertheless, families faced unique emotional and relational challenges that changed over the family lifecycle. Those challenges differed according to whether the child was asymptomatic or had a cancer diagnosis at testing. Parents of children with cancer described genetic consultations as a secondary concern to the immediate stressors of their child's treatment. CONCLUSIONS We conclude that the successful integration of cancer genetics into pediatric cancer care requires specialist pediatric genetic counseling and psychosocial support services that are able to respond to families' changing needs.
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Affiliation(s)
- Brittany C McGill
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Sydney, New South Wales, Australia
| | - Claire E Wakefield
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Sydney, New South Wales, Australia
| | - Janine Vetsch
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Sydney, New South Wales, Australia
| | - Qishan Lim
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Sydney, New South Wales, Australia
| | - Meera Warby
- Hereditary Cancer Clinic, Department of Medical Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Alison Metcalfe
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, United Kingdom
| | - Jennifer A Byrne
- Molecular Oncology Laboratory, Children's Cancer Research Unit, Kids Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,The University of Sydney Discipline of Child and Adolescent Health, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Richard J Cohn
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Sydney, New South Wales, Australia
| | - Katherine M Tucker
- Hereditary Cancer Clinic, Department of Medical Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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34
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Qian F, Wang S, Mitchell J, McGuffog L, Barrowdale D, Leslie G, Oosterwijk JC, Chung WK, Evans DG, Engel C, Kast K, Aalfs CM, Adank MA, Adlard J, Agnarsson BA, Aittomäki K, Alducci E, Andrulis IL, Arun BK, Ausems MGEM, Azzollini J, Barouk-Simonet E, Barwell J, Belotti M, Benitez J, Berger A, Borg A, Bradbury AR, Brunet J, Buys SS, Caldes T, Caligo MA, Campbell I, Caputo SM, Chiquette J, Claes KBM, Margriet Collée J, Couch FJ, Coupier I, Daly MB, Davidson R, Diez O, Domchek SM, Donaldson A, Dorfling CM, Eeles R, Feliubadaló L, Foretova L, Fowler J, Friedman E, Frost D, Ganz PA, Garber J, Garcia-Barberan V, Glendon G, Godwin AK, Gómez Garcia EB, Gronwald J, Hahnen E, Hamann U, Henderson A, Hendricks CB, Hopper JL, Hulick PJ, Imyanitov EN, Isaacs C, Izatt L, Izquierdo Á, Jakubowska A, Kaczmarek K, Kang E, Karlan BY, Kets CM, Kim SW, Kim Z, Kwong A, Laitman Y, Lasset C, Hyuk Lee M, Won Lee J, Lee J, Lester J, Lesueur F, Loud JT, Lubinski J, Mebirouk N, Meijers-Heijboer HEJ, Meindl A, Miller A, Montagna M, Mooij TM, Morrison PJ, Mouret-Fourme E, Nathanson KL, Neuhausen SL, Nevanlinna H, Niederacher D, Nielsen FC, Nussbaum RL, Offit K, Olah E, Ong KR, Ottini L, Park SK, Peterlongo P, Pfeiler G, Phelan CM, Poppe B, Pradhan N, Radice P, Ramus SJ, Rantala J, Robson M, Rodriguez GC, Schmutzler RK, Hutten Selkirk CG, Shah PD, Simard J, Singer CF, Sokolowska J, Stoppa-Lyonnet D, Sutter C, Yen Tan Y, Teixeira RM, Teo SH, Terry MB, Thomassen M, Tischkowitz M, Toland AE, Tucker KM, Tung N, van Asperen CJ, van Engelen K, van Rensburg EJ, Wang-Gohrke S, Wappenschmidt B, Weitzel JN, Yannoukakos D, Greene MH, Rookus MA, Easton DF, Chenevix-Trench G, Antoniou AC, Goldgar DE, Olopade OI, Rebbeck TR, Huo D. Height and Body Mass Index as Modifiers of Breast Cancer Risk in BRCA1/2 Mutation Carriers: A Mendelian Randomization Study. J Natl Cancer Inst 2019; 111:350-364. [PMID: 30312457 PMCID: PMC6449171 DOI: 10.1093/jnci/djy132] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 06/03/2018] [Accepted: 06/29/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND BRCA1/2 mutations confer high lifetime risk of breast cancer, although other factors may modify this risk. Whether height or body mass index (BMI) modifies breast cancer risk in BRCA1/2 mutation carriers remains unclear. METHODS We used Mendelian randomization approaches to evaluate the association of height and BMI on breast cancer risk, using data from the Consortium of Investigators of Modifiers of BRCA1/2 with 14 676 BRCA1 and 7912 BRCA2 mutation carriers, including 11 451 cases of breast cancer. We created a height genetic score using 586 height-associated variants and a BMI genetic score using 93 BMI-associated variants. We examined both observed and genetically determined height and BMI with breast cancer risk using weighted Cox models. All statistical tests were two-sided. RESULTS Observed height was positively associated with breast cancer risk (HR = 1.09 per 10 cm increase, 95% confidence interval [CI] = 1.0 to 1.17; P = 1.17). Height genetic score was positively associated with breast cancer, although this was not statistically significant (per 10 cm increase in genetically predicted height, HR = 1.04, 95% CI = 0.93 to 1.17; P = .47). Observed BMI was inversely associated with breast cancer risk (per 5 kg/m2 increase, HR = 0.94, 95% CI = 0.90 to 0.98; P = .007). BMI genetic score was also inversely associated with breast cancer risk (per 5 kg/m2 increase in genetically predicted BMI, HR = 0.87, 95% CI = 0.76 to 0.98; P = .02). BMI was primarily associated with premenopausal breast cancer. CONCLUSION Height is associated with overall breast cancer and BMI is associated with premenopausal breast cancer in BRCA1/2 mutation carriers. Incorporating height and BMI, particularly genetic score, into risk assessment may improve cancer management.
