Quality of Cancer Family History and Referral for Genetic Counseling and Testing Among Oncology Practices: A Pilot Test of Quality Measures As Part of the American Society of Clinical Oncology Quality Oncology Practice Initiative
Quality of Cancer Family History and Referral for Genetic Counseling and Testing Among Oncology Practices: A Pilot Test of Quality Measures As Part of the American Society of Clinical Oncology Quality Oncology Practice Initiative
复制标题
DOI：
10.1200/jco.2013.51.4661
复制
发表时间：
2014-03-10
影响因子：
45.3
通讯作者：
Hughes, Kevin S.
中科院分区：
文献类型：
--
作者：
Wood, Marie E.;Kadlubek, Pamela;Hughes, Kevin S.
目的癌症家族史（CFH）是确定个体接受遗传咨询/检测（GC/GT）的重要依据。先前的研究表明，GC/GT的家族史记录和转诊率很低。方法对2011年秋季参加美国临床肿瘤协会肿瘤质量实践倡议的271家医院对乳腺癌（BC）或结肠癌（CRC）患者的CFH质量和GC/GT实践进行评估。结果10466例患者共有212例完成了CFH和GC/GT的测量；77.4%的医疗记录记录了一级亲属存在或不存在CFH， 61.5%的医疗记录记录了二级亲属存在或不存在CFH，与CRC患者相比，BC患者的记录明显更高。30.7%的医疗记录记录了所有癌症亲属的诊断年龄（BC, 45.2%； CRC, 35.4%; P .001）。在所有BC或CRC患者中，有22.1%的患者转诊为GC/GT。在遗传性癌症风险增加的患者中，52.2%的BC患者和26.4%的CRC患者被转诊为GC/GT。当进行基因检测时，77.7%的人记录了同意，78.8%的人记录了结果的讨论。结论：我们发现，在美国肿瘤学家的转诊指南中，完整的CFH记录率和BC或CRC患者的转诊率都很低。与结直肠癌患者相比，BC患者的文献记录和转诊更多。关于准确CFH的重要性和前瞻性高风险患者管理的益处的教育和支持显然是必要的。
Purpose Family history of cancer (CFH) is important for identifying individuals to receive genetic counseling/testing (GC/GT). Prior studies have demonstrated low rates of family history documentation and referral for GC/GT.Methods CFH quality and GC/GT practices for patients with breast (BC) or colon cancer (CRC) were assessed in 271 practices participating in the American Society of Clinical Oncology Quality Oncology Practice Initiative in fall 2011.Results A total of 212 practices completed measures regarding CFH and GC/GT practices for 10,466 patients; 77.4% of all medical records reviewed documented presence or absence of CFH in first-degree relatives, and 61.5% of medical records documented presence or absence of CFH in second-degree relatives, with significantly higher documentation for patients with BC compared with CRC. Age at diagnosis was documented for all relatives with cancer in 30.7% of medical records (BC, 45.2%; CRC, 35.4%; P .001). Referall for GC/GT occurred in 22.1% of all patients with BC or CRC. Of patients with increased risk for hereditary cancer, 52.2% of patients with BC and 26.4% of those with CRC were referred for GC/GT. When genetic testing was performed, consent was documented 77.7% of the time, and discussion of results was documented 78.8% of the time.Conclusion We identified low rates of complete CFH documentation and low rates of referral for those with BC or CRC meeting guidelines for referral among US oncologists. Documentation and referral were greater for patients with BC compared with CRC. Education and support regarding the importance of accurate CFH and the benefits of proactive high-risk patient management are clearly needed.