Evaluation of a Streamlined Oncologist-Led BRCA Mutation Testing and Counseling Model for Patients With Ovarian Cancer
Evaluation of a Streamlined Oncologist-Led BRCA Mutation Testing and Counseling Model for Patients With Ovarian Cancer
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DOI：
10.1200/jco.2017.76.2781
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发表时间：
2018-05-01
影响因子：
45.3
通讯作者：
Blakeley, Christopher
中科院分区：
文献类型：
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作者：
Colombo, Nicoletta;Huang, Gloria;Blakeley, Christopher
目的卵巢癌患者对BRCA1/2突变(BRCAm)检测的需求越来越大；然而，有限的遗传咨询师数量构成了一个潜在的障碍。为了便于在卵巢癌中进行更广泛的BRCAm检测，肿瘤学团队的检测前咨询可以缩短检测周转时间，减轻遗传顾问的压力。患者和方法前瞻性、观察性评估卵巢癌患者简化的致癌BRCA检测和咨询模型(Engage)研究评估了一种由肿瘤学家领导的简化BRCAm检测途径。分析人群包括美国、意大利和西班牙26个地点的700名卵巢癌患者。主要目标是评估周转时间，并使用问卷评估利益相关者(患者、肿瘤学家、遗传学家或遗传咨询师)对肿瘤学家领导的BRCAM测试路径的满意度。结果总体周转时间的中位数为9.1周(范围为0.9至37.1周)，美国、意大利和西班牙的中位数周转时间分别为4.1周(范围为0.9至37.1周)、20.4周(范围为2.9至35.4周)和12.0周(范围为2.0至36.7周)。患者对肿瘤学家主导的BRCAm测试途径的满意度很高，99%的患者对BRCAm测试前后的咨询表示满意。肿瘤学家对BRCAm检测途径的满意度也很高，80%的人同意进行BRCAm检测的过程效果良好，咨询患者进行BRCAm检测是对他们时间的有效利用。与遗传学家或遗传咨询师相比，肿瘤学家对BRCAm检测途径的满意度更高。结论Engage研究结果表明，由肿瘤学家领导的BRCAm检测过程在卵巢癌中是可行的。制定类似于本研究中使用的本地BRCAM检测指南，可以在卵巢癌患者的管理中更快地做出治疗决定，并更好地利用资源。
PurposeThere is a growing demand for BRCA1/2 mutation (BRCAm) testing in patients with ovarian cancer; however, the limited number of genetic counselors presents a potential barrier. To facilitate more widespread BRCAm testing in ovarian cancer, pretest counseling by the oncology team could shorten testing turnaround times and ease the pressure on genetic counselors.Patients and MethodsThe prospective, observational Evaluating a Streamlined Onco-genetic BRCA Testing and Counseling Model Among Patients With Ovarian Cancer (ENGAGE) study evaluated a streamlined, oncologist-led BRCAm testing pathway. The analysis population comprised 700 patients with ovarian cancer at 26 sites in the United States, Italy, and Spain. The primary objectives were to assess turnaround time and, using questionnaires, to evaluate stakeholder satisfaction (patients, oncologists, and geneticists or genetic counselors) with the oncologist-led BRCAm testing pathway.ResultsThe median overall turnaround time was 9.1 weeks (range, 0.9 to 37.1 weeks), with median turnaround times in the United States, Italy, and Spain of 4.1 weeks (range, 0.9 to 37.1 weeks), 20.4 weeks (range, 2.9 to 35.4 weeks), and 12.0 weeks (range, 2.0 to 36.7 weeks), respectively. Patient satisfaction with the oncologist-led BRCAm testing pathway was high, with > 99% of patients expressing satisfaction with pre- and post-BRCAm test counseling. Oncologist satisfaction with the BRCAm testing pathway was also high, with > 80% agreeing that the process for performing BRCAm testing worked well and that counseling patients on BRCAm testing was an efficient use of their time. Oncologists expressed higher levels of satisfaction with the BRCAm testing pathway than did geneticists or genetic counselors.ConclusionThe results of the ENGAGE study demonstrate that an oncologist-led BRCAm testing process is feasible in ovarian cancer. Development of local BRCAm testing guidelines similar to the one used in this study could allow faster treatment decisions and better use of resources in the management of patients with ovarian cancer.