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Familial cancer syndromes: Tools that can help connect the dots in primary care Emily Edelman, MS, CGC NCHPEG Cancer in the family: Primary Care Matters Bar Harbor, Maine April 13, 2012. Outline. VISULIZE ACTIVITIES WITH TIMELINES!. Information at the point of care and beyond - PowerPoint PPT Presentation
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Familial cancer syndromes: Tools that can help connect the dots in primary care
Emily Edelman, MS, CGCNCHPEG
Cancer in the family: Primary Care MattersBar Harbor, MaineApril 13, 2012
VISULIZE ACTIVITIES WITH TIMELINES!Outline
• Information at the point of care and beyond
• Clinical needs & tools that can help• Identifying and assessing risk• Managing genetic risk – testing, referring, screening• Communicating genetic risk
• New CME - “CRC: Are your patients at increased risk?”
VISULIZE ACTIVITIES WITH TIMELINES!Genetics Resources
Point of care Journals
Lectures
Peer learning
Self-directed CMETraining programs
Conferences
Information
Time
Web resources
Audit & feedback
Professional guidelines
Point of care tools
• “Just in time” information
• Motivation to learn
• Minimum to address a specific clinical action or question
Non-geneticists need information about genetic conditions
Levy H et al. Genet Med 2008:10(9):659– 667
VISULIZE ACTIVITIES WITH TIMELINES!Role of the PCP Role in Genomic Medicine
• Minimum Roles• Triaging • Coordinating • Counseling
• August 2010: NCHPEG & AMA Advisory Committee Meeting
Identify Intervene CollaborateAwareness of testing process
What do PCPs need to know how to do regarding hereditary (colon) cancer?
VISULIZE ACTIVITIES WITH TIMELINES!Identifying & Assessing Risk
• Clinical opportunities • New patient• Change in family history• Cancer or polyp diagnosis • Patient question
• Maria• 34 y/o woman presenting for annual exam• Mother diagnosed with breast cancer 3
months ago• Worried about her own cancer risk
VISULIZE ACTIVITIES WITH TIMELINES!Risk Assessment
Ask the right questions
Identify patterns of high risk
Classify risk level
Identifying Risk: Maria
What information should I collect to assess Maria’s cancer risk?
www.uch.edu/pdf/HerCan_Family_History_questionnaire.pdf
Identifying Risk: Maria
What information should I collect to assess Maria’s cancer risk?
familyhistory.hhs.gov
Identifying Risk: Maria
What information should I collect to assess Maria’s cancer risk?
www.nchpeg.orgFrom “CRC: Are your patients at increased risk?”
Identifying Risk: Maria
Information
What information should I collect to assess Maria’s cancer risk?
USPSTF. 2005. Ann Intern Med; 143:355-361.
Identifying Risk: Maria
Information
What information should I collect to assess Maria’s cancer risk?
www.nchpeg.orgFrom “Core Principles in Family History for All Health Professionals”
Identifying Risk: Maria
Information
What information should I collect to assess Maria’s cancer risk?
www.medicalhomeinfo.org/GPCI.aspx
Identifying Risk: Maria
64 yo 61 yo 58 yo 55 yo 57 yodx. 60 dx. 58 dx. 55
40 yo 37 yo 26 yo 34 yo 27 yo 32 yo 28 yo dx. 30
d. 68 d. 65 d. 52 yo 82 yo dx 70
Ovarian ca Prostate caBreast ca
What are the factors that increase Maria’s risk of breast cancer?
Identifying Risk: Maria
64 yo 61 yo 58 yo 55 yo 57 yodx. 60 dx. 58 dx. 55
40 yo 37 yo 26 yo 34 yo 27 yo 32 yo 28 yo dx. 30
d. 68 d. 65 d. 52 yo 82 yo dx 70
What are the factors that increase Maria’s risk of breast cancer?
www.nsgc.orgFrom “Cancer Genetic Counselors: Working Hand-In-Hand with Physicians to Educate and Care for Patients,” brochure.
