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Familial cancer syndromes: Tools that can help connect the dots in primary care

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

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Familial cancer syndromes: Tools that can help connect the dots in primary care

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  1. 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

  2. Outline VISULIZE ACTIVITIES WITH TIMELINES! • 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?”

  3. Genetics Resources VISULIZE ACTIVITIES WITH TIMELINES! Audit & feedback Lectures Conferences Journals Point of care Peer learning Professional guidelines Training programs Web resources Self-directed CME Information Time

  4. Point of care tools • “Just in time” information • Motivation to learn • Minimum to address a specific clinical action or question

  5. Non-geneticists need information about genetic conditions Levy H et al. Genet Med 2008:10(9):659– 667

  6. Role of the PCP Role in Genomic Medicine VISULIZE ACTIVITIES WITH TIMELINES! • Minimum Roles • Triaging • Coordinating • Counseling • August 2010: NCHPEG & AMA Advisory Committee Meeting What do PCPs need to know how to do regarding hereditary (colon) cancer? Awareness of testing process Identify Intervene Collaborate

  7. Identifying & Assessing Risk VISULIZE ACTIVITIES WITH TIMELINES! • 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

  8. Risk Assessment VISULIZE ACTIVITIES WITH TIMELINES! • Identify patterns of high risk Ask the right questions • Classify risk level

  9. Identifying Risk: Maria What information should I collect to assess Maria’s cancer risk? www.uch.edu/pdf/HerCan_Family_History_questionnaire.pdf

  10. Identifying Risk: Maria What information should I collect to assess Maria’s cancer risk? familyhistory.hhs.gov

  11. Identifying Risk: Maria What information should I collect to assess Maria’s cancer risk? www.nchpeg.org From “CRC: Are your patients at increased risk?”

  12. Identifying Risk: Maria What information should I collect to assess Maria’s cancer risk? Information USPSTF. 2005. Ann Intern Med; 143:355-361.

  13. Identifying Risk: Maria What information should I collect to assess Maria’s cancer risk? Information www.nchpeg.org From “Core Principles in Family History for All Health Professionals”

  14. Identifying Risk: Maria What information should I collect to assess Maria’s cancer risk? Information www.medicalhomeinfo.org/GPCI.aspx

  15. Identifying Risk: Maria What are the factors that increase Maria’s risk of breast cancer? d. 68 d. 65 d. 52 yo 82 yo dx 70 64 yo 61 yo 58 yo 55 yo 57 yo dx. 60 dx. 58 dx. 55 40 yo 37 yo 26 yo 34 yo 27 yo 32 yo 28 yo dx. 30 Breast ca Ovarian ca Prostate ca

  16. Identifying Risk: Maria What are the factors that increase Maria’s risk of breast cancer? d. 68 d. 65 d. 52 yo 82 yo dx 70 64 yo 61 yo 58 yo 55 yo 57 yo dx. 60 dx. 58 dx. 55 40 yo 37 yo 26 yo 34 yo 27 yo 32 yo 28 yo dx. 30 www.nsgc.org From “Cancer Genetic Counselors: Working Hand-In-Hand with Physicians to Educate and Care for Patients,” brochure.

  17. Identifying Risk: Maria What are the factors that increase Maria’s risk of breast cancer? d. 68 d. 65 d. 52 yo 82 yo dx 70 64 yo 61 yo 58 yo 55 yo 57 yo dx. 60 dx. 58 dx. 55 40 yo 37 yo 26 yo 34 yo 27 yo 32 yo 28 yo dx. 30 www.nchpeg.org From “CRC: Are your patients at increased risk?”

  18. Assessing Risk: Maria What does this family history mean? d. 68 d. 65 d. 52 yo 82 yo dx 70 64 yo 61 yo 58 yo 55 yo 57 yo dx. 60 dx. 58 dx. 55 40 yo 37 yo 26 yo 34 yo 27 yo 32 yo 28 yo dx. 30 Breast ca Ovarian ca Prostate ca

  19. Assessing Risk: Maria What does this family history mean? d. 68 d. 65 d. 52 yo 82 yo dx 70 64 yo 61 yo 58 yo 55 yo 57 yo dx. 60 dx. 58 dx. 55 40 yo 37 yo 26 yo 34 yo 27 yo 32 yo 28 yo dx. 30 www.nchpeg.org From “CRC: Are your patients at increased risk?”

  20. Assessing Risk: Maria What does this family history mean? www.hughesriskapps.net/

  21. Assessing Risk: Maria What does this family history mean? www.cancer.gov/bcrisktool/

  22. Assessing Risk: Maria What does this family history mean? www.nchpeg.org From “CRC: Are your patients at increased risk?”

  23. Assessing Risk: Maria What does this family history mean? Information

  24. Assessing Risk: Maria What does this family history mean? Information www.nchpeg.org From “CRC: Are your patients at increased risk?”