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Affiliation(s)
- Frank Qian
- Department of Medicine, The University of Chicago, Chicago, IL
| | - Shengfeng Wang
- Center for Clinical Cancer Genetics, The University of Chicago, Chicago, IL
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jonathan Mitchell
- Division of Gastroenterology, Department of Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Lesley McGuffog
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, UK
| | - Daniel Barrowdale
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, UK
| | - Goska Leslie
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, UK
| | - Jan C Oosterwijk
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Wendy K Chung
- Departments of Pediatrics and Medicine, Columbia University, New York, NY
| | - D Gareth Evans
- Division of Evolution and Genomic Sciences, Genomic Medicine, Manchester Academic Health Sciences Centre, University of Manchester, Central Manchester University Hospitals, NHS Foundation Trust, Manchester, UK
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Karin Kast
- Department of Gynecology and Obstetrics, Technical University of Dresden, Dresden, Germany
- Department of Clinical Genetics and GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Cora M Aalfs
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, the Netherlands
- Center for Medical Genetics, NorthShore University HealthSystem, Evanston, IL
- The University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Muriel A Adank
- Family Cancer Clinic, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Julian Adlard
- Yorkshire Regional Genetics Service, Chapel Allerton Hospital, Leeds, UK
- Department of Clinical Genetics and GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Bjarni A Agnarsson
- Department of Pathology, National Institute of Oncology, Budapest, Hungary
- School of Medicine, University of Iceland, Reykjavik, Iceland
| | - Kristiina Aittomäki
- Department of Clinical Genetics, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Elisa Alducci
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
- Department of Clinical Genetics and GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Irene L Andrulis
- Fred A. Litwin Center for Cancer Genetics, Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Toronto, ON, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Banu K Arun
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Jacopo Azzollini
- Unit of Medical Genetics, Department of Medical Oncology and Hematology, Fondazione IRCCS (Istituto Di Ricovero e Cura a Carattere Scientifico) Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Emmanuelle Barouk-Simonet
- Oncogénétique, Institut Bergonié, Bordeaux, France
- Department of Pathology and Laboratory Medicine, Kansas University Medical Center, Kansas City, KS
| | - Julian Barwell
- Leicestershire Clinical Genetics Service, University Hospitals of Leicester NHS Trust, Leicester, UK
- Genetic Counseling Unit, Hereditary Cancer Program, IDIBGI (Institut d'Investigació Biomèdica de Girona), Catalan Institute of Oncology, CIBERONC, Girona, Spain
| | | | - Javier Benitez
- Schools of Medicine and Public Health, Division of Cancer Prevention & Control Research, Jonsson Comprehensive Cancer Center, University of California Los Angeles, CA
| | - Andreas Berger
- Department of Oncology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Ake Borg
- Cancer Risk and Prevention Clinic, Dana-Farber Cancer Institute, Boston, MA
- Institute of Genetic Medicine, Centre for Life, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Angela R Bradbury
- Department of Medicine, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Joan Brunet
- Service de Génétique, Institut Curie, Paris, France
- Human Cancer Genetics Program, Spanish National Cancer Research Centre, Madrid, Spain
- Centro de Investigación en Red de Enfermedades Raras (CIBERER), Valencia, Spain, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Saundra S Buys
- Department of Medicine, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Trinidad Caldes
- Molecular Oncology Laboratory, Hospital Clinico San Carlos, IdISSC, CIBERONC, Madrid, Spain
| | - Maria A Caligo
- Section of Genetic Oncology, Department of Laboratory Medicine, University and University Hospital of Pisa, Pisa, Italy
| | - Ian Campbell
- Peter MacCallum Cancer Center, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sandrine M Caputo
- Leicestershire Clinical Genetics Service, University Hospitals of Leicester NHS Trust, Leicester, UK
- Service de Génétique, Institut Curie, Paris, France
| | - Jocelyne Chiquette
- Unité de recherche en santé des populations, Centre des maladies du sein Deschênes-Fabia, Hôpital du Saint-Sacrement, Québec, QC, Canada
| | | | - J Margriet Collée
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Fergus J Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Isabelle Coupier
- Unité d'Oncogénétique, CHU Arnaud de Villeneuve, Montpellier, France
| | - Mary B Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA
| | - Rosemarie Davidson
- Department of Clinical Genetics, South Glasgow University Hospitals, Glasgow, UK
| | - Orland Diez
- N.N. Petrov Institute of Oncology, St. Petersburg, Russia
| | - Susan M Domchek
- Department of Medicine, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Alan Donaldson
- Oncogenetics Group, Clinical and Molecular Genetics Area, Vall d'Hebron Institute of Oncology (VHIO), University Hospital, Vall d'Hebron, Barcelona, Spain (OD); Clinical Genetics Department, St Michael's Hospital, Bristol, UK
| | - Cecilia M Dorfling
- Department of Genetics, University of Pretoria, Arcadia, South Africa
- City of Hope Clinical Cancer Genetics Community Research Network, Duarte, CA
| | - Ros Eeles
- Ocogenetics Team, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Lidia Feliubadaló
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lenka Foretova
- Molecular Diagnostic Unit, Hereditary Cancer Program, ICO-IDIBELL (Catalan Institute of Oncology, Bellvitge Biomedical Research Institute), CIBERONC, Barcelona, Spain
- Department of Cancer Epidemiology and Genetics, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Jeffrey Fowler
- The Ohio State University, Columbus Cancer Council, Columbus, OH
| | - Eitan Friedman
- The Susanne Levy Gertner Oncogenetics Unit, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Debra Frost
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, UK
| | - Patricia A Ganz
- Schools of Medicine and Public Health, Division of Cancer Prevention & Control Research, Jonsson Comprehensive Cancer Center, University of California Los Angeles, CA
| | - Judy Garber
- Cancer Risk and Prevention Clinic, Dana-Farber Cancer Institute, Boston, MA
| | - Vanesa Garcia-Barberan
- Molecular Oncology Laboratory, Hospital Clinico San Carlos, IdISSC, CIBERONC, Madrid, Spain
| | - Gord Glendon
- Fred A. Litwin Center for Cancer Genetics, Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Toronto, ON, Canada
| | - Andrew K Godwin
- Department of Pathology and Laboratory Medicine, Kansas University Medical Center, Kansas City, KS
| | - Encarna B Gómez Garcia
- Department of Clinical Genetics and GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jacek Gronwald
- Department of Clinical Genetics and GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Eric Hahnen
- Centers for Hereditary Breast and Ovarian Cancer, Integrated Oncology and Molecular Medicine, University Hospital of Cologne, Cologne, Germany Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Alex Henderson
- Institute of Genetic Medicine, Centre for Life, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Carolyn B Hendricks
- City of Hope Clinical Cancer Genetics Community Research Network, Duarte, CA
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter J Hulick
- Center for Medical Genetics, NorthShore University HealthSystem, Evanston, IL
- The University of Chicago Pritzker School of Medicine, Chicago, IL
| | | | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC (CI)
| | - Louise Izatt
- Clinical Genetics, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Ángel Izquierdo
- Genetic Counseling Unit, Hereditary Cancer Program, IDIBGI (Institut d'Investigació Biomèdica de Girona), Catalan Institute of Oncology, CIBERONC, Girona, Spain
| | - Anna Jakubowska
- Department of Clinical Genetics and GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Katarzyna Kaczmarek
- Department of Clinical Genetics and GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Eunyoung Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Beth Y Karlan
- Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Carolien M Kets
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sung-Won Kim
- Department of Surgery, Daerim Saint Mary's Hospital, Seoul, Korea
| | - Zisun Kim
- Department of Surgery, Soonchunhyang University Hospital Bucheon, Bucheon, Korea
| | - Ava Kwong
- Hong Kong Hereditary Breast Cancer Family Registry, Happy Valley, Hong Kong
- Department of Surgery, The University of Hong Kong, Pok Fu Lam, Hong Kong
- Department of Surgery, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong
| | - Yael Laitman
- The Susanne Levy Gertner Oncogenetics Unit, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Christine Lasset
- Unité de Prévention et d’Epidémiologie Génétique, Centre Léon Bérard, Lyon, France
| | - Min Hyuk Lee
- Department of Surgery, Soonchunhyang University College of Medicine and Soonchunhyang University Hospital, Seoul, Korea
| | - Jong Won Lee
- Department of Surgery, Ulsan University College of Medicine and Asan Medical Center, Seoul, Korea
| | - Jihyoun Lee
- Department of Clinical Genetics and GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
- Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
- Department of Surgery, Soonchunhyang University College of Medicine and Soonchunhyang University Hospital, Seoul, Korea
| | - Jenny Lester
- Department of Clinical Genetics and GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Fabienne Lesueur
- Genetic Epidemiology of Cancer team, Institut Curie, Paris, France
- U900, INSERM, Paris, France
- PSL University, Paris, France
- Mines ParisTech, Fontainebleau, France
| | - Jennifer T Loud
