Initiation of universal tumor screening for Lynch syndrome in colorectal cancer patients as a model for the implementation of genetic information into clinical oncology practice

被引:29
作者
Cohen, Stacey A. [1 ,2 ]
Laurino, Mercy [3 ,4 ,5 ]
Bowen, Deborah J. [6 ]
Upton, Melissa P. [7 ]
Pritchard, Colin [8 ]
Hisama, Fuki [3 ]
Jarvik, Gail [3 ,9 ]
Fichera, Alessandro [10 ]
Sjoding, Britta [4 ]
Bennett, Robin L. [3 ,4 ]
Naylor, Lorraine [3 ,4 ]
Jacobson, Angela [8 ]
Burke, Wylie [6 ]
Grady, William M. [2 ,5 ,11 ]
机构
[1] Univ Washington, Div Oncol, 825 Eastlake Ave East,G4830, Seattle, WA 98109 USA
[2] Fred Hutchinson Canc Res Ctr, Div Clin Res, 1124 Columbia St, Seattle, WA 98104 USA
[3] Univ Washington, Div Med Genet, Seattle, WA 98109 USA
[4] Seattle Canc Care Alliance, Genet Counseling, Seattle, WA USA
[5] Fred Hutchinson Canc Res Ctr, Div Publ Hlth Sci, 1124 Columbia St, Seattle, WA 98104 USA
[6] Univ Washington, Dept Bioeth & Humanities, Seattle, WA 98109 USA
[7] Univ Washington, Dept Pathol, Seattle, WA 98109 USA
[8] Univ Washington, Dept Lab Med, Seattle, WA 98109 USA
[9] Univ Washington, Dept Genome Sci, Seattle, WA 98109 USA
[10] Univ Washington, Dept Surg, Seattle, WA 98109 USA
[11] Univ Washington, Div Gastroenterol, Seattle, WA 98109 USA
基金
美国国家卫生研究院;
关键词
genetics; genomics; Lynch syndrome; microsatellite instability; molecular oncology; MICROSATELLITE INSTABILITY; COLLABORATIVE-GROUP; CONSOLIDATED FRAMEWORK; COST-EFFECTIVENESS; IMMUNOHISTOCHEMISTRY; STRATEGIES; HNPCC;
D O I
10.1002/cncr.29758
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
BACKGROUNDLynch syndrome confers a hereditary predisposition to colorectal and other cancers. Universal tumor screening (UTS) for Lynch syndrome is recommended by several professional societies, but the implementation can be complex. This article describes the evaluation, process development, and initiation of Lynch syndrome UTS at a tertiary referral cancer center. METHODSA multidisciplinary team developed the new process design. Issues in 5 themes were noted: timing, funding, second-opinion patients, result processing, and the role of genetics providers. A committee approach was used to examine each issue for process-improvement development. RESULTSThe issues related to testing were addressed individually for the successful implementation of UTS at the institutional level. In the conventional-care period, 9 of 30 cases (30%) received Lynch syndrome screening, and 4 cases were referred to medical genetics. During the 6 months following the implementation of UTS, 32 of 44 patients (73%) received Lynch syndrome screening. The 13 unscreened patients all had identified reasons for nonscreening (eg, financial limitations). Ten patients were referred to medical genetics, which identified no new cases of Lynch syndrome, but a low-risk adenomatous polyposis coli (APC) variant was detected in 1 individual. CONCLUSIONSThe implementation of effective Lynch syndrome UTS can feasibly alter practice at the institutional level. This experience with the assessment and management of issues relevant to the successful implementation of a new clinical care paradigm based on emerging technology has implications for the uptake of advances across molecular oncology into clinical practice, and this is highly relevant in the current era of rapidly evolving genomic technology. Cancer 2016;122:393-401. (c) 2015 American Cancer Society.
引用
收藏
页码:393 / 401
页数:9
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