Brennsteiner, Daniel
(2023)
A Focus on Interventions to Increase Rates of Genetic Services for Patients with Pancreatic Cancer.
Master's Thesis, University of Pittsburgh.
(Unpublished)
Abstract
Pancreatic cancer progresses rapidly and has historically been difficult to treat, with a 5-year relative survival rate of about 9-12%. Screening and early-detection are also challenging, contributing to disease morbidity. Within the past five years, a growing body of literature has demonstrated increased rates of survival and improved outcomes in individuals with germline BRCA pathogenic or likely pathogenic variants when offered targeted therapeutics such as PARP inhibitor maintenance therapy, showing evidence of anti-tumor activity and extended median progression-free survival.
About 5-10% of pancreatic cancer diagnoses have an underlying genetic cause. 2-5% are caused by BRCA1/2 variants that may direct use of targeted therapies. The National Comprehensive Cancer Network (NCCN) has recognized the importance of identifying germline status in the context of pancreatic cancer treatment in addition to understanding familial health implications due to inheritance and increased cancer risks. On December 4, 2019, NCCN released Genetic/Familial High-Risk Assessment Guidelines for Breast, Ovarian, and Pancreatic cancers (Version 1.2020), recommending genetic counseling and genetic testing for every individual diagnosed with exocrine type pancreatic cancer. These rates are far lower than 100% for several reasons related to testing service access, therapeutic decision-making, and disease progression.
This quality improvement study was completed to better understand cancer genetic counseling referral and genetic testing rates in the clinical setting to identify areas that could benefit from public health intervention strategies aimed at increasing rates of genetic services. Deidentified electronic medical record (EHR) data was collected from 449 patients diagnosed with exocrine pancreatic cancer between July 2019 and June of 2020 across three Geisinger hospital sites across central Pennsylvania. Overall, 1/5 patients (88/449) were referred to genetic counseling, and half of those referrals (44/88) were completed. In total, only 13% (59/449) underwent genetic testing. For patients completing genetic counseling appointments, 86% had testing. Comparatively, for patients that did not have genetic counseling, 5% completed testing. Understanding current gaps in clinical practice will help focus public health intervention methods aimed toward increasing overall health outcomes of pancreatic cancer patients and healthcare provider service delivery. Additionally, this study explores related interventions attempted by Geisinger and offers direction for future strategies.
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Details
| Item Type: |
University of Pittsburgh ETD
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| Status: |
Unpublished |
| Creators/Authors: |
|
| ETD Committee: |
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| Date: |
27 April 2023 |
| Defense Date: |
14 April 2023 |
| Approval Date: |
11 May 2023 |
| Submission Date: |
27 April 2023 |
| Access Restriction: |
No restriction; Release the ETD for access worldwide immediately. |
| Number of Pages: |
87 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Public Health > Human Genetics |
| Degree: |
MS - Master of Science |
| Thesis Type: |
Master's Thesis |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
Pancreatic cancer, germline genetic testing, interventions, increase genetic services, genetic counseling, genetic testing, referrals |
| Date Deposited: |
11 May 2023 16:36 |
| Last Modified: |
11 May 2023 16:36 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/44773 |
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