Post on 31-Mar-2015
transcript
Advisory Committee on Breast Cancer in Young Women
January 9, 2014
M o n i q u e M a r t i n , M P H , C H E SH e a l t h E d u c a t i o n a n d C o m m u n i c a t i o n S p e c i a l i s t
G e o r g i a C e n t e r f o r O n c o l o g y R e s e a r c h a n d E d u c a t i o n ( G e o r g i a C O R E )
OUTLINE
Cancer Care in Georgia
Consortium’s Background
Accomplishments
• Education
• Policy
• Surveillance
Challenges & Successes
CANCER CARE in GEORGIA
159 Counties 17 Cancer Genetic Counselors 18 Health Districts 1 NCI Hospital 42 CoC Hospitals Resources are largely based in Atlanta
Metropolitan Area
Source: statecancerprofiles.cancer.gov
Georgia State University
Morehouse School of Medicine
A Public Private Partnership
CONSORTIUM’S STRUCTURE
PURPOSETo promote use of evidence-based guidelines for breast and
ovarian cancer genetic risk assessment, counseling and testing, and improve the identification of young women at genetic risk
for these cancers.
EducationState & National Organizations’ Posters/ Presentations
National Society of Genetic Counselors (NSGC) Society of Public Health Education (SOPHE) American Association of Cancer Research (AACR) International Society of Nurses in Genetics (ISONG) Oncology Nursing Society (ONS) American Society of Breast Surgeons (ASBS)
University of Georgia 2nd Annual State of Public Health Conference
Breast Health Seminar @ GA Dept. of Public Health GA Health News Cancer Patient Navigators of Georgia at GASCO Annual
Meeting Georgia Society of Obstetrics and Gynecology 12 Breast health programs in GA Georgia Public Health Association (GPHA)
275 licensed Primary Care Providers were surveyed.
Found a significant HBOC knowledge deficit among Georgia PCPs, particularly with respect to identification of high-risk individuals.
Paternal Inheritance Autosomal Dominant Inheritance
Highest Risk - Family History Only
Highest Risk - Personal History
0
10
20
30
40
50
60
70
80
90
100
68
56.5
39.8
4.2
47.6
32.836.9
3.6
Recognition of Key HBOC Genetics Concepts among Primary Care Providers by Confidence Level
Very High/High Confidence Level
Average/ Low/ Very Low Con-fidence LevelP
erc
ent
Corr
ect
Source: Schmitt, E., Webster, R., Bellcross, C., & Meaney-Delman, D. (2013). Georgia healthcare provider knowledge, practice patterns, and education needs regarding hereditary breast and ovarian cancer. National Society of Genetic Counselors 2013 Annual Conference.Source: MDCH Provider Survey
Education
Needs Assessments:Young Breast Cancer Survivors
Primary Care Residencies
Cancer Genetic Counselors
Primary Care Providers
Goal: Communicate the importance of genomics in primary care clinical practice to providers and give information on current
cancer genomic standards and guidelines.
Education
Inclusion of a new objective in GA’s Comprehensive Cancer Control Plan Objective 2.3A: By 2017, increase the number of high risk Georgians with
access to breast, ovarian, and colorectal cancer genetic risk assessment (i.e. genetic counseling and testing) by 20%.
Meetings with: GA Insurance Commissioner Medical Directors of Leading Health plans GDPH Telehealth & Partnership for Telehealth Program Directors
Analysis of GA Health Plans
Policy
Policy
Policy
Approval of $46,000 Genetic Testing Fund with proceeds from GA Breast Cancer License Tag
Every $22 Dollars from the purchase or renewal of a GA Breast Cancer License Tag is deposited in the Indigent Care Fund for breast health programs for the underserved
Creates a new stream of funding for the underinsured for genetic testing for hereditary breast and ovarian cancer in Georgia.
Available January 2014
USPSTF’s recommendation cites Breast Cancer Genetics Referral Screening Tool (B-RST*) and www.BreastCancerGeneScreen.org
“Simplest and quickest to administer.”