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Jan Lubinski
- Department of Clinical Genetics and GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Noura Mebirouk
- Genetic Epidemiology of Cancer team, Institut Curie, Paris, France
- U900, INSERM, Paris, France
- PSL University, Paris, France
- Mines ParisTech, Fontainebleau, France
| | | | - Alfons Meindl
- Division of Gynaecology and Obstetrics, Technische Universität München, Munich, Germany
- NRG Oncology, Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, NY
| | - Austin Miller
- Division of Gynaecology and Obstetrics, Technische Universität München, Munich, Germany
| | - Marco Montagna
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Thea M Mooij
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Patrick J Morrison
- Centre for Cancer Research and Cell Biology, Queens University Belfast, Belfast, UK
| | | | | | - Susan L Neuhausen
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA
| | - Heli Nevanlinna
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Dieter Niederacher
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Finn C Nielsen
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Robert L Nussbaum
- Cancer Genetics and Prevention Program, University of California San Francisco, San Francisco, CA
| | - Kenneth Offit
- Clinical Genetics Research Laboratory, Department of Cancer Biology and Genetics, Memorial Sloan-Kettering Cancer Center, New York, NY
- Clinical Genetics Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Edith Olah
- Department of Molecular Genetics, National Institute of Oncology, Budapest, Hungary
| | - Kai-Ren Ong
- West Midlands Regional Genetics Service, Birmingham Women’s Hospital Healthcare NHS Trust, Birmingham, UK
| | - Laura Ottini
- Department of Molecular Medicine, University La Sapienza, Rome, Italy
| | - Sue K Park
- Departments of Preventive Medicine and Biomedical Sciences, and Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Paolo Peterlongo
- IFOM, The FIRC (Italian Foundation for Cancer Research) Institute of Molecular Oncology, Milan, Italy
| | - Georg Pfeiler
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | | | - Bruce Poppe
- Centre for Medical Genetics, Ghent University, Ghent, Belgium
| | - Nisha Pradhan
- Clinical Genetics Research Laboratory, Department of Cancer Biology and Genetics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Paolo Radice
- Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Research, Fondazione IRCCS (Istituto Di Ricovero e Cura a Carattere Scientifico) Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Susan J Ramus
- School of Women's and Children's Health, University of New South Wales Sydney, New South Wales, Australia
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | | | - Mark Robson
- Clinical Genetics Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Gustavo C Rodriguez
- Division of Gynecologic Oncology, NorthShore University HealthSystem, University of Chicago, Evanston, IL
| | - Rita K Schmutzler
- Centers for Hereditary Breast and Ovarian Cancer, Integrated Oncology and Molecular Medicine, University Hospital of Cologne, Cologne, Germany Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Payal D Shah
- Department of Medicine, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Jacques Simard
- Laboratoire de génétique médicale, Nancy Université, Centre Hospitalier Régional et Universitaire, Vandoeuvre-les-Nancy, France
| | - Christian F Singer
- Department of Obstetrics and Gynecology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Johanna Sokolowska
- Genomics Center, Centre Hospitalier Universitaire de Québec Research Center, Laval University, Québec City, QC, Canada
| | - Dominique Stoppa-Lyonnet
- Department of Tumour Biology, Institut Curie, INSERM U830, Paris, France
- Université Paris Descartes, Paris, France
| | - Christian Sutter
- Institute of Human Genetics, University Hospital Heidelberg, Heidelberg, Germany
| | - Yen Yen Tan
- Centro de Investigación en Red de Enfermedades Raras (CIBERER), Valencia, Spain, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - R Manuel Teixeira
- Department of Genetics, Portuguese Oncology Institute, Porto, Portugal
- Biomedical Sciences Institute (ICBAS), University of Porto, Porto, Portugal
| | - Soo H Teo
- Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
- Breast Cancer Research Unit, Cancer Research Institute, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Mads Thomassen
- Department of Clinical Genetics, Odense University Hospital, Odense C, Denmark
| | - Marc Tischkowitz
- Program in Cancer Genetics, Departments of Human Genetics and Oncology, McGill University, Montréal, QC, Canada
- Department of Medical Genetics, Addenbrooke's Hospital, Cambridge, UK
| | - Amanda E Toland
- Department of Cancer Biology and Genetics, Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Katherine M Tucker
- School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Hereditary Cancer Centre, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Nadine Tung
- Department of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Christi J van Asperen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Klaartje van Engelen
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Shan Wang-Gohrke
- Department of Gynaecology and Obstetrics, University of Ulm, Ulm, Germany
| | - Barbara Wappenschmidt
- Centers for Hereditary Breast and Ovarian Cancer, Integrated Oncology and Molecular Medicine, University Hospital of Cologne, Cologne, Germany Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Drakoulis Yannoukakos
- Molecular Diagnostics Laboratory, INRASTES, National Centre for Scientific Research ‘Demokritos’, Athens, Greece
| | - GEMO Study Collaborators
- Department of Tumour Biology, Institut Curie, INSERM U830, Paris, France
- Université Paris Descartes, Paris, France
| | - HEBON
- The Hereditary Breast and Ovarian Cancer Research Group Netherlands
- Coordinating Center, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - EMBRACE
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, UK
| | - Mark H Greene
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Matti A Rookus
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Douglas F Easton
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Georgia Chenevix-Trench
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Antonis C Antoniou
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, UK
| | - David E Goldgar
- Department of Dermatology, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | | | - Timothy R Rebbeck
- Harvard T.H. Chan School of Public Health, Boston, MA
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Dezheng Huo
- Department of Medicine, The University of Chicago, Chicago, IL
- Department of Public Health Sciences, The University of Chicago, Chicago, IL (DH)
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Young AL, Butow PN, Rhodes P, Tucker KM, Williams R, Healey E, Wakefield CE. Talking across generations: Family communication about BRCA1
and BRCA2
genetic cancer risk. J Genet Couns 2019; 28:516-532. [DOI: 10.1002/jgc4.1055] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Alison Luk Young
- School of Psychology; The University of Sydney; Sydney NSW Australia
- Behavioral Sciences Unit Proudly Supported by the Kids with Cancer Foundation, Kids Cancer Centre; Sydney Children’s Hospital; Randwick Australia
| | - Phyllis N. Butow
- School of Psychology; The University of Sydney; Sydney NSW Australia
| | - Paul Rhodes
- School of Psychology; The University of Sydney; Sydney NSW Australia
| | - Katherine M. Tucker
- Prince of Wales Hereditary Cancer Centre; Prince of Wales Hospital; Randwick NSW Australia
- Prince of Wales Clinical School, Faculty of Medicine; University of New South Wales; Randwick NSW Australia
| | - Rachel Williams
- Prince of Wales Hereditary Cancer Centre; Prince of Wales Hospital; Randwick NSW Australia
- Prince of Wales Clinical School, Faculty of Medicine; University of New South Wales; Randwick NSW Australia
| | - Emma Healey
- Illawarra Cancer Care Centre, Wollongong Hospital; Wollongong NSW Australia
| | - Claire E. Wakefield
- Behavioral Sciences Unit Proudly Supported by the Kids with Cancer Foundation, Kids Cancer Centre; Sydney Children’s Hospital; Randwick Australia
- School of Women’s and Children’s Health; University of New South Wales; Sydney NSW Australia
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36
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Warby M, Wakefield CE, Vetsch J, Tucker KM. Families' and health care professionals' attitudes towards Li-Fraumeni syndrome testing in children: A systematic review. Clin Genet 2019; 95:140-150. [PMID: 30191952 DOI: 10.1111/cge.13442] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 09/02/2018] [Accepted: 09/04/2018] [Indexed: 01/18/2023]
Abstract
Li-Fraumeni syndrome (LFS) is a highly penetrant cancer predisposition syndrome caused by germline TP53 mutations. Genetic testing is not routinely offered in asymptomatic children at risk of the condition as the benefits are debatable and the attitudes of families and health care professionals (HCPs) may vary. This review assessed the attitudes of families and HCPs towards offering genetic testing to children for LFS, with a focus on perceived advantages and disadvantages and involvement of children in the decision-making process. We searched three key databases (Medline, PsycINFO and EMBASE) to identify quantitative and qualitative studies. We screened 729 articles identifying eight studies for detailed review. Most parents perceived TP53 genetic testing to be beneficial in childhood, despite previous lack of surveillance guidelines. Parents raised some concerns, including decreased insurability and diminishing the child's autonomy. Most children tested reported no negative emotional concerns after testing, even if tested positive. Despite generally positive interest clinicians remain hesitant. Most families saw the value in involving children in decision-making. Families' acceptance of TP53 testing in childhood was high. This review highlights the need for research on the long-term psychosocial impacts of testing and the attitudes of families to be reflected in professional guidelines.
