Hereditary Cancer Clinics Improve Adherence to NCCN Germline Testing Guidelines for Pancreatic Cancer
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Division of Hematology/Oncology, Department of Medicine, UCI School of Medicine, Irvine, CA
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Division of Hematology/Oncology, Department of Medicine, UCI School of Medicine, Irvine, CA
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Division of Hematology/Oncology, Department of Medicine, UCI School of Medicine, Irvine, CA
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Division of Hematology/Oncology, Department of Medicine, UCI School of Medicine, Irvine, CA
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Division of Hematology/Oncology, Department of Medicine, UCI School of Medicine, Irvine, CA
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Background: Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis, with a 5-year overall survival rate of 10%. In November 2018, NCCN recommended that all patients with PDAC receive genetic counseling (GC) and germline testing regardless of family history. We hypothesized that patients with PDAC were more likely to be referred for testing after this change to the guidelines, regardless of presumed predictive factors, and that compliance would be further improved following the implementation of a hereditary cancer clinic (HCC). Methods: We conducted a single-institution retrospective analysis of patients diagnosed with PDAC from June 2017 through December 2021 at University of California, Irvine. We compared rates of genetics referral among patients in different diagnostic eras: the 18-month period before the NCCN Guideline change (pre-NCCN era: June 2017 through November 2018), 14 months following the change (post-NCCN era: December 2018 through January 2020), and 18 months after the creation of an HCC (HCC era: June 2020 through December 2021). Family and personal cancer history, genetics referral patterns, and results of GC were recorded. Data were compared using chi-square, Fisher exact, and multivariate analyses. Results: A total of 335 patients were treated for PDAC (123 pre-NCCN, 109 post-NCCN, and 103 HCC) at University of California, Irvine. Demographics across groups were comparable. Prior to the guideline changes, 30% were referred to GC compared with 54.7% in the post-NCCN era. After the implementation of the HCC, 77.4% were referred to GC (P<.0001). The odds ratio (OR) for referral to GC among patients with a positive family history of cancer progressively decreased following the change (pre-NCCN era: OR, 11.90 [95% CI, 3.00–80.14]; post-NCCN era: OR, 3.39 [95% CI, 1.13–10.76]; HCC era: OR, 3.11 [95% CI, 0.95–10.16]). Conclusions: The 2018 updates to the NCCN Guidelines for PDAC recommending germline testing for all patients with PDAC significantly increased GC referral rates at our academic medical center. Implementation of an HCC further boosted compliance with guidelines.
Submitted June 7, 2023; final revision received December 20, 2023; accepted for publication December 21, 2023. Published online June 18, 2024.
Author contributions: Conceptualization: Rosso, Marciano, Nathan, Valerin. Data curation: Rosso, Marciano. Formal analysis: Chen, McLaren, Osann, Flodman. Investigation: Rosso, Marciano, Nathan, Zell, Valerin. Methodology: Rosso, Marciano, Nathan, Chen, Osann, Flodman, Valerin. Supervision: Zell, Valerin. Writing—original draft: Rosso, Marciano. Writing—review & editing: Chen, Cho, Lee, Dayyani, Zell, Valerin.
Disclosures: Dr. Dayyani has disclosed receiving grant/research support from Amgen, AstraZeneca, Bristol Myers Squibb, Exelixis, Genentech, Ipsen, Signatera, and Taiho; serving as a consultant for AstraZeneca, Eisai, Exelixis, Genentech, Foundation Medicine, and Ipsen; receiving honoraria from Amgen, Deciphera, Eisai, Exelixis, Ipsen, Servier, Signatera, and Sirtex; and having a spouse who is employed by Roche Diagnostics US. Dr. Zell has disclosed serving as a consultant for Tempus. Dr. Valerin has disclosed serving as a consultant and on an advisory board for Tempus; and serving on the speakers bureau and as a scientific advisor for AstraZeneca. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
Funding: This publication was supported by the Chao Family Comprehensive Cancer Center Biostatistics Shared Resource, supported by the National Cancer Institute of the National Institutes of Health under award number P30CA062203.
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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