Cancer Genetics

special interest group newsletter

Volume 18, Issue 2, November 2014  
 
   
Coordinator’s Message:
Getting to Know You

Catherine Belt, RN, MSN, AOCN®
Hatfield, PA
cathy.belt@uphs.upenn.edu


If you are a fan of the CSI television series, you might remember that the soundtrack is the 1978 hit from The Who, “Who Are You.” Being a member of the 1970s generation, I am a fan of both! The chorus of the song goes, “Who are you, I really wanna know. Who are you, tell me, who are you?” As your SIG coordinator, to best represent your professional practice needs, I need to hear from you. I am hopeful that in “Getting to Know You” over the course of the next two years, we can work collaboratively to advance the issues relevant to our practice.

Historically, our SIG membership has not been particularly communicative through the means that are available (e.g., the Virtual Community, SIG discussion board, ONS surveys). Your leadership team needs your engagement, particularly as we continue to work for ONS-supported professional credentialing.

I am reminded of the phrase coined by President Nixon in the 1970s, the “silent majority.” The silent majority is defined as “any group of people who are not outspoken and who are considered to constitute a majority” (silent majority, n.d.). We have more than 2,200 registered members in the Cancer Genetics (CAG) SIG, and yet only 10 members completed the ONS survey last fall. This survey included key questions soliciting input for seeking ONS and Oncology Nursing Certification Corporation support to develop professional certification in cancer genetics. This year, our initial request was denied by the Board, but the door was left open for future consideration if the return on investment can be supported by membership interest. I am hopeful that, with your support, we can achieve success similar to the Bone and Marrow Stem Cell Transplant (BMT) SIG. The BMT SIG successfully achieved a certification exam within the past year, and about 300 nurses successfully have obtained the credential.

Since assuming office at ONS Congress in May, I have launched into many aspects of the coordinator role.

  • Chairing the SIG meeting at Congress—This gave me an opportunity to meet several SIG members and share some pressing SIG membership issues.
  • Conducting my first SIG leadership team conference call to revise the CAG SIG strategic goals
  • Submitting the SIG annual report to ONS, documenting our many 2013 accomplishments
  • Attending ONS Leadership Weekend to network with other SIG Leaders

We are entering a time of many challenges and changes for ONS. ONS’s new Chief Executive Officer (CEO), Brenda Nevidjon, RN, MSN, FAAN, assumed office in the beginning of September. Many of you will recognize Brenda’s name from her many years of active service and leadership within ONS. The Board of Directors bid farewell to retiring CEO Paula Rieger, RN, MSN, CAE, FAAN, who served for eight years. With Paula’s background in cancer genetics, I always felt that the CAG SIG had a Board member who understood our quest for cancer genetics nursing education and credentials. ONS also welcomed new Board members and President Margaret Barton-Burke, PhD, RN, FAAN. Margaret’s area of expertise is breast cancer research with an emphasis on African American women, an area of particular concern to our colleagues working in the area of cancer risk evaluation. The face of oncology nursing education will change as ONS Congress is reshaped to incorporate traditional ONS conferences that are being discontinued. We don’t know yet how changes to Congress will impact the in-person SIG meetings. ONS leadership is responding to the rapidly expanding field of cancer care and dwindling financial support from employers, and keeping faithful to the ONS mission. The most critical factor is engaging ONS membership in all aspects of oncology nursing practice. These are daunting challenges.

In the previous issue of the newsletter, I shared my personal and professional story so you could get to know the makeup of your new SIG coordinator. As your representative, I take seriously the responsibility of advocating for the needs and priorities of our SIG members within ONS and beyond. In recent years, emerging factors have impacted our roles as cancer genetics nurses—whether we are practicing in the area of cancer risk evaluation and germline testing, or we are clinical nurses providing targeted therapies and educating patients about the meaning of genomic tumor testing. The rapidity of technologic advancements forces us to expand our knowledge base, develop evidence-based practice, incorporate these advances into clinical practice, and seek professional credentialing for our unique scope of practice.