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Affiliation(s)
- Meera Warby
- Hereditary Cancer Centre, Department of Oncology and Haematology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Claire E Wakefield
- School of Women's and Children's Health, University of New South Wales, Kensington, New South Wales, Australia
- Behavioral Sciences Unit Proudly Supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Janine Vetsch
- School of Women's and Children's Health, University of New South Wales, Kensington, New South Wales, Australia
- Behavioral Sciences Unit Proudly Supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Katherine M Tucker
- Hereditary Cancer Centre, Department of Oncology and Haematology, Prince of Wales Hospital, Randwick, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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37
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Yanes T, Willis AM, Meiser B, Tucker KM, Best M. Psychosocial and behavioral outcomes of genomic testing in cancer: a systematic review. Eur J Hum Genet 2019; 27:28-35. [PMID: 30206354 PMCID: PMC6303287 DOI: 10.1038/s41431-018-0257-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/26/2018] [Accepted: 08/09/2018] [Indexed: 01/23/2023] Open
Abstract
Psychosocial and behavioral outcomes of genetic testing in oncology are well known, however, it is unclear how these findings will generalize to more complex genomic testing. The aim of this systematic review was to assess the psychosocial and behavioral outcomes of cancer genomic testing. Studies were selected for inclusion if they were published from January 2003 to January 2017 and addressed psychological and behavioral outcomes of cancer genomic testing in adults. A review of four databases identified 9620 abstracts, with 22 publications meeting the inclusion criteria. Of the included articles, 11 studies reported on outcomes of germline testing, with three articles assessing panel testing and eight SNP testing. No studies assessed the outcomes of WGS or WES. Eleven articles assessed the outcomes of somatic testing, including testing for cancer prognosis and for personalized therapies. Studies were biased toward breast cancer and Caucasian women with high education and socioeconomic status. While studies demonstrated limited adverse psychological outcomes associated with genomic testing, a lack of consistency in psychosocial measures precluded any meta-analysis. Changes in health behavior following positive results were limited, and in some cases risk perception was not altered following genomic testing. There is limited evidence of adverse psychosocial outcomes and changes in health behavior following genomic testing to assess cancer risk. Findings from this review highlight the need for longitudinal research with superior methodological and theoretical design.
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Affiliation(s)
- Tatiane Yanes
- Prince of Wales Clinical School, Faculty of Medicine, UNSW, Sydney, Australia.
- School of Psychiatry, Faculty of Medicine, UNSW, Sydney, Australia.
| | - Amanda M Willis
- Prince of Wales Clinical School, Faculty of Medicine, UNSW, Sydney, Australia
| | - Bettina Meiser
- Prince of Wales Clinical School, Faculty of Medicine, UNSW, Sydney, Australia
| | - Katherine M Tucker
- Prince of Wales Clinical School, Faculty of Medicine, UNSW, Sydney, Australia
- Hereditary Cancer Clinic, Prince of Wales Hospital, Sydney, Australia
| | - Megan Best
- Psycho-oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
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38
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Wakefield CE, Doolan EL, Fardell JE, Signorelli C, Quinn VF, Tucker KM, Patenaude AF, Marshall GM, Lock RB, Georgiou G, Cohn RJ. The Avatar Acceptability Study: Survivor, Parent and Community Willingness to Use Patient-Derived Xenografts to Personalize Cancer Care. EBioMedicine 2018; 37:205-213. [PMID: 30385234 PMCID: PMC6286267 DOI: 10.1016/j.ebiom.2018.10.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 10/22/2018] [Accepted: 10/24/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Using patient-derived xenografts (PDXs) to assess chemosensitivity to anti-cancer agents in real-time may improve cancer care by enabling individualized clinical decision-making. However, it is unknown whether this new approach will be met with acceptance by patients, family and community. METHODS We used a cross-sectional structured survey to investigate PDX acceptability with 1550 individuals across Australia and New Zealand (648 survivors of adult and childhood cancer, versus 650 community comparisons; and 48 parents of childhood cancer survivors versus 204 community parents). We identified factors influencing willingness-to-use PDXs, willingness-to-pay, maximum acceptable wait-time, and maximum acceptable number of mice used per patient. FINDINGS PDXs were highly acceptable: >80% of those affected by cancer felt the potential advantages of PDXs outweighed the disadvantages (community participants: 68%). Survivors' and survivors' parents' most highly endorsed advantage was 'increased chance of survival'. 'Harm to animals' was the least endorsed disadvantage for all groups. Cancer survivors were more willing to use PDXs than community comparisons [p < ·001]. Survivors and survivors' parents were willing to pay more [p < ·001; p = ∙004 respectively], wait longer for results [p = ·03; p = ∙01], and use more mice [p = ·01; p < ∙001] than community comparisons. Male survivors found PDXs more acceptable [p = ·01] and were willing to pay more [p < ·001] than female survivors. Survivors with higher incomes found PDXs more acceptable [p = ·002] and were willing to pay more [p < ·001] than survivors with lower incomes. Mothers found PDXs more acceptable [p = ·04] but were less willing to wait [p = ·02] than fathers. INTERPRETATION We found significant attitudinal support for PDX-guided cancer care. Willingness-to-pay and maximum acceptable number of mice align well with likely future usage. Maximum acceptable wait-times were lower than is currently achievable, highlighting an important area for future patient education until technology has caught up.
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Affiliation(s)
- C E Wakefield
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, UNSW, Sydney, NSW, Australia.
| | - E L Doolan
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, UNSW, Sydney, NSW, Australia
| | - J E Fardell
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, UNSW, Sydney, NSW, Australia
| | - C Signorelli
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, UNSW, Sydney, NSW, Australia
| | - V F Quinn
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, UNSW, Sydney, NSW, Australia
| | - K M Tucker
- Hereditary Cancer Clinic, Department of Medical Oncology, Prince of Wales Hospital, NSW, Australia.; Prince of Wales Clinical School, Faculty of Medicine, Prince of Wales Hospital, NSW, Australia
| | - A F Patenaude
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - G M Marshall
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, UNSW, Sydney, NSW, Australia; Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, NSW, Australia
| | - R B Lock
- School of Women's and Children's Health, UNSW, Sydney, NSW, Australia; Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, NSW, Australia
| | - G Georgiou
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, UNSW, Sydney, NSW, Australia
| | - R J Cohn
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, UNSW, Sydney, NSW, Australia
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39
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Allanson BM, Weber MA, Jackett LA, Chan C, Lau L, Ziegler DS, Warby M, Mayoh C, Cowley MJ, Tucker KM, Long GV, Maher A, Anazodo A, Scolyer RA. Oral malignant gastrointestinal neuroectodermal tumour with junctional component mimicking mucosal melanoma. Pathology 2018; 50:648-653. [PMID: 30177220 DOI: 10.1016/j.pathol.2018.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 07/16/2018] [Accepted: 07/22/2018] [Indexed: 02/07/2023]
Abstract
Malignant gastrointestinal neuroectodermal tumour (GNET) is a recently characterised rare and aggressive tumour that typically arises in association with the small intestine of adults. We present a novel case of this entity and expand the spectrum of its reported morphological features. The patient was a 5-year-old female, the youngest reported patient affected by the condition, and presented with extra-abdominal disease. The histopathological features included the presence of a junctional component of the palatal tumour, which mimicked mucosal melanoma, a feature that has not been previously reported in GNET. Whole genome and RNA sequencing was performed that demonstrated the EWSR1-ATF1 translocation characteristic of GNET. Knowledge of this entity and its features, together with careful morphological assessment supplemented by judicious immunohistochemical and molecular studies should enable the correct diagnosis to be established.
