Hereditary breast and ovarian cancer: Referral source for genetic assessment and communication regarding assessment with nongenetic clinicians in the community setting

Abstract

Purpose

To examine referral source to cancer genetic services; communication of results of genetic evaluation to clinicians; role of clinicians in postcounseling management; and use of alternative information sources after cancer genetic risk assessment/counseling in the community setting.

Methods

Retrospective telephone survey. Setting: A community/private hospital-based cancer genetic counseling service.

Patients

Women, at least 21 years of age, who had undergone cancer genetic counseling with (1) at least a 10% predicted likelihood of carrying a BRCA1/2 mutation or (2) a documented BRCA1/2 mutation.

Intervention

A 121-item telephone survey. Main outcome measure: (1) initial referral source to cancer genetic services; (2) women's communication of results of cancer genetic assessment to primary and (nongenetic) specialist clinician(s); (3) education and support role played by subjects' physician(s); and (4) use of other hereditary breast and ovarian cancer (HBOC) information resources.

Results

Of 225 women eligible for study, 69 (31%) completed the survey. Sixty-two percent were referred by their medical oncologist; 13% by their primary care physician, and fewer by their surgeon (6%) or gynecologist (4%). Results of the cancer genetic assessment were not shared with 19% of primary care clinicians, 26% of primary gynecologists, 12% of oncologists, and 36% of surgeons. Twenty-six percent of participants noted that their primary care clinician had not been involved in their HBOC-related, cancer prevention decisions, 16% had not included their gynecologist, 2% had not involved their oncologist, and 20% replied that their surgeon had not been involved in these decisions. Overall, clinicians were perceived as supportive when it came to a participants' information and decision support needs. One exception was that 21% of respondents reported the use by clinicians of medical terms, without definition. Over two-thirds had sought alternative “self-help” HBOC-related materials, most Internet based.

Conclusions

These results have implications for interdisciplinary communication and decision support for those with or at risk for HBOC, cared for in the community setting.