Representing you as the CAG SIG coordinator is my honor and privilege. I have budgeted time for my SIG responsibilities, and part of that time will be devoted to reaching out via email to our members. I want to get to know you, my colleagues and members of the CAG SIG. You joined this SIG for a reason. I’m eager to find out what that might be and how, together, we can help shape our future as genetics nurses. Drop me a line, post on the discussion board, and answer my emails as I reach out to you. Here’s to “Getting to Know You” better in the next year.

My predecessor, Jacqueline Hale, RN, APN-C, AOCN®, APNG, contributed greatly over the past two years to promoting and expanding our SIG mission. We are all the better for her leadership as she tirelessly represented our profession on several critical issues. I have benefitted from her mentorship during my year as coordinator-elect, and I thank her for her collegiality and generosity.

Reference
Silent majority. (n.d.). Dictionary.com Unabridged. Retrieved from http://dictionary.reference.com/browse/silent majority

 
The Cancer Genetics SIG Newsletter is produced by members of the
Cancer Genetics SIG and ONS staff and is not a peer-reviewed publication.

Cancer Genetics

Special Interest Group Newsletter  November 2014  
   

Your Vote Counts: ONS Coordinator-Elect Elections

Remember to vote in the upcoming Cancer Genetics (CAG) SIG coordinator-elect election from January 2–February 14. CAG SIG voting participation is one of the metrics used to evaluate SIG involvement. You will receive additional information via emails from ONS. You will have the opportunity to write in candidates.
 
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Cancer Genetics

Special Interest Group Newsletter  November 2014  
   

Persistence Pays Off: Identifying a Colon Cancer Syndrome

Jacqueline Hale, RN, APN-C, AOCN®, APNG
Flemington, NJ
Hale.jacqueline@hunterdonhealthcare.org

I first met Ms. K, an RN, at a local health fair in 2000. She invited me to present a session on hereditary cancer syndromes. After the session, Ms. K shared what she knew of her maternal and paternal family history—her father had colon cancer at age 67 years, two paternal uncles had lung cancer, and two paternal aunts lived into their 80s cancer-free. On the maternal side, Ms. K’s mother lived to age 93 years and had skin cancer, a maternal cousin had thyroid cancer, and a maternal aunt and two maternal uncles lived into their 80s and 90s cancer-free. The grandparents on the maternal and paternal side of the family didn’t have any known cancers. Although Ms. K was only 49 years old at the time, based upon her family history of a first-degree relative with colon cancer, we discussed beginning colorectal cancer screening with colonoscopy. At her colonoscopy, a cancerous polyp in the cecum was detected and removed. Ms. K subsequently had a right subtotal colectomy. When Ms. K’s sister learned of her sister’s diagnosis, she scheduled a colonoscopy and was found to have six cancerous polyps.

Ms. K and her sister came to our clinic for hereditary cancer risk assessment and testing prior to Ms. K’s sister’s colon cancer surgery. At the initial appointment, the family met Amsterdam criteria (i.e., three relatives with colon cancer, in two successive generations, and one with a diagnosis of colon cancer before the age of 50 years), suggesting Lynch syndrome (National Cancer Institute, 2014). Familial adenomatous polyposis (FAP) was not in the differential diagnosis at this time because no one in their parents’ or grandparents’ generations had reported any polyps (i.e., three generations were not affected), and FAP is autosomal dominant. Additionally, no one in the family reported more than 10 polyps, the minimum number to consider polyposis based on the available guidelines at that time. Ms. K’s sister requested to have a risk-reduction hysterectomy at the time of her colon surgery, as her personal and family history supported the diagnosis of Lynch syndrome. The surgeon reluctantly agreed. This proved to be an excellent decision, as her histopathology revealed an endometrial cancer.

Initial Testing Strategy
Microsatellite instability (MSI) tumor testing for patients newly diagnosed with colon cancer was not the standard of care in identification of Lynch syndrome when we first met the patient.

Definitions
“Microsatellite sequences are repetitive DNA sequences usually several base pairs in length. Microsatellite sequences are composed of non-coding DNA and are not parts of genes. They are used as genetic markers to follow the inheritance of genes in families” (National Human Genome Research Institute, n.d.). Microsatellite testing compares these sequences in the tumor tissue to the sequences in normal tissue in the individual.
Reference
National Human Genome Research Institute. (n.d.). Talking glossary of genetic terms: Microsatellite. Retrieved from https://www.genome.gov/glossary/index.cfm?id=126

Ms. K elected to have Lynch syndrome germline testing, which was commercially available in 2000. To test for hereditary cancer, the test sequenced MLH1 and MSH2. These test results did not identify any known mutations associated with Lynch syndrome. Ms. K and her sister continued to receive screening because of their clinical diagnosis of Lynch syndrome.