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Affiliation(s)
- Benjamin M Allanson
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
| | - Martin A Weber
- Department of Anatomical Pathology, NSW Health Pathology East, Prince of Wales Hospital/Sydney Children's Hospital, Randwick, NSW, Australia; School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Louise A Jackett
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Charles Chan
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Department of Anatomical Pathology, NSW Health Pathology, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Loretta Lau
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia; Children's Cancer Institute, University of New South Wales, Sydney, NSW, Australia
| | - David S Ziegler
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia; Children's Cancer Institute, University of New South Wales, Sydney, NSW, Australia
| | - Meera Warby
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Chelsea Mayoh
- Children's Cancer Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mark J Cowley
- Children's Cancer Institute, University of New South Wales, Sydney, NSW, Australia; Kinghorn Centre for Clinical Genomics, Garvan Institute, Sydney, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Katherine M Tucker
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Georgina V Long
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Annabelle Maher
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia; Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Richard A Scolyer
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
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40
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Abstract
Estimates of the number of childhood cancers with a genetic basis range from 5-8.5% found in germline samples to 29% based on clinical criteria. Family history-taking practice is a fundamental first step in detecting at risk individuals and families. This study focused on Li-Fraumeni Syndrome (LFS), a highly penetrant cancer syndrome. Reported family history in a cohort of 648 of cancer survivor cohort (CCS) was examined. Eligible CCS were: (i) aged up to 14 years at diagnosis; (ii) more than 5 years postdiagnosis; (iii) treated for a childhood cancer at the study hospitals in NSW, Australia; (iv) in remission for more than 3 years. CCS completed self-administered questionnaires. Medical records confirmed diagnosis and treatment-related information. Our findings reveal an increased cancer risk among sibling and relatives of CCS. 91% of siblings diagnosed with cancer were diagnosed under the age of 40 and about 30% diagnosed under the aged of 15 revealing a 5- (RR = 5.1; 95% CI, 3.3-7.9) and 44-fold (RR = 44.6; 95% CI, 18.4-108.3) increased risked of cancer compared with the Australian population, respectively. About 2% of CCS reported that they had been diagnosed with a genetic cancer syndrome. However, 11% of survivors described a family history pattern which met Chompret criteria for screening for TP53 mutations associated with LFS. Our data suggests that familial cancer predispositions may be initially overlooked. Aperiodic and accurate ascertainment of family cancer history of childhood cancer patients and survivors is therefore recommended.
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Affiliation(s)
- Selena Russo
- Behavioural Sciences Unit, Sydney Children's Hospital, Kids Cancer Centre, Level 1 South, Sydney Children's Hospital, High Street, Randwick, NSW, 2031, Australia. .,Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Kensington, NSW, Australia.
| | - Meera Warby
- Department of Medical Oncology, Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, Australia
| | - Katherine M Tucker
- Department of Medical Oncology, Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, Australia
| | - Claire E Wakefield
- Behavioural Sciences Unit, Sydney Children's Hospital, Kids Cancer Centre, Level 1 South, Sydney Children's Hospital, High Street, Randwick, NSW, 2031, Australia.,Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Kensington, NSW, Australia
| | - Richard J Cohn
- Behavioural Sciences Unit, Sydney Children's Hospital, Kids Cancer Centre, Level 1 South, Sydney Children's Hospital, High Street, Randwick, NSW, 2031, Australia.,Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Kensington, NSW, Australia
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41
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Wakefield CE, Quinn VF, Fardell JE, Signorelli C, Tucker KM, Patenaude AF, Malkin D, Walwyn T, Alvaro F, Cohn RJ. Family history-taking practices and genetic confidence in primary and tertiary care providers for childhood cancer survivors. Pediatr Blood Cancer 2018; 65. [PMID: 29286558 DOI: 10.1002/pbc.26923] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/06/2017] [Accepted: 11/20/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND There is growing impetus for increased genetic screening in childhood cancer survivors. Family history-taking is a critical first step in determining survivors' suitability. However, the family history-taking practices of providers of pediatric oncology survivorship care and the confidence of these providers to discuss cancer risks to relatives are unknown. PROCEDURE Fifty-four providers completed semistructured interviews in total, which included eight tertiary providers representing nine hospitals across two countries (63% male, 63% oncologists, 37% nurses) and 46 primary care providers (PCPs) nominated by a survivor (59% male, 35% regional practice). We used content analysis and descriptive statistics/regression to analyze the data. RESULTS Few tertiary (38%) or primary (35%) providers regularly collected survivors' family histories, often relying on survivors/parents to initiate discussions. Providers mostly took two-generation pedigrees (63% tertiary and 81% primary). Primary providers focused on adult cancers. Lack of time, alternative priorities, and perceived lack of relevance were common barriers. Half of all tertiary providers felt moderately comfortable discussing genetic cancer risk to children of survivors (88% felt similarly discussing risks to other relatives). Most primary providers lacked confidence: 41% felt confident regarding risks to survivors' children and 48% regarding risks to other relatives. CONCLUSIONS While family history-taking will not identify all survivors suitable for genetics assessment, recommendations for regular history-taking are not being implemented in tertiary or primary care. Additional PCP-targeted genetic education is warranted given that they are well placed to review family histories of pediatric cancer survivors.
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Affiliation(s)
- Claire E Wakefield
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Veronica F Quinn
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Joanna E Fardell
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Christina Signorelli
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Katherine M Tucker
- Hereditary Cancer Clinic, Department of Medical Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, UNSW Sydney, Sydney, New South Wales, Australia
| | - Andrea F Patenaude
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - David Malkin
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Departments of Pediatrics and Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Walwyn
- Department of Paediatric and Adolescent Oncology, Princess Margaret Hospital, Subiaco, Western Australia, Australia
| | - Frank Alvaro
- John Hunter Children's Hospital, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Richard J Cohn
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia
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42
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Dwight T, Na U, Kim E, Zhu Y, Richardson AL, Robinson BG, Tucker KM, Gill AJ, Benn DE, Clifton-Bligh RJ, Winge DR. Analysis of SDHAF3 in familial and sporadic pheochromocytoma and paraganglioma. BMC Cancer 2017; 17:497. [PMID: 28738844 PMCID: PMC5525311 DOI: 10.1186/s12885-017-3486-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 07/16/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Germline mutations in genes encoding subunits of succinate dehydrogenase (SDH) are associated with the development of pheochromocytoma (PC) and/or paraganglioma (PGL). As assembly factors have been identified as playing a role in maturation of individual SDH subunits and assembly of the functioning SDH complex, we hypothesized that SDHAF3 variants may be associated with PC/PGL and functionality of SDH. METHODS DNA was extracted from the blood of 37 individuals (from 23 families) with germline SDH mutations and 18 PC/PGL (15 sporadic, 3 familial) and screened for mutations using a custom gene panel, containing SDHAF3 (SDH assembly factor 3) as well as eight known PC/PGL susceptibility genes. Molecular and functional consequences of an identified sequence variant of SDHAF3 were assessed in yeast and mammalian cells (HEK293). RESULTS Using massively parallel sequencing, we identified a variant in SDHAF3, c.157 T > C (p.Phe53Leu), associated with increased prevalence in familial and sporadic PC/PGL (6.6%) when compared to normal populations (1.2% [1000 Genomes], p = 0.003; 2.1% [Exome Aggregation Consortium], p = 0.0063). In silico prediction tools suggest this variant is probably damaging to protein function, hence we assessed molecular and functional consequences of the resulting amino acid change (p.Phe53Leu) in yeast and human cells. We showed that introduction of SDHAF3 p.Phe53Leu into Sdh7 (ortholog of SDHAF3 in humans) null yeast resulted in impaired function, as observed by its failure to restore SDH activity when expressed in Sdh7 null yeast relative to WT SDHAF3. As SDHAF3 is involved in maturation of SDHB, we tested the functional impact of SDHAF3 c.157 T > C and various clinically relevant SDHB mutations on this interaction. Our in vitro studies in human cells show that SDHAF3 interacts with SDHB (residues 46 and 242), with impaired interaction observed in the presence of the SDHAF3 c.157 T > C variant. CONCLUSIONS Our studies reveal novel insights into the biogenesis of SDH, uncovering a vital interaction between SDHAF3 and SDHB. We have shown that SDHAF3 interacts directly with SDHB (residue 242 being key to this interaction), and that a variant in SDHAF3 (c.157 T > C [p.Phe53Leu]) may be more prevalent in individuals with PC/PGL, and is hypomorphic via impaired interaction with SDHB.
