University of Colorado Cancer Center, Aurora, CO.
University of Colorado School of Medicine, Aurora, CO.
JCO Precis Oncol. 2024 Jun;8:e2300699. doi: 10.1200/PO.23.00699.
Patients with hereditary cancer syndromes (HCS) have a high lifetime risk of developing cancer. Historically underserved populations have lower rates of genetic evaluation. We sought to characterize demographic factors that are associated with undergoing HCS evaluation in an urban safety-net patient population.
All patients who met inclusion criteria for this study from 2016 to 2021 at an urban safety-net hospital were included in this analysis. Inclusion criteria were pathologically confirmed breast, ovarian/fallopian tube, colon, pancreatic, and prostate cancers. Patients also qualified for hereditary breast and ovarian cancers or Lynch syndrome on the basis of National Comprehensive Cancer Network guidelines. Institutional review board approval was obtained. Demographic and oncologic data were collected through retrospective chart review. Univariable and multivariable logistic regression models were constructed.
Of the 637 patients included, 40% underwent genetic testing. Variables associated with receiving genetic testing on univariable analysis included patients living at the time of data collection, female sex, Latinx ethnicity, Spanish language, family history of cancer, and referral for genetic testing. Patients identifying as Black, having Medicare, having pancreatic or prostate cancer, having stage IV disease, having Eastern Cooperative Oncology Group (ECOG) prognostic score ≥1, having medium or high Charlson comorbidity index, with current or previous cigarette use, and with previous alcohol use were negatively associated with testing. On multivariable modeling, family history of cancer was positively associated with testing. Patients identifying as Black, having colon or prostate cancer, and having ECOG score of 2 had significantly lower association with genetic testing.
Uptake of HCS was lower in patients identifying as Black, those with colon or prostate cancer, and those with an ECOG score of 2. Efforts to increase HCS testing in these patients will be important to advance equitable cancer care.
遗传性癌症综合征 (HCS) 患者终生患癌风险较高。历史上服务不足的人群接受基因评估的比例较低。我们旨在描述与城市医疗保障患者人群中进行 HCS 评估相关的人口统计学因素。
本研究纳入了 2016 年至 2021 年期间在城市医疗保障医院就诊且符合纳入标准的所有患者。纳入标准为经病理证实的乳腺癌、卵巢/输卵管癌、结肠癌、胰腺癌和前列腺癌。根据国家综合癌症网络指南，患者还符合遗传性乳腺癌和卵巢癌或林奇综合征的条件。本研究获得了机构审查委员会的批准。通过回顾性病历审查收集人口统计学和肿瘤学数据。进行了单变量和多变量逻辑回归模型构建。
在纳入的 637 例患者中，有 40%接受了基因检测。单变量分析中与接受基因检测相关的变量包括数据收集时的患者居住地、女性、拉丁裔、西班牙语、癌症家族史以及遗传咨询。黑人患者、有医疗保险、患有胰腺癌或前列腺癌、疾病分期为 IV 期、东部肿瘤协作组 (ECOG) 预后评分≥1、中等或高度 Charlson 合并症指数、当前或既往吸烟以及既往饮酒与检测结果呈负相关。多变量模型显示，癌症家族史与检测呈正相关。黑人患者、结肠癌或前列腺癌患者以及 ECOG 评分为 2 的患者与基因检测的相关性显著降低。
黑人、患有结肠癌或前列腺癌以及 ECOG 评分为 2 的患者接受 HCS 检测的比例较低。在这些患者中增加 HCS 检测的努力对于推进公平的癌症护理将非常重要。