Interval Findings
Ms. K remained in contact, had follow-up colonoscopies, and reported more adenomatous polyps that were removed by colonoscopy. In 2007, we offered to obtain a tumor block from her colon resection for MSI testing. Ms. K agreed. No instability was identified in the panel of five markers used to screen tumors for indications of Lynch syndrome. This did not completely rule out Lynch syndrome for this family, as sensitivity of MSI testing is 93% (Shia, 2008). Ms. K continued to occasionally develop benign colon polyps. Ms. K elected to have a risk-reduction hysterectomy and oophorectomy, and no cancer was identified.

Recent Results
In 2013, Ms. K contacted me to present another program; this time, for a local nursing organization. We took this opportunity to discuss her family history and recent technologic advances (e.g., panel testing) for hereditary colon cancer syndromes, not just Lynch syndrome. Ms. K shared that a young family relative, a second-degree relative younger than 40 years old, recently had been diagnosed with stage 3 endometrial cancer. Ms. K elected to have a colon cancer panel test that included the genes associated with Lynch syndrome but not included in her original test, as well as genes associated with other colon cancers and polyposis syndromes.

According to the test results, Ms. K is heterozygous for the p.Y179C pathogenic mutation and p.G396D pathogenic mutation in the MUTYH gene. One or both of these mutations are identified in up to 70% of individuals with MUTYH-associated polyposis (MAP) (Brand, Nielsen, Lynch, & Infante, 2012).

Although we have identified the hereditary cancer syndrome responsible for Ms. K’s colon cancer and polyposis, and possibly responsible for her sister’s colon and endometrial cancer, further evaluation is appropriate for this family. The 40-year-old second-degree relative with endometrial cancer has not had genetic testing. Neither the 40-year-old’s mother nor father has had polyps or cancer of any kind. However, two first-degree maternal relatives have a lymphoma diagnosis. Further evaluation is needed to ascertain if MAP, caused by a MUTYH mutation (previously known as MYH), is responsible for all of the cancers and polyposis in this family. We have the answer for Ms. K, but it may not be the answer for the rest of the family.

This case is an excellent reminder to carefully factor patient findings and family history. Although most hereditary cancer syndromes are autosomal dominant disorders, not all are. The following are key takeaways.

  • MAP generally presents at about age 50 years, with 10 to a few hundred colonic adenomatous polyps, in an autosomal recessive pattern.
  • Look for red herrings. In this case, red flag cancers (e.g., early-onset colon cancer, right-sided cancers/polyps, endometrial cancers) existed for Lynch syndrome and MAP. The proband’s father also had colon cancer, suggesting an autosomal dominant pattern.
  • Autosomal recessive conditions often skip generations, and a three- and, preferably, four-generation or more family history assessment is critical.
  • Genetic testing guidelines and technology change. Staying abreast of new information and recommendations is important.
  • Establish a trusting relationship with your family, and emphasize the importance of ongoing contact. “Solving the puzzles” takes a team.

The author gratefully acknowledges Ms. K for allowing her story to be shared, and Julie Eggert, RN, PhD, GNP-C, AOCN®, and Patricia Kelly, DNP, APRN, CNS, AOCN®, for their review.

References
Brand, R., Nielsen, M., Lynch, H., & Infante, E. (2012). MUTYH-associated polyposis. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK107219/

National Cancer Institute. (2014). Genetics of colorectal cancer (PDQ®). Retrieved from http://www.cancer.gov/cancertopics/pdq/genetics/colorectal/healthprofessional/

Shia, J. (2008). Immunohistochemistry versus microsatellite instability testing for screening colorectal cancer patients at risk for hereditary nonpolyposis colorectal cancer syndrome. Journal of Molecular Diagnostics, 10(4), 293–300. http://dx.doi.org/10.2353/jmoldx.2008.080031