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Affiliation(s)
- Trisha Dwight
- Cancer Genetics, Hormones and Cancer Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, 2065 Australia
- University of Sydney, Sydney, 2006 Australia
| | - Un Na
- Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, UT 84132 USA
- Department of Biochemistry, University of Utah Health Sciences Center, Salt Lake City, UT 84132 USA
| | - Edward Kim
- Cancer Genetics, Hormones and Cancer Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, 2065 Australia
- University of Sydney, Sydney, 2006 Australia
| | - Ying Zhu
- Hunter New England Health, Royal North Shore Hospital, Sydney, 2065 Australia
| | - Anne Louise Richardson
- Cancer Genetics, Hormones and Cancer Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, 2065 Australia
| | - Bruce G. Robinson
- Cancer Genetics, Hormones and Cancer Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, 2065 Australia
- University of Sydney, Sydney, 2006 Australia
| | | | - Anthony J. Gill
- University of Sydney, Sydney, 2006 Australia
- Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, 2065 Australia
- Northern Cancer Translational Research Unit, Royal North Shore Hospital, Sydney, 2065 Australia
| | - Diana E. Benn
- Cancer Genetics, Hormones and Cancer Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, 2065 Australia
- University of Sydney, Sydney, 2006 Australia
| | - Roderick J. Clifton-Bligh
- Cancer Genetics, Hormones and Cancer Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, 2065 Australia
- University of Sydney, Sydney, 2006 Australia
| | - Dennis R. Winge
- Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, UT 84132 USA
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Lim Q, McGill BC, Quinn VF, Tucker KM, Mizrahi D, Patenaude AF, Warby M, Cohn RJ, Wakefield CE. Parents' attitudes toward genetic testing of children for health conditions: A systematic review. Clin Genet 2017; 92:569-578. [PMID: 28170090 DOI: 10.1111/cge.12989] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 12/13/2022]
Abstract
This review assessed parents' attitudes toward childhood genetic testing for health conditions, with a focus on perceived advantages and disadvantages. We also evaluated the factors that influence parents' attitudes toward childhood genetic testing. We searched Medline, Medline In-Process, EMBASE, PsycINFO, Social Work Abstracts and CINAHL. We screened 945 abstracts and identified 21 studies representing the views of 3934 parents. Parents reported largely positive attitudes toward childhood genetic testing across different genetic tests with varying medical utility. Parents perceived a range of advantages and disadvantages of childhood genetic testing. Childhood genetic testing was viewed by most as beneficial. Parents' education level, genetic status, sex and sociodemographic status were associated with reported attitudes. This yielded some conflicting findings, indicating the need for further research. Genetic counseling remains essential to support this population in making well-informed decisions. Targeted interventions tailored to specific families with different sociodemographic characteristics may be useful. Further research on the long-term impact of childhood genetic testing on families is warranted.
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Affiliation(s)
- Q Lim
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - B C McGill
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.,Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - V F Quinn
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.,Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - K M Tucker
- Hereditary Cancer Clinic, Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - D Mizrahi
- Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - A F Patenaude
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - M Warby
- Hereditary Cancer Clinic, Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - R J Cohn
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - C E Wakefield
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.,Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
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44
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Win AK, Reece JC, Dowty JG, Buchanan DD, Clendenning M, Rosty C, Southey MC, Young JP, Cleary SP, Kim H, Cotterchio M, Macrae FA, Tucker KM, Baron JA, Burnett T, Le Marchand L, Casey G, Haile RW, Newcomb PA, Thibodeau SN, Hopper JL, Gallinger S, Winship IM, Lindor NM, Jenkins MA. Risk of extracolonic cancers for people with biallelic and monoallelic mutations in MUTYH. Int J Cancer 2016; 139:1557-63. [PMID: 27194394 PMCID: PMC5094810 DOI: 10.1002/ijc.30197] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/03/2016] [Accepted: 05/06/2016] [Indexed: 01/07/2023]
Abstract
Germline mutations in the DNA base excision repair gene MUTYH are known to increase a carrier's risk of colorectal cancer. However, the risks of other (extracolonic) cancers for MUTYH mutation carriers are not well defined. We identified 266 probands (91% Caucasians) with a MUTYH mutation (41 biallelic and 225 monoallelic) from the Colon Cancer Family Registry. Mutation status, sex, age and histories of cancer from their 1,903 first- and 3,255 second-degree relatives were analyzed using modified segregation analysis conditioned on the ascertainment criteria. Compared with incidences for the general population, hazard ratios (HRs) (95% confidence intervals [CIs]) for biallelic MUTYH mutation carriers were: urinary bladder cancer 19 (3.7-97) and ovarian cancer 17 (2.4-115). The HRs (95% CI) for monoallelic MUTYH mutation carriers were: gastric cancer 9.3 (6.7-13); hepatobiliary cancer 4.5 (2.7-7.5); endometrial cancer 2.1 (1.1-3.9) and breast cancer 1.4 (1.0-2.0). There was no evidence for an increased risk of cancers at the other sites examined (brain, pancreas, kidney or prostate). Based on the USA population incidences, the estimated cumulative risks (95% CI) to age 70 years for biallelic mutation carriers were: bladder cancer 25% (5-77%) for males and 8% (2-33%) for females and ovarian cancer 14% (2-65%). The cumulative risks (95% CI) for monoallelic mutation carriers were: gastric cancer 5% (4-7%) for males and 2.3% (1.7-3.3%) for females; hepatobiliary cancer 3% (2-5%) for males and 1.4% (0.8-2.3%) for females; endometrial cancer 3% (2%-6%) and breast cancer 11% (8-16%). These unbiased estimates of both relative and absolute risks of extracolonic cancers for people, mostly Caucasians, with MUTYH mutations will be important for their clinical management.
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Affiliation(s)
- Aung Ko Win
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Jeanette C. Reece
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - James G. Dowty
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Daniel D. Buchanan
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
- Colorectal Oncogenomics Group, Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Parkville, Victoria, Australia
| | - Mark Clendenning
- Colorectal Oncogenomics Group, Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Parkville, Victoria, Australia
| | - Christophe Rosty
- Colorectal Oncogenomics Group, Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Parkville, Victoria, Australia
- School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Melissa C. Southey
- Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Parkville, Victoria, Australia
| | - Joanne P. Young
- Departments of Haematology and Oncology, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
- SAHMRI Colorectal Node, Basil Hetzel Institute for Translational Research, Woodville, South Australia, Australia
- School of Medicine, University of Adelaide, South Australia, Australia
| | - Sean P. Cleary
- Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Hyeja Kim
- Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Cotterchio
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Finlay A. Macrae
- Genetic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
- Colorectal Medicine and Genetics, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Katherine M. Tucker
- Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - John A. Baron
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | | | - Graham Casey
- Department of Preventive Medicine, Keck School of Medicine and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Robert W. Haile
- Department of Medicine, Division of Oncology, Stanford University, California, USA
| | - Polly A. Newcomb
- School of Public Health, University of Washington, Seattle, Washington, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Stephen N. Thibodeau
- Molecular Genetics Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - John L. Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
- Department of Epidemiology and Institute of Health and Environment, School of Public Health, Seoul National University, Seoul, Korea
| | - Steven Gallinger
- SAHMRI Colorectal Node, Basil Hetzel Institute for Translational Research, Woodville, South Australia, Australia
| | - Ingrid M. Winship
- Genetic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Noralane M. Lindor
- Department of Health Science Research, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Mark A. Jenkins
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
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Win AK, Reece JC, Buchanan DD, Clendenning M, Young JP, Cleary SP, Kim H, Cotterchio M, Dowty JG, MacInnis RJ, Tucker KM, Winship IM, Macrae FA, Burnett T, Le Marchand L, Casey G, Haile RW, Newcomb PA, Thibodeau SN, Lindor NM, Hopper JL, Gallinger S, Jenkins MA. Risk of colorectal cancer for people with a mutation in both a MUTYH and a DNA mismatch repair gene. Fam Cancer 2016. [PMID: 26202870 DOI: 10.1007/s10689-015-9824-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The base excision repair protein, MUTYH, functionally interacts with the DNA mismatch repair (MMR) system. As genetic testing moves from testing one gene at a time, to gene panel and whole exome next generation sequencing approaches, understandin g the risk associated with co-existence of germline mutations in these genes will be important for clinical interpretation and management. From the Colon Cancer Family Registry, we identified 10 carriers who had both a MUTYH mutation (6 with c.1187G>A p.(Gly396Asp), 3 with c.821G>A p.(Arg274Gln), and 1 with c.536A>G p.(Tyr179Cys)) and a MMR gene mutation (3 in MLH1, 6 in MSH2, and 1 in PMS2), 375 carriers of a single (monoallelic) MUTYH mutation alone, and 469 carriers of a MMR gene mutation alone. Of the 10 carriers of both gene mutations, 8 were diagnosed with colorectal cancer. Using a weighted cohort analysis, we estimated that risk of colorectal cancer for carriers of both a MUTYH and a MMR gene mutation was substantially higher than that for carriers of a MUTYH mutation alone [hazard ratio (HR) 21.5, 95% confidence interval (CI) 9.19-50.1; p < 0.001], but not different from that for carriers of a MMR gene mutation alone (HR 1.94, 95% CI 0.63-5.99; p = 0.25). Within the limited power of this study, there was no evidence that a monoallelic MUTYH gene mutation confers additional risk of colorectal cancer for carriers of a MMR gene mutation alone. Our finding suggests MUTYH mutation testing in MMR gene mutation carriers is not clinically informative.
