ABSTRACT
BACKGROUND: The US Preventive Services Task Force (USPSTF) endorses routine screening for genetic risk of breast and/or ovarian cancer as a component of primary health care. Implementation of this recommendation may prove challenging, especially in clinics serving disadvantaged communities. METHODS: The authors tested the feasibility of implementing the USPSTF mandate at a federally qualified health center (FQHC) to identify women who were eligible for genetic counseling (GC). A 12-month usual-care phase was followed by a 12-month intervention phase, during which time cancer genetic risk assessment (CGRA) was systematically performed for all women aged 25 to 69 years who presented for an annual examination. Women who were eligible for GC were recruited to participate in the study. RESULTS: After initiating CGRA, 112 women who were eligible for GC consented to study participation, and 56% of them received a referral for GC from their primary care physician. A subgroup of 50 participants were seen by the same primary care physician during both the usual-care and intervention phases. None of these patients was referred for GC during usual care, compared with 64% after the initiation of CGRA (P < .001). Only 16% of referred participants attended a GC session. CONCLUSIONS: Implementing USPSTF recommendations for CGRA as a standard component of primary health care in FQHCs is feasible and improves referral of minority women for GC, but more work is needed to understand the beliefs and barriers that prevent many underserved women from accessing cancer genetic services.
Subject(s)
Breast Neoplasms/diagnosis , Breast Neoplasms/genetics , Genetic Testing , Health Plan Implementation , Physicians, Primary Care/statistics & numerical data , Referral and Consultation/statistics & numerical data , Adult , Aged , Breast Neoplasms/epidemiology , Chicago/epidemiology , Feasibility Studies , Female , Financing, Government , Genetic Counseling/economics , Genetic Counseling/organization & administration , Genetic Counseling/statistics & numerical data , Genetic Testing/economics , Genetic Testing/methods , Genetic Testing/statistics & numerical data , Health Plan Implementation/economics , Health Plan Implementation/organization & administration , Health Plan Implementation/statistics & numerical data , Health Status Disparities , Humans , Mass Screening/economics , Mass Screening/methods , Mass Screening/statistics & numerical data , Middle Aged , Ovarian Neoplasms/diagnosis , Ovarian Neoplasms/epidemiology , Ovarian Neoplasms/genetics , Physicians, Primary Care/economics , Practice Patterns, Physicians'/economics , Practice Patterns, Physicians'/statistics & numerical data , Preventive Health Services/methods , Primary Health Care/methods , Program Evaluation , Referral and Consultation/economics , Referral and Consultation/organization & administration , Risk Assessment , United States/epidemiologyABSTRACT
BACKGROUND: There are few efficacy and toxicity data on sorafenib for patients treated for hepatocellular carcinoma (HCC) who are not Caucasian or Asian. MATERIALS AND METHODS: A retrospective analysis was carried out on 67 patients treated with sorafenib for advanced HCC at an urban referral center. Patients were categorized by race, age, sex, status, stage, and dose. Primary outcomes were time to progression (TTP), toxicity, and treatment discontinuation by race. RESULTS: African-Americans and Caucasians had significantly shorter TTP than patients of other races (Hispanic, Asian, and unidentified) [African-Americans: hazard ratio (HR)=5.01, p=0.0068; Caucasians: HR=8.25, p=0.0008). There were no significant differences in time to toxicity (p=0.99). Caucasians had the shortest time to therapy discontinuation (p=0.0298). TTP was shorter for males (HR=3.51, p=0.028), and longer for patients experiencing toxicity (HR=0.47, p=0.046). CONCLUSION: Among patients treated with sorafenib for advanced HCC, non African-American/non-Caucasian race, female sex, and toxicity were associated with significantly longer time to progression.