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Clinician-Reported Impact of Germline Multigene Panel Testing on Cancer Risk Management Recommendations

BACKGROUND: With increased adoption of multi-gene panel testing (MGPT) for hereditary cancer, management guidelines now include a wider range of predisposition genes. Yet little is known about whether MGPT results prompt changes to clinicians’ risk management recommendations and whether those recomm...

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Autores principales: Horton, Carolyn, Blanco, Kirsten, Lo, Min-Tzu, Speare, Virginia, LaDuca, Holly, Dolinsky, Jill S, Kurian, Allison W
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8904928/
https://www.ncbi.nlm.nih.gov/pubmed/35603838
http://dx.doi.org/10.1093/jncics/pkac002
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author Horton, Carolyn
Blanco, Kirsten
Lo, Min-Tzu
Speare, Virginia
LaDuca, Holly
Dolinsky, Jill S
Kurian, Allison W
author_facet Horton, Carolyn
Blanco, Kirsten
Lo, Min-Tzu
Speare, Virginia
LaDuca, Holly
Dolinsky, Jill S
Kurian, Allison W
author_sort Horton, Carolyn
collection PubMed
description BACKGROUND: With increased adoption of multi-gene panel testing (MGPT) for hereditary cancer, management guidelines now include a wider range of predisposition genes. Yet little is known about whether MGPT results prompt changes to clinicians’ risk management recommendations and whether those recommendations adhere to guidelines. METHODS: We assessed cancer risk management recommendations made by clinicians ordering MGPT for hereditary cancer at a diagnostic laboratory using an internet-based survey. We received paired pre- and posttest responses for 2172 patients (response rate = 14.3%). Unpaired posttest responses were received in 168 additional patients with positive results. All tests were 2-sided. RESULTS: Clinicians reported a change in risk management recommendations for 76.6% of patients who tested positive for a pathogenic or likely pathogenic variant, with changes to surveillance being most common (71.1%), followed by surgical (33.6%), chemoprevention (15.1%), and clinical trial (9.4%) recommendations. Clinicians recommended risk-reducing interventions more often for patients with pathogenic variants in high-risk than moderate-risk genes (P < .001), whereas surveillance recommendations were similar for high-risk and moderate-risk genes. Guideline adherence was high for surveillance (86.3%) and surgical (79.6%) recommendations. Changes to risk management recommendations occurred in 8.8% and 7.6% of patients with uncertain and negative results, respectively. CONCLUSIONS: Clinicians report frequent changes to cancer risk management recommendations based on positive results in both high-risk and moderate-risk genes. Reported introduction of interventions in patients with inconclusive and negative results is rare and adherence to practice guidelines is high in patients with positive results, suggesting a low probability of harm resulting from MGPT.
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spelling pubmed-89049282022-03-09 Clinician-Reported Impact of Germline Multigene Panel Testing on Cancer Risk Management Recommendations Horton, Carolyn Blanco, Kirsten Lo, Min-Tzu Speare, Virginia LaDuca, Holly Dolinsky, Jill S Kurian, Allison W JNCI Cancer Spectr Article BACKGROUND: With increased adoption of multi-gene panel testing (MGPT) for hereditary cancer, management guidelines now include a wider range of predisposition genes. Yet little is known about whether MGPT results prompt changes to clinicians’ risk management recommendations and whether those recommendations adhere to guidelines. METHODS: We assessed cancer risk management recommendations made by clinicians ordering MGPT for hereditary cancer at a diagnostic laboratory using an internet-based survey. We received paired pre- and posttest responses for 2172 patients (response rate = 14.3%). Unpaired posttest responses were received in 168 additional patients with positive results. All tests were 2-sided. RESULTS: Clinicians reported a change in risk management recommendations for 76.6% of patients who tested positive for a pathogenic or likely pathogenic variant, with changes to surveillance being most common (71.1%), followed by surgical (33.6%), chemoprevention (15.1%), and clinical trial (9.4%) recommendations. Clinicians recommended risk-reducing interventions more often for patients with pathogenic variants in high-risk than moderate-risk genes (P < .001), whereas surveillance recommendations were similar for high-risk and moderate-risk genes. Guideline adherence was high for surveillance (86.3%) and surgical (79.6%) recommendations. Changes to risk management recommendations occurred in 8.8% and 7.6% of patients with uncertain and negative results, respectively. CONCLUSIONS: Clinicians report frequent changes to cancer risk management recommendations based on positive results in both high-risk and moderate-risk genes. Reported introduction of interventions in patients with inconclusive and negative results is rare and adherence to practice guidelines is high in patients with positive results, suggesting a low probability of harm resulting from MGPT. Oxford University Press 2022-01-18 /pmc/articles/PMC8904928/ /pubmed/35603838 http://dx.doi.org/10.1093/jncics/pkac002 Text en © The Author(s) 2022. Published by Oxford University Press. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Article
Horton, Carolyn
Blanco, Kirsten
Lo, Min-Tzu
Speare, Virginia
LaDuca, Holly
Dolinsky, Jill S
Kurian, Allison W
Clinician-Reported Impact of Germline Multigene Panel Testing on Cancer Risk Management Recommendations
title Clinician-Reported Impact of Germline Multigene Panel Testing on Cancer Risk Management Recommendations
title_full Clinician-Reported Impact of Germline Multigene Panel Testing on Cancer Risk Management Recommendations
title_fullStr Clinician-Reported Impact of Germline Multigene Panel Testing on Cancer Risk Management Recommendations
title_full_unstemmed Clinician-Reported Impact of Germline Multigene Panel Testing on Cancer Risk Management Recommendations
title_short Clinician-Reported Impact of Germline Multigene Panel Testing on Cancer Risk Management Recommendations
title_sort clinician-reported impact of germline multigene panel testing on cancer risk management recommendations
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8904928/
https://www.ncbi.nlm.nih.gov/pubmed/35603838
http://dx.doi.org/10.1093/jncics/pkac002
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