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Affiliation(s)
- Aung Ko Win
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3, 207 Bouverie Street, Parkville, VIC, 3010, Australia.
| | - Jeanette C Reece
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3, 207 Bouverie Street, Parkville, VIC, 3010, Australia
| | - Daniel D Buchanan
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3, 207 Bouverie Street, Parkville, VIC, 3010, Australia
- Oncogenomics Group, Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Parkville, VIC, Australia
| | - Mark Clendenning
- Oncogenomics Group, Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Parkville, VIC, Australia
| | - Joanne P Young
- Department of Oncology, The Queen Elizabeth Hospital, Woodville, SA, Australia
- SAHMRI Colorectal Node, Basil Hetzel Institute for Translational Research, Woodville, SA, Australia
- School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Sean P Cleary
- Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Hyeja Kim
- Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | | | - James G Dowty
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3, 207 Bouverie Street, Parkville, VIC, 3010, Australia
| | - Robert J MacInnis
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3, 207 Bouverie Street, Parkville, VIC, 3010, Australia
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Katherine M Tucker
- Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Ingrid M Winship
- Genetic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Finlay A Macrae
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
- Colorectal Medicine and Genetics, Royal Melbourne Hospital, Parkville, VIC, Australia
| | | | | | - Graham Casey
- Department of Preventive Medicine, Keck School of Medicine and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Robert W Haile
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Polly A Newcomb
- School of Public Health, University of Washington, Seattle, WA, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Stephen N Thibodeau
- Molecular Genetics Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Noralane M Lindor
- Department of Health Science Research, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3, 207 Bouverie Street, Parkville, VIC, 3010, Australia
- Department of Epidemiology and Institute of Health and Environment, School of Public Health, Seoul National University, Seoul, Korea
| | - Steven Gallinger
- Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Mark A Jenkins
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3, 207 Bouverie Street, Parkville, VIC, 3010, Australia
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Antill YC, Dowty JG, Win AK, Thompson T, Walsh MD, Cummings MC, Gallinger S, Lindor NM, Le Marchand L, Hopper JL, Newcomb PA, Haile RW, Church J, Tucker KM, Buchanan DD, Young JP, Winship IM, Jenkins MA. Lynch syndrome and cervical cancer. Int J Cancer 2015; 137:2757-61. [PMID: 26077226 DOI: 10.1002/ijc.29641] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 06/03/2015] [Indexed: 01/13/2023]
Abstract
Carriers of germline mutations in DNA mismatch repair (MMR) genes are at increased risk of several cancers including colorectal and gynecologic cancers (Lynch syndrome). There is no substantial evidence that these mutations are associated with an increased risk of cervical cancer. A total of 369 families with at least one carrier of a mutation in a MMR gene (133 MLH1, 174 MSH2, 35 MSH6 and 27 PMS2) were ascertained via population cancer registries or via family cancer clinics in Australia, New Zealand, Canada, and USA. Personal and family histories of cancer were obtained from participant interviews. Modified segregation analysis was used to estimate the hazard ratio (incidence rates for carriers relative to those for the general population), and age-specific cumulative risks of cervical cancer for carriers. A total of 65 cases of cervical cancer were reported (including 10 verified by pathology reports). The estimated incidence was 5.6 fold (95% CI: 2.3-13.8; p = 0.001) higher for carriers than for the general population with a corresponding cumulative risk to 80 years of 4.5% (95% CI: 1.9-10.7%) compared with 0.8% for the general population. The mean age at diagnosis was 43.1 years (95% CI: 40.0-46.2), 3.9 years younger than the reported USA population mean of 47.0 years (p = 0.02). Women with MMR gene mutations were found to have an increased risk of cervical cancer. Due to limited pathology verification we cannot be certain that a proportion of these cases were not lower uterine segment endometrial cancers involving the endocervix, a recognized cancer of Lynch syndrome.
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Affiliation(s)
- Yoland C Antill
- Familial Cancer Centre, Royal Melbourne Hospital, Cabrini Health and Southern Health, Parkville, VIC, Australia
| | - James G Dowty
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Aung Ko Win
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Tina Thompson
- Familial Cancer Centre, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
| | - Michael D Walsh
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Margaret C Cummings
- University of Queensland Centre for Clinical Research, Royal Brisbane Hospital, Herston, Queensland, Australia
| | - Steven Gallinger
- Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Noralane M Lindor
- Department of Health Science Research, Mayo Clinic Arizona, Scottsdale, AZ
| | - Loïc Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia.,Department of Epidemiology and Institute of Health and Environment, School of Public Health, Seoul National University, Seoul, Korea
| | - Polly A Newcomb
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA.,School of Public Health, University of Washington, Seattle, WA
| | - Robert W Haile
- Division of Oncology, Department of Medicine, Stanford Cancer Institute, Stanford University, CA
| | - James Church
- Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH
| | - Katherine M Tucker
- Hereditary Cancer Clinic, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Daniel D Buchanan
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia.,Oncogenomics Group, Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Parkville, VIC, Australia
| | - Joanne P Young
- Department of Haematology and Oncology, The Queen Elizabeth Hospital, Woodville, SA, Australia.,SAHMRI Colorectal Node, Basil Hetzel Institute for Translational Research, Woodville, SA, Australia.,School of Medicine, University of Adelaide, SA, Australia
| | - Ingrid M Winship
- Genetic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Mark A Jenkins
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
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47
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Humphris JL, Johns AL, Simpson SH, Cowley MJ, Pajic M, Chang DK, Nagrial AM, Chin VT, Chantrill LA, Pinese M, Mead RS, Gill AJ, Samra JS, Kench JG, Musgrove EA, Tucker KM, Spigelman AD, Waddell N, Grimmond SM, Biankin AV. Clinical and pathologic features of familial pancreatic cancer. Cancer 2014; 120:3669-75. [PMID: 25313458 DOI: 10.1002/cncr.28863] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 04/20/2014] [Accepted: 05/07/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Inherited predisposition to pancreatic cancer contributes significantly to its incidence and presents an opportunity for the development of early detection strategies. The genetic basis of predisposition remains unexplained in a high proportion of patients with familial PC (FPC). METHODS Clinicopathologic features were assessed in a cohort of 766 patients who had been diagnosed with pancreatic ductal adenocarcinoma (PC). Patients were classified with FPC if they had ≥1 affected first-degree relatives; otherwise, they were classified with sporadic PC (SPC). RESULTS The prevalence of FPC in this cohort was 8.9%. In FPC families with an affected parent-child pair, 71% in the subsequent generation were 12.3 years younger at diagnosis. Patients with FPC had more first-degree relatives who had an extrapancreatic malignancy (EPM) (42.6% vs 21.2; P<.0001), particularly melanoma and endometrial cancer, but not a personal history of EPM. Patients with SPC were more likely to be active smokers, have higher cumulative tobacco exposure, and have fewer multifocal precursor lesions, but these were not associated with differences in survival. Long-standing diabetes mellitus (>2 years) was associated with poor survival in both groups. CONCLUSIONS FPC represents 9% of PC, and the risk of malignancy in kindred does not appear to be confined to the pancreas. Patients with FPC have more precursor lesions and include fewer active smokers, but other clinicopathologic factors and outcome are similar to those in patients with SPC. Furthermore, some FPC kindreds may exhibit anticipation. A better understanding of the clinical features of PC will facilitate efforts to uncover novel susceptibility genes and the development of early detection strategies.