 
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Cancer Genetics

Special Interest Group Newsletter  November 2014  
   

Clinical Practice Nuances of Moderately
Penetrant Genes


Laura Panos, MS, CGC
Dallas, TX
lpanos@ambrygen.com

Multi-gene cancer panels have been available on a clinical basis for longer than two years, analyzing 2–51 cancer susceptibility genes simultaneously by next-generation sequencing. These tests are clinically promising, boasting an additional 5.1%–10% clinical yield in pathogenic mutation detection compared to single-gene tests (Castera et al., 2014; Laduca et al., 2014; Mauer, Pirzadeh-Miller, Robinson, & Euhus, 2014; Walsh et al., 2011). However, these tests include genes with various levels of associated cancer risks, phenotypic data classifying cancer risks, and recommendations for long-term follow-up.

Defining Gene Risk
Some cancer panel offerings include a combination of high- and moderate- risk cancer genes; others include only genes that have high penetrance (e.g., BRCA1/2, TP53). In cancer genetics, penetrance refers to the percentage of individuals with a mutation in a gene that will develop cancer or other related features. The highly penetrant genes often are well understood and have management and testing guidelines—two criteria that Fecteau, Vogel, Hanson, and Morrill-Cornelius (2014) use to define “category 1” genes. In contrast, Fecteau et al. (2014) define “category 3” genes as newly described, with no available management guidelines and limited phenotypic data. This category includes MRE11A, NBN, RAD50, RAD51C, RAD51D, and others.

Many of these category 3 genes were discovered partly because of their involvement in the same or a similar pathway of the highly penetrant genes BRCA1 and BRCA2. However, most of these genes are not as penetrant as BRCA1/2. MRE11A, NBN, and RAD50 are components of the MRE11A-RAD50-Nibrin complex, which helps with DNA double-strand repair. These genes are moderately penetrant, and carriers have an average breast cancer odds ratio of 2.88 (Damiola et al., 2014). RAD51C and RAD51D are involved in the homologous repair pathway and interact closely with BRCA1 and BRCA2, but, interestingly, mutations in these genes seem to have more of an impact on ovarian cancer risk than breast cancer risk (Meindl et al., 2010; Osher et al., 2012). Although these genes are involved in similar biologic pathways, the specific lifetime risks and organs that are affected may vary, and further research is needed to better define their relative cancer risks.

Patient Management and Counseling
Because a number of these genes do not have management guidelines, clinicians should rely on expert knowledge, family history, and literature review (Mauer et al., 2014) to create management plans for individuals with pathogenic mutations and variants of unknown significance (VUS) in these genes. For example, a gene mutation in RAD51D may cause a relative risk of ovarian cancer of 6.3 (Loveday et al., 2011). This level of risk may warrant increased screening or risk-reduction surgery. Following patient education and counseling, the patient and clinician should make the decision of which option to choose.

Not unique to moderate penetrant genes, but nonetheless relevant, are modifiers and VUS rates. Antoniou and colleagues (2014) concluded that female PALB2 mutation carriers have an absolute breast cancer risk of 33% (with no family history) and 58% (with a strong family history) by age 70 years. The difference is thought to be because of genetic or environmental modifiers. Because moderate-risk genes are offered on a multi-gene platform, the inherent risk for VUS is higher than in a single-gene test because each gene has an approximate 1%–2% VUS rate. Pre- and post-test counseling regarding VUS should be incorporated into clinical practice.

The world of cancer genetics is evolving rapidly, and much still needs to be learned regarding new cancer susceptibility genes. The complexities of moderate-risk gene panels are another indication that patient and family counseling and education are crucial to the genetic testing process at the time of initial testing as well as long-term.

