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.
OBJECTIVE
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.


CONCLUSIONS
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.
Marie E. Wood, University of Vermont, Burlington, VT; Pamela Kadlubek, Trang H. Pham, and Dana S. Wollins, American Society of Clinical Oncology, Alexandria, VA; Karen H. Lu, MD Anderson Cancer Center, Houston, TX; Jeffrey N. Weitzel, City of Hope, Duarte, CA; Michael N. Neuss, Vanderbilt- Ingram Cancer Center, Nashville, TN; and Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Mass General Hospital, Boston, MA.
Marie E
ME
Wood
Pamela
P
Kadlubek
Trang H
TH
Pham
Dana S
DS
Wollins
Karen H
KH
Lu
Jeffrey N
JN
Weitzel
Michael N
MN
Neuss
Kevin S
KS
Hughes
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000235:genetics*; D003110:Colonic Neoplasms / Q000235:genetics*; D005260:Female; D005817:Genetic Counseling / Q000592:standards*; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing / Q000592:standards*; D019983:Guideline Adherence / Q000592:standards; D019538:Health Care Surveys; D040941:Heredity; D006801:Humans; D008297:Male; D008487:Medical History Taking / Q000592:standards*; D008495:Medical Oncology / Q000592:standards*; D008875:Middle Aged; D010375:Pedigree; D010641:Phenotype; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D011237:Predictive Value of Tests; D011379:Prognosis; D015397:Program Evaluation; D019984:Quality Indicators, Health Care / Q000592:standards*; D012017:Referral and Consultation / Q000592:standards*; D012307:Risk Factors; D014481:United States