*Developed and validated by Cecelia Bellcross, PhD, MS, CGC, Emory University School of Medicine, Department of Human Genetics, Member of Winship Cancer Institute
SURVEILLANCE
SURVEILLANCE
Website developed using B-RST Algorithm
6 Questions
3 Results: Negative Moderate Positive
Targeted provider and public information
National Cancer Institute (NCI)Source: http://www.cancer.gov/cancertopics/pdq/genetics
0
50
100
150
200
250
BreastCancerGeneScreen.org – web traffic, ~495 unique visitors/month
MAY 2013 Angelina Jolie’s New York Times Editorial – 5/14/2013
SURVEILLANCE & EDUCATION
0
100
200
300
400
500
MAY 2013 Angelina Jolie’s New York Times Editorial – 5/14/2013
DEC 2013 Release of USPSTF’s Recommendation Statement– 12/23/2013
Moderate18%
Negative73%
Positive9%
Screening Results of Public Users
1184 Public Users
Under 180%
18-4981%
50+12%
Not Specified7%
Age of Public Users
Native Hawaiian / Pacific Islander
0%
Other1%Hispanic /
Latino20%
Caucasian / White29%
African Amer-ican / Black
41%
Asian2%
Not Specified7%
Race/Ethnicity of Public Users
SURVEILLANCE & EDUCATION
SURVEILLANCE
Location of counties with clinics using B-RST screening*
* From Top to Bottom: Gwinnett , Cobb/Douglas, DeKalb, Clayton, Bibb, Chatham
USE of B-RST in GA PUBLIC HEALTH CLINICS
Clients visit clinic. Clinic staff incorporate HBOC screening into typical process for collecting client’s medical history using BreastCancerGeneScreen.org.
Clients with Moderate & Negative screening results given information. Routine health screenings are encouraged.
Clients with Positive screening results are contacted by a genetics professional, unless they opt-out.
SURVEILLANCE
SURVEILLANCE
SURVEILLANCE
Cobb/Douglas DeKalb Gwinnett Bibb Chatham Clayton
19
41
3217 16 3
108
1134
373263 228 14
B-RST Screening in Public Health clinics (N=2120)# Positive Total # Screened
SURVEILLANCE
Data presented collected from 2012 – 2013 Clinics have varying:
Implementation dates Structures Number of providers
SURVEILLANCE
Patients screened using the B-RST in 6 public health clinics by Zip Code
Source: Map by E. Dauria, 2013
73.2%
(1551)
0.2% (4)
1.2% (26)
12.9%
(273)
8.0% (170)
0.1% (3) 2.7% (57) 1.7% (36)
Race/Ethnicity of Individuals Screened in 6 Public Health Clinics (N=2120)
African American/Black
American Indian/Alaskan Native
Asian
Caucasian/White
Hispanic / Latino
Native Hawaiian/Pacific Islander
Not specified
Other
4.1% (86)
88.3% (1871)
5.1% (109)
2.5% (54)
Age of Individuals Screened in 6 Public Health Clinics (N=2120)
Under 18
18-49
50+
Not Specified
SURVEILLANCE
B-RST Positive Screenings in Public Health Clinics (N=2120)
Positive rt:
Positive Screens in Public Health clinicsNegative/Moderate Screens in Public Health clinics
SURVEILLANCE
1. Total number divided by number of patients that agreed to follow-up2. Obtained detailed family history and provided resource(s)/counseling/education.3. Reported breast concern as reason for coming to public health clinic.4. Total number of patients with the test result divided by number of patients tested.5. Not enough information about genetic change to know whether or not it results in increased risk of
cancer.
95 (74.2%) Pa-
tients
Agreed to
Fol-low Up
128 Positive Patients Screened Patient Follow-Up N (%)1
Successfully Contacted2 66 (69.4%)
Meet NCCN High Risk guidelines 44 (46.3%)
Tested 14 (14.7%)
Patients that reported findings3 20 (21.1%)
N (%)4
Test Results
BRCA 1/2 Positive
Genetic Variant of Uncertain Significance5
Negative
1 (7.1%)
1(7.1%)
9 (64.3%)
Pending Test Results 3 (21.4%)
SURVEILLANCE
Challenges Newly Funded State Uncertainty about future funding opportunities (sustainability!) Limited access to genetic counselors Lack of genomics awareness among providers & the public Policy Limbo
Implementation of ACA Implications of patent challenge
Successes Collaboration Work within public health clinics USPSTF recommendation statement
SUMMARY
GEORGIA DEPARTMENT OF PUBLIC HEALTH
Barbara Crane, MN, APRN
GEORGIA CORE
Nancy M. Paris, MS, FACHE Monique L. Martin, MPH, CHESAlice Kerber, RN, MN, APRN, ACNS-BC, AOCN, APNG
EMORY UNIVERSITYWinship Cancer Institute
Cecelia Bellcross, PhD, MS, CGCSheryl G. A. Gabram-Mendola, MD, MBA, FACSVictoria Green, MD, MHSA, MBA, JDL. Brannon Traxler, MD
GEORGIA STATE UNIVERSITYRobyn Bussey, MBA, MHAKaren Minyard, PhDChristopher Parker, BSc, MBBS, MPH
MOREHOUSE SCHOOL OF MEDICINERoland Matthews, MDIjeoma Azonobi, MD
THANK YOUMONIQUE MARTIN, MPH, CHES(O) 404-584-5640(F) 404-584-8839MMARTIN@GEORGIACORE.ORG