References
Antoniou, A.C., Casadei, S., Heikkinen, T., Barrowdale, D., Pylkäs, K., Roberts, J., . . . Tischkowitz, M. (2014). Breast-cancer risk in families with mutations in PALB2. New England Journal of Medicine, 371(6), 497–506. http://dx.doi.org/10.1056/NEJMoa1400382

Castéra, L., Krieger S., Rousselin, A., Legros, A., Baumann, J.J., Bruet, O., . . . Vaur, D. (2014). Next-generation sequencing for the diagnosis of hereditary breast and ovarian cancer using genomic capture targeting multiple candidate genes. Retrieved from http://www.nature.com/ejhg/journal/vaop/ncurrent/full/ejhg201416a.html

Damiola, F., Pertesi, M., Oliver, J., Le Calvez-Kelm, F., Voegele, C., Young, E.L., . . . Tavtigian, S.V. (2014). Rare key functional domain missense substitutions in MRE11A, RAD50, and NBN contribute to breast cancer susceptibility: Results from a Breast Cancer Family Registry case-control mutation-screening study. Breast Cancer Research, 16(3), R58. http://dx.doi.org/10.1186/bcr3669

Fecteau, H., Vogel, K.J., Hanson, K., & Morrill-Corenelius, S. (2014). The evolution of cancer risk assessment in the era of next generation sequencing. Journal of Genetic Counseling, 23(4), 633–639. http://dx.doi.org/10.1007/s10897-014-9714-7

Laduca, H., Stuenkel, A.J., Dolinsky, J.S., Keiles, S., Tandy, S., Pesaran, T., . . . Chao, E. (2014). Utilization of multigene panels in hereditary cancer predisposition testing: Analysis of more than 2,000 patients. Retrieved from http://www.nature.com/gim/journal/vaop/ncurrent/full/gim201440a.html

Loveday, C., Turnbull, C., Ramsay, E., Hughes, D., Ruark, E., Frankum, J.R., . . . Rahman, N. (2011). Germline mutations in RAD51D confer susceptibility to ovarian cancer. Nature Genetics, 43(9), 879–882. http://dx.doi.org/10.1038/ng.893

Mauer, C.B., Pirzadeh-Miller, S.M., Robinson, L.D., & Euhus, D.M. (2014). The integration of next-generation sequencing panels in the clinical cancer genetics practice: An institutional experience. Genetics in Medicine, 16(5), 407–412. http://dx.doi.org/10.1038/gim.2013.160

Meindl, A., Hellebrand, H., Wiek, C., Erven, V., Wappenschmidt, B., Niederacher, D., . . .Hanenberg, H. (2010). Germline mutations in breast and ovarian cancer pedigrees establish RAD51C as a human cancer susceptibility gene. Nature Genetics, 42(5), 410–414. http://dx.doi.org/10.1038/ng.569

Osher, D.J., De Leeneer, K., Michils, G., Hamel, N., Tomiak, E., Poppe, B., . . . Foulkes, W.D. (2012). Mutation analysis of RAD51D in non-BRCA1/2 ovarian and breast cancer families. British Journal of Cancer, 106(8), 1460–1463. http://dx.doi.org/10.1038/bjc.2012.87

Walsh, T., Casadei, S., Lee, M.K., Pennil, C.C., Nord, A.S., Thornton, A.M., . . . Swisher, E.M. (2011). Mutations in 12 genes for inherited ovarian, fallopian tube, and peritoneal carcinoma identified by massively parallel sequencing. Retrieved from http://www.pnas.org/content/108/44/18032.full

 
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Cancer Genetics

Special Interest Group Newsletter  November 2014  
   

Update on NCCN Guidelines for Identifying
and Managing Hereditary Cancer


Karen Heller, MS, CGC
Dallas, TX
kheller@myriad.com

Teri Howell, RN, BSN, OCN®, CBCN®
Suffolk, VA
thowell@myriad.com

The National Comprehensive Cancer Network (NCCN), an alliance of 25 of the world’s leading cancer centers, publishes the NCCN Clinical Practice Guidelines in Oncology, which include several guidelines that focus on detection, prevention, and risk reduction for breast, cervical, colorectal, lung, and prostate cancers. The Genetic/Familial High-Risk Assessment: Breast and Ovarian guideline includes guidance for hereditary breast and ovarian cancer as well as Li-Fraumeni and Cowden syndromes. In 2014, sections pertaining to hereditary colon cancer syndromes were removed from the Colorectal Cancer Screening guideline to create a new guideline, Genetic/Familial High-Risk Assessment: Colorectal, which contains guidance on Lynch syndrome and the various polyposis syndromes. In this article, we will review some pertinent updates to the guidelines for 2014. Refer to the NCCN web site for a complete review of the guidelines and all changes. Unless otherwise specified, all recommendations are category 2A: “Based upon lower-level evidence, there is uniform NCCN consensus that the intervention is appropriate” (NCCN, 2014d).

