Publications by authors named "Hetal S Vig"

7 Publications

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Age at diagnosis may trump family history in driving BRCA testing in a population of breast cancer patients.

Cancer Epidemiol Biomarkers Prev 2013 Oct 5;22(10):1778-85. Epub 2013 Aug 5.

Authors' Affiliations: Cancer Institute of New Jersey, New Brunswick, New Jersey; and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.

Background: Standard BRCA genetic testing criteria include young age of diagnosis, family history, and Jewish ancestry. The purpose of this study was to assess the effect of these criteria on BRCA test utilization in breast cancer patients.

Methods: Breast cancer patients aged 18 to 64 years living in Pennsylvania in 2007 completed a survey on family history of breast and ovarian cancer and BRCA testing (N = 2,213). Multivariate logistic regression was used to estimate odds of BRCA testing by patient characteristics, and predicted probabilities of testing were calculated for several clinical scenarios.

Results: Young age at diagnosis (<50 years) was strongly associated with BRCA testing, with women diagnosed before age 50 years having nearly five times the odds of receiving BRCA testing compared to women diagnosed at age 50 or older (OR = 4.81; 95% CI, 3.85-6.00; P < 0.001). Despite a similar BRCA mutation prevalence estimate (8-10%), a young Jewish patient <50 years with no family history had markedly higher predicted probability of testing (63%) compared with an older, non-Jewish breast cancer patient with more than one first-degree relative (43%).

Conclusion: Age at diagnosis, Jewish ancestry, and both maternal and paternal family history are strongly predictive of BRCA testing. However, among women diagnosed at age 50 or older, family history may be an underused criterion that may benefit from targeted intervention.

Impact: Robust methods specific to ascertaining detailed family history, such as through electronic medical records, are needed to accurately identify patients for BRCA testing.
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http://dx.doi.org/10.1158/1055-9965.EPI-13-0426DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3799946PMC
October 2013

Identification of genetic counseling service delivery models in practice: a report from the NSGC Service Delivery Model Task Force.

J Genet Couns 2013 Aug 25;22(4):411-21. Epub 2013 Apr 25.

Cancer Genetics Risk Assessment Program, St. Vincent Hospital, 8301 Harcourt Rd #100, Indianapolis, IN 46260, USA.

Increasing demand for genetic services has resulted in the need to evaluate current service delivery models (SDMs) and consider approaches that improve access to and efficiency of genetic counseling (GC). This study aimed to describe SDMs currently used by the GC community. The NSGC membership was surveyed regarding the use of four SDMs: in-person GC, telephone GC, group GC, and telegenetics GC. Variables related to access and components of use were also surveyed, including: appointment availability, time-per-patient, number of patients seen, billing, and geographic accessiblity. Seven hundred one usable responses were received. Of these, 54.7 % reported using an in-person SDM exclusively. The remainder (45.3 %) reported using multiple SDMs. Telephone, group and telegenetics GC were used often or always by 8.0 %, 3.2 % and 2.2 % of respondents, respectively. Those using an in-person SDM reported the ability to see the highest number of patients per week (p < 0.0001) and were the most likely to bill in some manner (p < 0.0001). Those using telegenetic and telephone GC served patients who lived the furthest away, with 48.3 % and 35.8 %% respectively providing GC to patients who live >4 h away. This study shows that genetic counselors are incorporating SDMs other than traditional in-person genetic counseling, and are utilizing more than one model. These adaptations show a trend toward shorter wait time and shorter length of appointments. Further study is indicated to analyze benefits and limitations of each individual model and factors influencing the choice to adopt particular models into practice.
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http://dx.doi.org/10.1007/s10897-013-9588-0DOI Listing
August 2013

The evolution of personalized cancer genetic counseling in the era of personalized medicine.

Fam Cancer 2012 Sep;11(3):539-44

Practice changes in cancer genetic counseling have occurred to meet the demand for cancer genetic services. As cancer genetics continues to impact not only prevention strategies but also treatment decisions, current cancer genetic counseling models will need to be tailored to accommodate emerging clinical indications. These clinical indications include: surgical prophylactic bilateral mastectomy candidates, PARP-inhibitor candidates, patients with abnormal tumor screening results for Lynch syndrome, and post-test counseling patients (after genetic testing is ordered by another healthcare provider). A more personalized, multidisciplinary approach to selecting the best framework, for a given clinical indication, may become increasingly necessary in this era of personalized medicine.
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http://dx.doi.org/10.1007/s10689-012-9524-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3905734PMC
September 2012

Delivery of Internet-based cancer genetic counselling services to patients' homes: a feasibility study.