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Affiliation(s)
- Jeremy L Humphris
- The Kinghorn Cancer Center, Cancer Research Program, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
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48
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Win AK, Dowty JG, Cleary SP, Kim H, Buchanan DD, Young JP, Clendenning M, Rosty C, MacInnis RJ, Giles GG, Boussioutas A, Macrae FA, Parry S, Goldblatt J, Baron JA, Burnett T, Marchand LL, Newcomb PA, Haile RW, Hopper JL, Cotterchio M, Gallinger S, Lindor NM, Tucker KM, Winship IM, Jenkins MA. Risk of colorectal cancer for carriers of mutations in MUTYH, with and without a family history of cancer. Gastroenterology 2014; 146:1208-11.e1-5. [PMID: 24444654 PMCID: PMC3992182 DOI: 10.1053/j.gastro.2014.01.022] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 01/10/2014] [Accepted: 01/14/2014] [Indexed: 12/12/2022]
Abstract
We studied 2332 individuals with monoallelic mutations in MUTYH among 9504 relatives of 264 colorectal cancer (CRC) cases with a MUTYH mutation. We estimated CRC risks through 70 years of age of 7.2% for male carriers of monoallelic mutations (95% confidence interval [CI], 4.6%-11.3%) and 5.6% for female carriers of monoallelic mutations (95% CI, 3.6%-8.8%), irrespective of family history. For monoallelic MUTYH mutation carriers with a first-degree relative with CRC diagnosed by 50 years of age who does not have the MUTYH mutation, risks of CRC were 12.5% for men (95% CI, 8.6%-17.7%) and 10% for women (95% CI, 6.7%-14.4%). Risks of CRC for carriers of monoallelic mutations in MUTYH with a first-degree relative with CRC are sufficiently high to warrant more intensive screening than for the general population.
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Affiliation(s)
- Aung Ko Win
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Parkville, Victoria, Australia
| | - James G. Dowty
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Parkville, Victoria, Australia
| | - Sean P. Cleary
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.,Cancer Care Ontario, Toronto, Ontario, Canada
| | - Hyeja Kim
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.,Cancer Care Ontario, Toronto, Ontario, Canada
| | - Daniel D. Buchanan
- Cancer and Population Studies Group, Queensland Institute of Medical Research, Bancroft Centre, Herston, Queensland, Australia
| | - Joanne P. Young
- Cancer and Population Studies Group, Queensland Institute of Medical Research, Bancroft Centre, Herston, Queensland, Australia
| | - Mark Clendenning
- Cancer and Population Studies Group, Queensland Institute of Medical Research, Bancroft Centre, Herston, Queensland, Australia
| | - Christophe Rosty
- Cancer and Population Studies Group, Queensland Institute of Medical Research, Bancroft Centre, Herston, Queensland, Australia.,Department of Molecular and Cellular Pathology, University of Queensland, Herston, Queensland, Australia.,Envoi Specialist Pathologists, Herston, Queensland, Australia
| | - Robert J. MacInnis
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Parkville, Victoria, Australia.,Cancer Epidemiology Centre, Cancer Council Victoria, Carlton, Victoria, Australia
| | - Graham G. Giles
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Parkville, Victoria, Australia.,Cancer Epidemiology Centre, Cancer Council Victoria, Carlton, Victoria, Australia
| | - Alex Boussioutas
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia.,Cancer Genomics and Predictive Medicine, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Finlay A. Macrae
- Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Susan Parry
- New Zealand Familial Gastrointestinal Cancer Registry, Auckland City Hospital, Auckland, New Zealand.,Department of Gastroenterology, Middlemore Hospital, Auckland, New Zealand New Zealand
| | - Jack Goldblatt
- Genetic Services & Familial Cancer Program of Western Australia and School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
| | - John A. Baron
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | | | - Polly A. Newcomb
- Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Robert W. Haile
- Department of Medicine, Division of Oncology, Stanford University, California, USA
| | - John L. Hopper
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Steven Gallinger
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.,Cancer Care Ontario, Toronto, Ontario, Canada
| | - Noralane M. Lindor
- Department of Health Science Research, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Katherine M. Tucker
- Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Ingrid M. Winship
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia.,Genetic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, Australia
| | - Mark A. Jenkins
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Parkville, Victoria, Australia
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Kasparian NA, Rutstein A, Sansom-Daly UM, Mireskandari S, Tyler J, Duffy J, Tucker KM. Through the looking glass: an exploratory study of the lived experiences and unmet needs of families affected by Von Hippel-Lindau disease. Eur J Hum Genet 2014; 23:34-40. [PMID: 24690678 DOI: 10.1038/ejhg.2014.44] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 01/27/2014] [Accepted: 02/13/2014] [Indexed: 12/31/2022] Open
Abstract
Despite well-established protocols for the medical management of Von Hippel-Lindau disease (VHL), families affected by this rare tumour syndrome continue to face numerous psychological, social, and practical challenges. To our knowledge, this is one of the first qualitative studies to explore the psychosocial difficulties experienced by families affected by VHL. A semi-structured interview was developed to explore patients' and carers' experiences of VHL along several life domains, including: self-identity and self-esteem, interpersonal relationships, education and career opportunities, family communication, physical health and emotional well-being, and supportive care needs. Quantitative measures were also used to examine the prevalence of anxiety, depression, and disease-specific distress in this sample. Participants were recruited via the Hereditary Cancer Clinic at the Prince of Wales Hospital in Sydney, Australia. A total of 23 individual telephone interviews were conducted (15 patients, 8 carers), yielding a response rate of 75%. A diverse range of experiences were reported, including: sustained uncertainty about future tumour development, frustration regarding the need for lifelong medical screening, strained family relationships, difficulties communicating with others about VHL, perceived social isolation and limited career opportunities, financial and care-giving burdens, complex decisions in relation to childbearing, and difficulties accessing expert medical and psychosocial care. Participants also provided examples of psychological growth and resilience, and voiced support for continued efforts to improve supportive care services. More sophisticated systems for connecting VHL patients and their families with holistic, empathic, and person-centred medical and psychosocial care are urgently needed.
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Affiliation(s)
- Nadine A Kasparian
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, NSW, Australia
| | - Alison Rutstein
- 1] Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, NSW, Australia [2] Psychosocial Research Group, Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Ursula M Sansom-Daly
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, NSW, Australia
| | - Shab Mireskandari
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, NSW, Australia
| | - Janet Tyler
- Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Jessica Duffy
- Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Katherine M Tucker
- Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, NSW, Australia
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50
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Choi JDW, Tucker KM, Lee TT, Chong GC. Hereditary paraganglioma-pheochromocytoma syndromes associated with SDHD and RET mutations. Head Neck 2014; 36:E99-E102. [PMID: 24375508 DOI: 10.1002/hed.23598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 11/13/2013] [Accepted: 12/20/2013] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Hereditary paraganglioma-pheochromocytoma syndromes (PGL/PCC) are rare tumors arising from neuroendocrine cells. METHODS AND RESULTS The proband, a 59-year-old white man and his 42-year-old elder son had a medical history of bilateral carotid body PGL and both presented for treatment of abdominal PGLs. His 36-year-old daughter had excision of recurrent malignant carotid body PGL and vertebral metastasis. His 33-year-old youngest son presented for excision of a unilateral carotid body PGL. All 4 members had succinate dehydrogenase subunit D (SDHD) mutations, whereas the proband and youngest son also had concurrent rearranged during transfection (RET) mutation. CONCLUSION This is the first report of PGL/PCC with SDHD and RET mutations. The role of the RET gene as a modifier remains speculative. Additionally, the family pedigree suggests maternal inheritance of disease from the probands' paternal grandmother. Clinicians should refer PGL/PCC families for mutation analysis as well as being alert to changes in the classification of mutations.
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Affiliation(s)
- Joseph Do Woong Choi
- Academic Unit of Surgery, Australian National University Medical School, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
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