Genetic/Familial High-Risk Assessment: Breast and Ovarian, Version 1.2014 (NCCN, 2014b)

Hereditary Breast and Ovarian Cancer (HBOC)

  • The criteria for testing for HBOC now are grouped based on age of breast cancer diagnosis (45, 50, or 60 years or younger, or any age).
  • A new criterion was added for Ashkenazi Jewish patients with pancreatic cancer and only one affected relative (with breast, ovarian, pancreatic, or prostate cancer).
  • Although women with HBOC previously were recommended to receive mammograms and magnetic resonance imaging (MRI) annually starting at age 25 years, this year the guidelines suggests that, for women aged 25–29 years, annual MRI alone is preferred. For women aged 30–75 years, annual mammograms and MRIs are recommended. For women aged 75 years and older, management should be considered on an individual basis.
  • The guideline now “recommends” prostate cancer screening starting at age 40 years for male BRCA2 carriers, keeping the wording of “consider” for BRCA1 carriers.

Li-Fraumeni Syndrome

  • A provision was added to allow for concurrent, as opposed to sequential, testing of HBOC and Li-Fraumeni for women with breast cancer aged 35 years or younger.
  • The previous guideline suggested beginning mammograms and MRIs at age 20–25 years for women with Li-Fraumeni syndrome; however, this year the guideline states that MRI alone is preferred for women younger than 30 years, and that management should be considered on an individual basis for women older than 75 years.
  • The caution against therapeutic radiation for patients with Li-Fraumeni syndrome was strengthened and now states that it “should be avoided when possible.”

Cowden Syndrome

  • PTEN hamartoma tumor syndrome has been added as an alternative name to Cowden syndrome.
  • In addition to the testing criteria for Cowden syndrome, the guideline also now defines operational diagnostic criteria for the syndrome.
  • The following are additional recommendations for Cowden syndrome management.
    • Consider annual endometrial biopsies or ultrasound beginning at age 30–35 years.
    • Annual thyroid ultrasounds starting at age 18 years or 5–10 years before the earliest diagnosis in the family
    • Colonoscopy every five years, rather than every 5–10 years
    • Renal ultrasound to be considered every one to two years, starting at age 40 years

Genetic/Familial High-Risk Assessment: Colorectal, Version 2.2014 (NCCN, 2014c)

This new guideline only includes high-risk colorectal cancer syndromes; screening guidelines for patients at average risk and those at increased risk based on personal history of adenomas, cancer, inflammatory bowel disease, or family history remain in the guideline Colorectal Cancer Screening.

Lynch Syndrome
The algorithm for Lynch syndrome testing now is divided into two pages.

  • Clinical testing based on personal and family history—changes from the 2013 guideline include
    • Addition of a new criterion to consider testing for individuals with a 5% or greater chance of having Lynch syndrome as predicted by the MMRpro, PREMM1, 2, 6 or MMRpredict models
    • Addition of provider discretion regarding the option for concurrent testing of all Lynch genes and EPCAM when the tumor is unavailable or insufficient, rather than stepwise testing (starting with MLH1 and MSH2)
    • Deletion of the footnote about managing individuals who have loss of MSH2 or MSH6 by immunohistochemistry as if they have Lynch syndrome, regardless of germline testing results
  • Routine tumor testing
  • Either immunohistochemistry or microsatellite instability is recommended for all patients with colorectal cancer or those diagnosed when they are younger than 70 years old.

For Lynch syndrome management,

    • The surveillance recommendations for MLH1 and MSH2 carriers now also apply to EPCAM mutation carriers.
    • Surveillance recommendations for MSH6 and PMS2 carriers were combined. The age to begin colonoscopies is now 25–30 years for these patients, and endometrial and ovarian surveillance should be similar to that for MLH1, MSH2, or MSH6.

Peutz-Jeghers Syndrome

  • MRI enterography was added as an alternative option to computed tomography enterography for small-bowel visualization.
  • The age to begin pancreatic cancer screening was changed from 25–30 years to 30–35 years.

