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“It’s the Wild, Wild West Out There” Experiences of a Multidisciplinary Genomic Breast Cancer Tumor Board Implementing Tumor Sequencing in Clinical Care

Fishler, Kristen, B.S.
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1525169475571341

Abstract Details

2018, MS, University of Cincinnati, Medicine: Genetic Counseling.
Multidisciplinary genomic tumor boards (MGTBs) discuss the results of tumor sequencing and have become increasingly prevalent in the cancer field. Oncologists order sequencing on solid tumors to provide additional genetic information that may be used for diagnosis and risk stratification, but may also provide insight into possible novel treatment strategies and clinical trials for patients. Previous publication of one breast cancer MGTB, which met 13 times over a 12-month period from 2013-2014, revealed that decisions about which patients should receive tumor sequencing and subsequent referral to genetics were not consistent or standardized. The role of a medical geneticist on this MGTB was minimal, and genetic counselors were invited to the MGTB, but did not attend and did not seem to be consulted. The role of a genetic counselor on a multidisciplinary cancer research team has been suggested previously. A qualitative analysis of interviews with MGTB members and MGTB meeting minutes was performed using a grounded theory approach. Current gaps in the literature include how MGTBs make decisions about who to refer to genetics after a tumor sequencing result has been generated. This study identified ethical and logistical challenges that may occur when integrating tumor sequencing into clinical care with minimal involvement or consultation with a medical geneticist/genetic counselor. Additionally, this study aimed to identify how the MGTB formed their recommendations based on the results of tumor sequencing and how they decided which patients were referred to genetics. Four themes emerged regarding ethical and logistical issues that may be present when implementing and/or utilizing tumor sequencing including (1) blurred lines between research and clinical care, (2) contradiction between who should have testing and who may benefit, (3) interpretation of mutations that may be germline, and (4) delineation of the role of a genetics professional. Results revealed opportunities to improve the incorporation of tumor sequencing into the medical field such as standardizing which patients are referred for germline genetic testing through routine collection of a family history and/or obtaining previous genetic testing results prior to conducting tumor sequencing, educating providers about specific genes that should raise their concern for germline presence, mitigating therapeutic misconception pertaining to clinical utility during the consent process, and providing psychosocial counseling to patients who have psychosocial concerns as a result of their tumor sequencing. Results from this study encourage collection of personal and family history prior to interpreting tumor sequencing results as well as knowledge regarding NCCN recommendations for germline testing following tumor sequencing to better triage patients to genetic counseling and interpret tumor sequencing results that may also be in the germline.
Melanie Myers, Ph.D. (Committee Chair)
Erin Breese, M.D. Ph.D. (Committee Member)
Michelle Mcgowan, Ph.D. (Committee Member)
Rebecca Sisson, M.S. L.G.C. (Committee Member)
Lauren Walters-Sen, Ph.D. (Committee Member)
69 p.
Health Sciences
multidisciplinary genomic tumor boards; breast cancer tumor boards; tumor sequencing; genetics professionals; molecular tumor boards

Recommended Citations

Citations

  • Fishler, K. (2018). “It’s the Wild, Wild West Out There” Experiences of a Multidisciplinary Genomic Breast Cancer Tumor Board Implementing Tumor Sequencing in Clinical Care [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1525169475571341

    APA Style (7th edition)

  • Fishler, Kristen. “It’s the Wild, Wild West Out There” Experiences of a Multidisciplinary Genomic Breast Cancer Tumor Board Implementing Tumor Sequencing in Clinical Care. 2018. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1525169475571341.

    MLA Style (8th edition)

  • Fishler, Kristen. "“It’s the Wild, Wild West Out There” Experiences of a Multidisciplinary Genomic Breast Cancer Tumor Board Implementing Tumor Sequencing in Clinical Care." Master's thesis, University of Cincinnati, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1525169475571341

    Chicago Manual of Style (17th edition)

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This open access ETD is published by University of Cincinnati and OhioLINK.