Ayush N. Shah, DO1, Anuhya Gampa, MD1, Jamie Tjaden, MD2, Omar Khan, MD3, Allison DePersia, MD1
1NorthShore University HealthSystem, Evanston, IL; 2North Shore University Health System, Evanston, IL; 3North Shore Medical Center, Evanston, IL
Introduction: Lynch syndrome (LS) is the most common inherited cause of colorectal (CRC) and endometrial cancer (EC) worldwide. Universal tumor screening (UTS) for LS is recommended in all CRC/EC patients via microsatellite instability (MSI) or immunohistochemistry (IHC) testing for the absence of mismatch repair proteins. Patients with positive UTS should be referred for genetic counseling (GC) and testing. At our institution, UTS is performed for all patients with CRC or EC, and the result is reported as an addendum on pathology reports and as a separate file. The proceduralist (surgeon or gastroenterologist) is responsible for referring positive UTS patients to GC. But, many are lost to follow-up. Historically, a secondary reminder was sent to the proceduralist by the genetic counselor to encourage GC for patients with positive UTS. This workflow was not executed 6/2017 - 9/2018. Our quality initiative aims to evaluate how modifications in the UTS workflow (with or without a secondary reminder) affected patient follow-up and determine the best approach for future UTS follow-up.
Methods: Cases reviewed 6/24/17 – 9/12/18 that underwent UTS for CRC/EC. These patients did not have a secondary GC reminder. UTS positive patient charts were analyzed to see: 1. if a GC referral was placed or recommended in the progress note, 2. if GC follow-up was completed and 3. if genetic testing was completed. Rates of patients with appropriate referrals and genetic testing were calculated. These were compared to historical results 2010–2017 when the UTS workflow included secondary reminders.
Results: Of the 239 patients with CRC/EC without a secondary reminder, 63(26.4%) screened positive. Of the 63 patients, 29(46%) had a referral ordered, 9(14.3%) had GC recommended by the provider in the progress note, 27(43.9%) had both a referral and documentation in a progress note. 40(63.5%) of the 63 patients had one or both modes of GC referrals. 21(33.3%) of the 63 followed up with GC. Of the 21, 20(95.2%) had genetic testing. The historical rate of presentation to GC following positive UTS when a secondary reminder was part of the workflow was 89/192 (46.4%).
Discussion: 33% of CRC/EC patients with positive UTS followed up with GC during the current UTS workflow compared to 46% when a secondary reminder was sent to the proceduralist by the genetic counselor. Implementing a standardized approach for follow-up of patients with positive UTS that includes genetic counselor reminders improves GC rates for LS in CRC/EC patients.
Citation: Ayush N. Shah, DO; Anuhya Gampa, MD; Jamie Tjaden, MD; Omar Khan, MD; Allison DePersia, MD. P1019 - GENETIC COUNSELING FOLLOW-UP RATES AFTER POSITIVE LYNCH SYNDROME UNIVERSAL TUMOR SCREENING: A QUALITY ASSESSMENT. Program No. P1019. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.