Identifying Risk: Maria
64 yo 61 yo 58 yo 55 yo 57 yodx. 60 dx. 58 dx. 55
40 yo 37 yo 26 yo 34 yo 27 yo 32 yo 28 yo dx. 30
d. 68 d. 65 d. 52 yo 82 yo dx 70
What are the factors that increase Maria’s risk of breast cancer?
www.nchpeg.orgFrom “CRC: Are your patients at increased risk?”
Assessing Risk: Maria
64 yo 61 yo 58 yo 55 yo 57 yodx. 60 dx. 58 dx. 55
40 yo 37 yo 26 yo 34 yo 27 yo 32 yo 28 yo dx. 30
d. 68 d. 65 d. 52 yo 82 yo dx 70
Ovarian ca Prostate caBreast ca
What does this family history mean?
Assessing Risk: Maria
64 yo 61 yo 58 yo 55 yo 57 yodx. 60 dx. 58 dx. 55
40 yo 37 yo 26 yo 34 yo 27 yo 32 yo 28 yo dx. 30
d. 68 d. 65 d. 52 yo 82 yo dx 70
What does this family history mean?
www.nchpeg.orgFrom “CRC: Are your patients at increased risk?”
Assessing Risk: Maria
What does this family history mean?
www.hughesriskapps.net/
Assessing Risk: Maria
What does this family history mean?
www.cancer.gov/bcrisktool/
Assessing Risk: Maria
What does this family history mean?
www.nchpeg.orgFrom “CRC: Are your patients at increased risk?”
Assessing Risk: Maria
What does this family history mean?
Information
Assessing Risk: Maria
What does this family history mean?
Information
www.nchpeg.orgFrom “CRC: Are your patients at increased risk?”
Assessing Risk: Maria
What does this family history mean?
Information
www.nsgc.org
Assessing Risk: Maria
What does this family history mean?
Information
www.mainedartmouth.org/Cancer-inthe-family.html
VISULIZE ACTIVITIES WITH TIMELINES!Coordinating & Managing Risk
• Clinical opportunities • Risk is assessed• Referring or consulting • Genetic testing • Screening
• Ben• 62 y/o man presenting for annual exam• Update history: 3 adenomatous polyps• Perform risk assessment
VISULIZE ACTIVITIES WITH TIMELINES!Ben: Coordinating & Managing Risk
Female ca, NOS Endometrial caColon caPolyps
Endometrial Ca dx 44
CRC dx 62
CRC 70s3 polyps 50
Ben62
3 polyps
d.“female”cancer 50s
VISULIZE ACTIVITIES WITH TIMELINES!Ben: Coordinating & Managing Risk
Additional Genetic
Evaluation
Refer or Consult
Order Genetic Testing
Order Screening
Test
Communicate
VISULIZE ACTIVITIES WITH TIMELINES!Ben: Coordinating & Managing Risk
What do I do for a patient at increased risk? How do I refer or find a specialist?
VISULIZE ACTIVITIES WITH TIMELINES!Ben: Coordinating & Managing Risk
What do I do for a patient at increased risk? How do I refer or find a specialist?
www.nchpeg.orgFrom “CRC: Are your patients at increased risk?”
VISULIZE ACTIVITIES WITH TIMELINES!Ben: Coordinating & Managing Risk
What do I do for a patient at increased risk? How do I refer or find a specialist?
www.nchpeg.orgFrom “CRC: Are your patients at increased risk?”
VISULIZE ACTIVITIES WITH TIMELINES!Ben: Coordinating & Managing Risk
What do I do for a patient at increased risk? How do I refer or find a specialist?
www.nchpeg.orgFrom “CRC: Are your patients at increased risk?”
VISULIZE ACTIVITIES WITH TIMELINES!Ben: Coordinating & Managing Risk
What do I do for a patient at increased risk? How do I refer or find a specialist?
