The integration of BRCA testing into oncology clinics

Percival, Natalie; George, Angela; Gyertson, Jennifer; Hamill, Monica; Fernandes, Andreia; Davies, Emily; Rahman, Nazneen; Banerjee, Susana

doi:10.12968/bjon.2016.25.12.690

Cited by 53 publications

(63 citation statements)

References 11 publications

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“…In line with other literature sources 5,8,18 , this study highlights that knowledge of a patient's BRCAm status had an impact on the management of their ovarian cancer and their ability to access PARP inhibitor treatment. At the time of this study, NHS-funded PARP inhibitor treatment was only accessible to BRCAm patients, and no BRCAwt patient at Imperial College Healthcare NHS Trust was eligible for PARP inhibitor treatment outside of a clinical trial or Expanded Access Program.…”

Section: Impact Of Brcam Testing On Patient Management and Access To supporting

confidence: 85%

“…Although relatively new, there is a growing body of evidence supporting the feasibility of an oncologist-led 'mainstreaming' approach 5,8,17,18 -where the oncology team introduce the concept of genetic testing and obtain patient consent as part of routine appointments, deliver initial results and then refer any identified BRCAm patients or those with a Variant of Unknown Significance (VUS) on to specialised genetic departments for counselling and cascade testing of potentially affected family members.…”

Section: Access To Brca Testing In the United Kingdommentioning

confidence: 99%

“…In December 2014 PARP inhibitor olaparib received European Medicines Agency (EMA) Marketing Authorisation for the treatment of relapsed, platinum-sensitive BRCAm ovarian cancer 15 and was made available by the National Health Service (NHS) in early 2016 16 . The availability of this targeted therapy for BRCA-mutated patients created a shift towards a more personalised approach to the management of ovarian cancer and further highlighted the need for BRCA testing 5,6,13,17,18 . Following the approval of olaparib, clinical utility has also been demonstrated in both BRCAm and BRCAwt cohorts with other licenced PARP inhibitors, niraparib and rucaparib 19,20 .…”

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confidence: 99%

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Oncologist-led BRCA ‘mainstreaming’ in the ovarian cancer clinic: A study of 255 patients and its impact on their management

Rumford

Lythgoe

McNeish

et al. 2020

Sci Rep

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Although guidelines recommend BRcA testing for all women with non-mucinous epithelial ovarian cancer, there is significant variability in access to testing across the UK. A germline BRCA mutation (BRCAm) in ovarian cancer patients provides prognostic and predictive information and influences clinical management, such as the use of pARp inhibitors, which have demonstrated a progression-free survival benefit in the BRCAm cohort. Additionally, the finding of a BRCAm has significant implications for patients and their families in terms of cancer risk and prevention. We studied the impact of a newlyformed, oncologist-led 'mainstreaming' germline BRCA testing pathway in 255 ovarian cancer patients at Imperial College NHS Trust. Prior to the establishment of 'mainstreaming', uptake of germline BRCA testing was 14% with a mean turnaround time of 148.2 calendar days. The 'mainstreaming' approach led to a 95% uptake of germline BRCA testing and a mean turnaround time of 20.6 days. Thirty-four (13.33%) BRCAm patients were identified. At the time of data collection nine BRCAm patients had received a PARP inhibitor off-trial, three had entered a PARP inhibitor trial and 5 were receiving platinum-based chemotherapy with a plan to receive PARP inhibitor maintenance. This study provides further evidence of the impact of oncologist-led 'mainstreaming' programs. Uptake and utility of mainstreaming pathway. There was a 95% uptake of BRCA testing via the Scientific RepoRtS | (2020) 10:3390 | https://doi.