J Telemed Telecare 2011 19;17(1):36-40. Epub 2010 Nov 19.

University Hospitals Case Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University, 11100 Euclid Avenue, Lakeside 1200, Cleveland, OH 44106-5065, USA.

We examined the feasibility of home videoconferencing for providing cancer genetic education and risk information to people at risk. Adults with possible hereditary colon or breast and ovarian cancer syndromes were offered Internet-based counselling. Participants were sent web cameras and software to install on their home PCs. They watched a prerecorded educational video and then took part in a live counselling session with a genetic counsellor. A total of 31 participants took part in Internet counselling sessions. Satisfaction with counselling was high in all domains studied, including technical (mean 4.3 on a 1-5 scale), education (mean 4.7), communication (mean 4.8), psychosocial (mean 4.1) and overall (mean 4.2). Qualitative data identified technical aspects that could be improved. All participants reported that they would recommend Internet-based counselling to others. Internet-based genetic counselling is feasible and associated with a high level of satisfaction among participants.
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http://dx.doi.org/10.1258/jtt.2010.100116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263376PMC
May 2011

Cancer genetic risk assessment and referral patterns in primary care.

Genet Test Mol Biomarkers 2009 Dec;13(6):735-41

Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA.

Purpose: This study was undertaken to describe cancer risk assessment practices among primary care providers (PCPs).

Methods: An electronic survey was sent to PCPs affiliated with a single insurance carrier. Demographic and practice characteristics associated with cancer genetic risk assessment and testing activities were described. Latent class analysis supported by likelihood ratio tests was used to define PCP profiles with respect to the level of engagement in genetic risk assessment and referral activity based on demographic and practice characteristics.

Results: 860 physicians responded to the survey (39% family practice, 29% internal medicine, 22% obstetrics/gynecology (OB/GYN), 10% other). Most respondents (83%) reported that they routinely assess hereditary cancer risk; however, only 33% reported that they take a full, three-generation pedigree for risk assessment. OB/GYN specialty, female gender, and physician access to a genetic counselor were independent predictors of referral to cancer genetics specialists. Three profiles of PCPs, based upon referral practice and extent of involvement in genetics evaluation, were defined.

Conclusion: Profiles of physician characteristics associated with varying levels of engagement with cancer genetic risk assessment and testing can be identified. These profiles may ultimately be useful in targeting decision support tools and services.
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http://dx.doi.org/10.1089/gtmb.2009.0037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935840PMC
December 2009

Knowledge and attitudes about microsatellite instability testing among high-risk individuals diagnosed with colorectal cancer.

Cancer Epidemiol Biomarkers Prev 2007 Oct;16(10):2110-7

Division of Population and Medical Science, Fox Chase Cancer Center, 333 Cottman Avenue, P1100 Philadelphia, PA 19111, USA.

For individuals meeting Bethesda criteria for hereditary nonpolyposis colorectal cancer syndrome, the microsatellite instability (MSI) test is recommended as a screening evaluation before proceeding to genetic testing. The MSI test is new to the medical setting, but will be increasingly used to screen patients at high risk for hereditary nonpolyposis colorectal cancer. The main goals of this study were to examine knowledge about and exposure to the MSI test among individuals considering the test, to evaluate perceived benefits and barriers to undergoing the MSI test, and to identify the demographic, medical, and psychosocial correlates of the perceived benefits and barriers to undergoing the test. One hundred and twenty-five patients completed a survey after being offered the test, but prior to making the decision whether to pursue MSI testing. Results indicated low levels of knowledge about and previous exposure to the MSI test. Participants held positive attitudes about the potential benefits of the test and perceived few barriers to undergoing the test. Motivations were similar to those cited by individuals considering other genetic tests. Participants with nonmetastatic disease, with lower perceived risk for cancer recurrence, and who reported more self-efficacy endorsed more benefits from the test. Higher levels of cancer-specific psychological distress were associated with more perceived barriers to having the test. These findings suggest that individuals considering the MSI test know very little about it but hold positive attitudes about the test's utility. More distressed patients, patients who perceive themselves at higher risk for cancer recurrence, and patients with metastatic disease might be less motivated to have the MSI test.
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http://dx.doi.org/10.1158/1055-9965.EPI-07-0412DOI Listing
October 2007

Hereditary colorectal cancer syndromes. Start risk assessment in primary care.

Adv Nurse Pract 2007 Jul;15(7):49-52

Fox Chase Cancer Center, Philadelphia, USA.

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July 2007