Information
VISULIZE ACTIVITIES WITH TIMELINES!Ben: Coordinating & Managing Risk
What do I do for a patient at increased risk? How do I order and use genetic testing?
VISULIZE ACTIVITIES WITH TIMELINES!Ben: Coordinating & Managing Risk
What do I do for a patient at increased risk? How do I order and use genetic testing?
www.arupconsult.com/Algorithms/HNPCC.pdf
VISULIZE ACTIVITIES WITH TIMELINES!Ben: Coordinating & Managing Risk
What do I do for a patient at increased risk? How do I order and use genetic testing?
www.nchpeg.orgFrom “CRC: Are your patients at increased risk?”
VISULIZE ACTIVITIES WITH TIMELINES!Ben: Coordinating & Managing Risk
What do I do for a patient at increased risk? How do I order and use genetic testing?
www.nchpeg.orgFrom “CRC: Are your patients at increased risk?”
VISULIZE ACTIVITIES WITH TIMELINES!Ben: Coordinating & Managing Risk
What do I do for a patient at increased risk? How do I order and use genetic testing?
Information
VISULIZE ACTIVITIES WITH TIMELINES!Ben: Coordinating & Managing Risk
What do I do for a patient at increased risk? How do I order and use genetic testing?
Information
ASCO. 2010. JCO; 28(5): 893-901http://jco.ascopubs.org/content/28/5/893.full.pdf
VISULIZE ACTIVITIES WITH TIMELINES!Ben: Coordinating & Managing Risk
What do I do for a patient at increased risk? How do I order and use genetic testing?
Information
www.nchpeg.orgFrom “CRC: Are your patients at increased risk?”
VISULIZE ACTIVITIES WITH TIMELINES!Ben: Coordinating & Managing Risk
What do I do for a patient at increased risk? How do I order and use genetic testing?
Information
City of Hope Intensive Course in Cancer Risk Assessmentwww.cityofhope.org/education/health-professional-education/intensive-course/Pages/default.aspx
VISULIZE ACTIVITIES WITH TIMELINES!Ben: Coordinating & Managing Risk
What do I do for a patient at increased risk? How do I select the appropriate screening plan?
VISULIZE ACTIVITIES WITH TIMELINES!Ben: Coordinating & Managing Risk
What do I do for a patient at increased risk? How do I select the appropriate screening plan?
www.nchpeg.orgFrom “CRC: Are your patients at increased risk?”
VISULIZE ACTIVITIES WITH TIMELINES!Ben: Coordinating & Managing Risk
What do I do for a patient at increased risk? How do I select the appropriate screening plan?
Genetic/Familial High-Risk Assessment: Breast and Ovarian, 2010, www.nccn.org
VISULIZE ACTIVITIES WITH TIMELINES!Ben: Coordinating & Managing Risk
What do I do for a patient at increased risk? How do I select the appropriate screening plan?
www.genefacts.org
VISULIZE ACTIVITIES WITH TIMELINES!Ben: Coordinating & Managing Risk
What do I do for a patient at increased risk? How do I select the appropriate screening plan?
Information
VISULIZE ACTIVITIES WITH TIMELINES!Tools can help with risk assessment
Ask the right questions
Identify patterns of high risk
Classify risk level
VISULIZE ACTIVITIES WITH TIMELINES!Tools can help with coordinating & managing risk
Additional Genetic
Evaluation
Refer or Consult
Order Genetic Testing
Order Screening
Test
Communicate
Visit nchpeg.org to hone your skills and download point of care tools
GRAPHIC: NCHPEG/AMA CRC program
VISULIZE ACTIVITIES WITH TIMELINES!Summary
• PCP has a critical role in management of cancer risk
• Many tools available that can help at the point of care and beyond
VISULIZE ACTIVITIES WITH TIMELINES!
Thank you!
eedelman@nchpeg.org
www.nchpeg.org
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