Moving into the mainstream: healthcare professionals’ views of implementing treatment focussed genetic testing in breast cancer care

Springer Science and Business Media LLC - Tập 18 - Trang 293-301 - 2019
Nina Hallowell1, S. Wright2, D. Stirling3, C. Gourley3,4, O. Young5, M. Porteous3
1Wellcome Centre for Ethics and Humanities and the Ethox Centre, Nuffield Department of Population Health, Big Data Institute Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
2Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
3MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
4Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
5Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK

Tóm tắt

A proportion of breast cancers are attributable to BRCA1 or BRCA2 mutations. Technological advances has meant that mutation testing in newly diagnosed cancer patients can be used to inform treatment plans. Although oncologists increasingly deliver treatment-focused genetic testing (TFGT) as part of mainstream ovarian cancer care, we know little about non-genetics specialists’ views about offering genetic testing to newly diagnosed breast cancer patients. This study sought to determine genetics and non-genetics specialists’ views of a proposal to mainstream BRCA1 and 2 testing in newly diagnosed breast cancer patients. Qualitative interview study. Nineteen healthcare professionals currently responsible for offering TFGT in a standard (triage + referral) pathway (breast surgeons + clinical genetics team) and oncologists preparing to offer TFGT to breast cancer patients in a mainstreamed pathway participated in in-depth interviews. Genetics and non-genetics professionals’ perceptions of mainstreaming are influenced by their views of: their clinical roles and responsibilities, the impact of TFGT on their workload and the patient pathway and the perceived relevance of genetic testing for patient care in the short-term. Perceived barriers to mainstreaming may be overcome by: more effective communication between specialities, clearer guidelines/patient pathways and the recruitment of mainstreaming champions.

Tài liệu tham khảo

Claus EB, Schildkraut JM, Thompson WD et al (1996) The genetic attributable risk of breast and ovarian cancer. Cancer 77:2318–2324

Zhang S, Royer R, Li S et al (2011) Frequencies of BRCA1 and BRCA2 mutations among 1,342 unselected patients with invasive ovarian cancer. Gynecol Oncol 121:353–357

Kuchenbaecker KB, Hopper JL, Barnes DR et al (2017) Risks of breast, ovarian, and contralateral breast cancer for BRCA1 and BRCA2 mutation carriers. JAMA 317:2402–2416

Haffty BG, Harrold E, Khan AJ et al (2002) Outcome of conservatively managed early-onset breast cancer by BRCA1/2 status. Lancet 359:1471–1477

National Institute for Health and Clinical Excellence (2013) Familial breast cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer. NICE guideline [CG164]. National Institute for Health and Clinical Excellence

George A, Kaye S, Banerjee S (2017) Delivering widespread BRCA testing and PARP inhibition to patients with ovarian cancer. Nat Rev Clin Oncol 14:284–296

Weitzel JN, McCaffrey SM, Nedelcu R et al. Effect of genetic cancer risk assessment on surgical decisions at breast cancer diagnosis. Arch Surg. https://doi.org/10.1001/archsurg.138.12.1323

Telli ML, Jensen KC, Vinayak S, et a (2015) Phase II study of gemcitabine, carboplatin, and imiparib as neoadjuvant therapy for triple-negative and BRCA1/2 mutation-associated breast cancer with assessment of a tumor-based measure of genomic instability: PrECOG 0105. J Clin Oncol 33:1895–1901

Tutt A, Tovey H, Cheang MCU et al. Carboplatin in BRCA1/2-mutated and triple-negative breast cancer BRCAness subgroups: the TNT Trial. Nat Med. https://doi.org/10.1038/s41591-018-0009-7

Rafii S, Gourley C, Kumar R et al (2017) Baseline clinical predictors of antitumor response to the PARP inhibitor olaparib in germline BRCA1/2 mutated patients with advanced ovarian cancer. Oncotarget. https://doi.org/10.18632/oncotarget.17005

Davies SC (2017) Annual report of the Chief Medical Officer 2016, generation genome. Department of Health, London

Independent Cancer Taskforce (2015) Achieving world-class cancer outcomes a strategy for England 2015–2020

Slade I, Riddell D, Turnbull C et al. Development of cancer genetic services in the UK: a national consultation. Genome Med. https://doi.org/10.1186/s13073-015-0128-4

Bennett CL, Burke SE, Burton H et al. A toolkit for incorporating genetics into mainstream medical services: learning from service development pilots in England. BMC Health Serv Res. https://doi.org/10.1186/1472-6963-10-125

Percival N, George A, Gyertson J et al. The integration of BRCA testing into oncology clinics. Br J Nurs. https://doi.org/10.12968/bjon.2016.25.12.690

Kentwell M, Dow E, Antill Y et al (2017) Mainstreaming cancer genetics: a model integrating germline BRCA testing into routine ovarian cancer clinics. Gynecol Oncol 145:130–136

Rahman B, Lanceley A, Kristeleit RS et al. Mainstreamed genetic testing for women with ovarian cancer: first-year experience. J Med Genet. https://doi.org/10.1136/jmedgenet-2017-105140

Katz SJ, Ward KC, Hamilton AS et al. Gaps in receipt of clinically indicated genetic counselling after diagnosis of breast cancer. J Clin Oncol. https://doi.org/10.1200/JCO.2017.76.2369

Katz SJ, Kurian AW, Morrow M. Treatment decision making and genetic testing for breast cancer: mainstreaming mutations. JAMA. https://doi.org/10.1001/jama.2015.8088

Burcher S, Meiser B, Mitchell G Oncology health professionals’ attitudes toward treatment-focused genetic testing for women newly diagnosed with breast cancer. Personal Med. https://doi.org/10.2217/pme.13.45

Douma KFL, Meiser B, Kirk J et al. Health professionals’ evaluation of delivering treatment-focused genetic testing to women newly diagnosed with breast cancer. Fam Cancer. https://doi.org/10.1007/s10689-014-9770-z

Kurian AW, Li Y, Hamilton AS et al. Gaps in incorporating germline genetic testing into treatment decision-making for early-stage breast cancer. J Clin Oncol. https://doi.org/10.1200/JCO.2016.71.6480

Eccles BK, Copson E, Maishman T et al. Understanding of BRCA VUS genetic results by breast cancer specialists. BMC Cancer. https://doi.org/10.1186/s12885-015-1934-1

Maxwell JA (2012) Qualitative research design: an interactive approach, vol 41. Sage Publications, London

Mikat-Stevens NA, Larson IA, Tarini BA (2015) Primary-care providers’ perceived barriers to integration of genetics services: a systematic review of the literature. Genet Med 17:169–176

Martin G, Currie G, Finn RJ, Health Services Research Policy. Bringing genetics into primary care: findings from a national evaluation of pilots in England. J Health Serv Res Policy. https://doi.org/10.1258/jhsrp.2009.008158

Robins R, Metcalfe S (2004) Integrating genetics as practices of primary care. Soc Sci Med 59:223–233

Scheuner MT, Hamilton AB, Peredo J et al. A cancer genetics toolkit improves access to genetic services through documentation and use of the family history by primary-care clinicians. Genet Med. https://doi.org/10.1038/gim.2013.75

Sperber NR, Carpenter JR, Cavallari LH et al. Challenges and strategies for implementing genomic services in diverse settings: experiences from the Implementing GeNomics In pracTicE (IGNITE) network. BMC Med Genomics. https://doi.org/10.1186/s12920-017-0273-2

Thông tin
Thông tin xuất bản

Springer Science and Business Media LLC

Tập 18

293-301

Thông tin tác giả