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Section: Impact Of Brcam Testing On Patient Management and Access To supporting

confidence: 85%

Section: Access To Brca Testing In the United Kingdommentioning

confidence: 99%

mentioning

confidence: 99%

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Oncologist-led BRCA ‘mainstreaming’ in the ovarian cancer clinic: A study of 255 patients and its impact on their management

Rumford

Lythgoe

McNeish

et al. 2020

Sci Rep

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“…A 100% rate was achieved at the Royal Marsden Hospital in the United Kingdom, with motivated staff using mainstreaming. 57,63 The ENGAGE study (Evaluating a Novel Onco-Genetic BRCA Testing Counseling Model Among Patients With Ovarian Cancer), which has now finished accruing, is a prospective observational cohort study that replicates this mainstreaming model whereby oncologists or nurses inform the patients about BRCA testing and its values/drawbacks and obtain their consent before BRCA testing. The genetics team then only routinely sees in consult those with a mutation or a variant requiring evaluation.…”

Section: Genetics Referral/brca Testing Rates and Barriersmentioning

confidence: 99%

Missed therapeutic and prevention opportunities in women with BRCA‐mutated epithelial ovarian cancer and their families due to low referral rates for genetic counseling and BRCA testing: A review of the literature

Hoskins

Gotlieb

2017

CA A Cancer J Clinicians

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Answer questions and earn CME/CNE Fifteen percent of women with epithelial ovarian cancer have inherited mutations in the BRCA breast cancer susceptibility genes. Knowledge of her BRCA status has value both for the woman and for her family. A therapeutic benefit exists for the woman with cancer, because a new family of oral drugs, the poly ADP-ribose polymerase (PARP) inhibitors, has recently been approved, and these drugs have the greatest efficacy in women who carry the mutation. For her family, there is the potential to prevent ovarian cancer in those carrying the mutation by using risk-reducing surgery. Such surgery significantly reduces the chance of developing this, for the most part, incurable cancer. Despite these potential benefits, referral rates for genetic counseling and subsequent BRCA testing are low, ranging from 10% to 30%, indicating that these therapeutic and prevention opportunities are being missed. The authors have reviewed the relevant available literature. Topics discussed are BRCA and its relation to ovarian cancer, the rates of referral for genetic counseling/BRCA testing, reasons for these low rates, potential strategies to improve on those rates, lack of effectiveness of current screening strategies, the pros and cons of risk-reducing surgery, other prevention options, and the role and value of PARP inhibitors. CA Cancer J Clin 2017;67:493-506. © 2017 American Cancer Society.

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“…Although in its infancy, mainstreaming within the oncology setting provides a model by which genetics can be integrated within the palliative setting. In the UK, oncology health professionals (consultants, trainees and nurses) completed an educational training package, which enabled them to counsel and consent ovarian cancer patients for BRCA1 and BRCA2 genetic testing [35]. This has improved access to genetic testing and has been deemed by both patients and providers an acceptable alternative to traditional models of genetic service delivery [20,35].…”

Section: Discussionmentioning

confidence: 99%

Genetics in palliative oncology: a missing agenda? A review of the literature and future directions

Morrow

Jacobs

Best

et al. 2017

Support Care Cancer

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Purpose In the palliative oncology setting, genetic assessment may not impact on the patient's management but can be of vital importance to their surviving relatives. Despite care of the family being central to the ethos of palliative care, little is known about how hereditary aspects of cancer are addressed in this setting. This review aims to examine current practices, identify practice barriers and determine the genetic information and support needs of patients, family members and health providers. Methods Key databases were systematically searched to identify both quantitative and qualitative studies that addressed these aims. Data was extracted and coded using thematic analysis. Results Eight studies were included for review. Suboptimal genetic practices were identified, with lack of knowledge and poor confidence amongst providers reported as barriers in both qualitative and quantitative studies. Providers expressed concern about the emotional impact of initiating these discussions late in the disease trajectory; however, qualitative interviews amongst palliative patients suggested there may be emotional benefits. Conclusions All lines of evidence suggest that genetics is currently missing from the palliative agenda, signifying lost opportunities for mutation detection, genetic counselling and appropriate risk management for surviving relatives. There is an urgent need for interventions to improve provider knowledge and awareness of genetic referral pathways and for research into the genetic information and support needs of palliative care patients.

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The integration of BRCA testing into oncology clinics

Cited by 53 publications

References 11 publications

Oncologist-led BRCA ‘mainstreaming’ in the ovarian cancer clinic: A study of 255 patients and its impact on their management

Oncologist-led BRCA ‘mainstreaming’ in the ovarian cancer clinic: A study of 255 patients and its impact on their management

Missed therapeutic and prevention opportunities in women with BRCA‐mutated epithelial ovarian cancer and their families due to low referral rates for genetic counseling and BRCA testing: A review of the literature

Genetics in palliative oncology: a missing agenda? A review of the literature and future directions

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