  25. Assessing Risk: Maria What does this family history mean? Information www.nsgc.org

  26. Assessing Risk: Maria What does this family history mean? Information www.mainedartmouth.org/Cancer-inthe-family.html

  27. Coordinating & Managing Risk VISULIZE ACTIVITIES WITH TIMELINES! • 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

  28. Ben: Coordinating & Managing Risk VISULIZE ACTIVITIES WITH TIMELINES! d.“female” cancer 50s 3 polyps 50 CRC 70s Ben 62 3 polyps Endometrial Ca dx 44 CRC dx 62 Polyps Colon ca Female ca, NOS Endometrial ca

  29. Ben: Coordinating & Managing Risk VISULIZE ACTIVITIES WITH TIMELINES! Refer or Consult Additional Genetic Evaluation Order Genetic Testing Order Screening Test Communicate

  30. Ben: Coordinating & Managing Risk VISULIZE ACTIVITIES WITH TIMELINES! What do I do for a patient at increased risk? How do I refer or find a specialist?

  31. Ben: Coordinating & Managing Risk VISULIZE ACTIVITIES WITH TIMELINES! What do I do for a patient at increased risk? How do I refer or find a specialist? www.nchpeg.org From “CRC: Are your patients at increased risk?”

  32. Ben: Coordinating & Managing Risk VISULIZE ACTIVITIES WITH TIMELINES! What do I do for a patient at increased risk? How do I refer or find a specialist? www.nchpeg.org From “CRC: Are your patients at increased risk?”

  33. Ben: Coordinating & Managing Risk VISULIZE ACTIVITIES WITH TIMELINES! What do I do for a patient at increased risk? How do I refer or find a specialist? www.nchpeg.org From “CRC: Are your patients at increased risk?”

  34. Ben: Coordinating & Managing Risk VISULIZE ACTIVITIES WITH TIMELINES! What do I do for a patient at increased risk? How do I refer or find a specialist? Information

  35. Ben: Coordinating & Managing Risk VISULIZE ACTIVITIES WITH TIMELINES! What do I do for a patient at increased risk? How do I order and use genetic testing?

  36. Ben: Coordinating & Managing Risk VISULIZE ACTIVITIES WITH TIMELINES! What do I do for a patient at increased risk? How do I order and use genetic testing? www.arupconsult.com/Algorithms/HNPCC.pdf

  37. Ben: Coordinating & Managing Risk VISULIZE ACTIVITIES WITH TIMELINES! What do I do for a patient at increased risk? How do I order and use genetic testing? www.nchpeg.org From “CRC: Are your patients at increased risk?”

  38. Ben: Coordinating & Managing Risk VISULIZE ACTIVITIES WITH TIMELINES! What do I do for a patient at increased risk? How do I order and use genetic testing? www.nchpeg.org From “CRC: Are your patients at increased risk?”

  39. Ben: Coordinating & Managing Risk VISULIZE ACTIVITIES WITH TIMELINES! What do I do for a patient at increased risk? How do I order and use genetic testing? Information

  40. Ben: Coordinating & Managing Risk VISULIZE ACTIVITIES WITH TIMELINES! What do I do for a patient at increased risk? How do I order and use genetic testing? Information ASCO. 2010. JCO; 28(5): 893-901 http://jco.ascopubs.org/content/28/5/893.full.pdf

  41. Ben: Coordinating & Managing Risk VISULIZE ACTIVITIES WITH TIMELINES! What do I do for a patient at increased risk? How do I order and use genetic testing? Information www.nchpeg.org From “CRC: Are your patients at increased risk?”

  42. Ben: Coordinating & Managing Risk VISULIZE ACTIVITIES WITH TIMELINES! 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 Assessment www.cityofhope.org/education/health-professional-education/intensive-course/Pages/default.aspx

  43. Ben: Coordinating & Managing Risk VISULIZE ACTIVITIES WITH TIMELINES! What do I do for a patient at increased risk? How do I select the appropriate screening plan?

  44. Ben: Coordinating & Managing Risk VISULIZE ACTIVITIES WITH TIMELINES! What do I do for a patient at increased risk? How do I select the appropriate screening plan? www.nchpeg.org From “CRC: Are your patients at increased risk?”

  45. Ben: Coordinating & Managing Risk VISULIZE ACTIVITIES WITH TIMELINES! 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

  46. Ben: Coordinating & Managing Risk VISULIZE ACTIVITIES WITH TIMELINES! What do I do for a patient at increased risk? How do I select the appropriate screening plan? www.genefacts.org

  47. Ben: Coordinating & Managing Risk VISULIZE ACTIVITIES WITH TIMELINES! What do I do for a patient at increased risk? How do I select the appropriate screening plan? Information

  48. Tools can help with risk assessment VISULIZE ACTIVITIES WITH TIMELINES! • Identify patterns of high risk Ask the right questions • Classify risk level

  49. Tools can help with coordinating & managing risk VISULIZE ACTIVITIES WITH TIMELINES! Refer or Consult Additional Genetic Evaluation Order Genetic Testing Order Screening Test Communicate

  50. Visit nchpeg.org to hone your skills and download point of care tools GRAPHIC: NCHPEG/AMA CRC program

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