Juvenile Polyposis Syndrome

  • Clinical genetic testing is now “recommended” rather than “available.”
  • For families with known SMAD4 mutations (which cause combined features of juvenile polyposis and hereditary hemorrhagic telangiectasia), genetic testing should occur within the first six months of life, and, for those who test positive, screening for vascular lesions should occur within the first six months of life.

Colorectal Cancer Screening, Version 1.2014(NCCN, 2014a)

This guideline still contains the recommendations for colorectal cancer screening based on positive family history. A key change is that screening should begin at age 40 years for individuals with a first-degree relative with colorectal cancer who was diagnosed when they were younger than 60 years (last year, the recommended age was younger than 50 years), or two first-degree relatives with colorectal cancer at any age.

These guidelines are updated at least annually, and oncology practitioners should be familiar with the most current guidelines. The complete guidelines, including discussion sections, provide an excellent review of the conditions. They can be accessed on NCCN’s website.

Editor’s update: As of September 2014, the Breast and/or Ovarian Cancer Genetic Assessment guidelines have new updates that were not available when this article was written. The updated guidelines address multi-gene testing (panels). Please refer to NCCN’s website for more information.

References
National Comprehensive Cancer Network. (2014a). Colorectal cancer screening (version 2.2014). Retrieved from http://www.nccn.org/professionals/physician_gls/pdf/colorectal_screening.pdf

National Comprehensive Cancer Network. (2014b). Genetic/familial high-risk assessment: Breast and ovarian (version 1.2014). Retrieved from http://www.nccn.org/professionals/physician_gls/pdf/genetics_screening.pdf

National Comprehensive Cancer Network. (2014c). Genetic/familial high-risk assessment: Colorectal (version 2.2014). Retrieved from http://www.nccn.org/professionals/physician_gls/pdf/genetics_colon.pdf

National Comprehensive Cancer Network. (2014d). NCCN categories of evidence and consensus. Retrieved from http://www.nccn.org/professionals/physician_gls/f_guidelines.asp

 
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Cancer Genetics

Special Interest Group Newsletter  November 2014  
   

Improving Cancer Care One Nurse at a Time:
My Story of Opportunity, Enrichment,
and Genomics


Elizabeth C. Hassen, MSN, RN, OCN®
Clemson, SC
Hassen@g.clemson.edu

I was honored to receive one of ONS’s 2014 doctoral scholarships. I first was introduced to ONS more than 12 years ago during an externship on an inpatient oncology unit. Multiple mentors invited me to the local ONS meetings during this time. As a student, I soaked up the information like a sponge, finding it all new and interesting. Upon graduation and getting a job on that unit, those same mentors played a pivotal role in my oncology career by emphasizing the importance of personal patient care and promoting professional development through ONS at the national and local level.
My involvement with the local ONS chapter, South Carolina Upstate, and attendance at national conferences has enriched my knowledge, particularly on evidence-based practice. At the local level, I served as director at large, vice president, and president. This allowed me to attend ONS’s conferences and Leadership Weekend, providing me with new knowledge for recruitment, leadership, and mentorship in oncology. These experiences encouraged me to obtain and maintain my OCN® certification.

I am enrolled as a full-time PhD student in the Healthcare Genetics program at Clemson University in Clemson, SC, where I am learning research methods for application to identify best-care practices for patients with cancer. The ONS scholarship is helping with the cost of tuition and has allowed me to decrease my workload to focus on research. I have been involved in a research project that evaluated current genetic knowledge of nursing students and content in a nursing curriculum. I also am assisting with a research project assessing genetic and genomic knowledge of nursing faculty. Collecting and analyzing this data will help guide my dissertation research in genetic education for nurse faculty and practicing nurses.
Genetics and genomics are important in all areas of medicine. They play a critical role in oncology by guiding prevention, diagnosis, prognosis, treatment plans, and survivorship. With the expanding role of genomics in practice, genetic education is a priority in providing the personal patient care I was taught and mentored to provide. I want to use my research to increase the knowledge of nurses so they are competent in educating their patients.

Recognizing how ONS has had an impact on my career—from local chapter meetings to national conferences—I knew an ONS scholarship would allow me to further my research to help colleagues provide evidence-based care for patients. If you, too, are interested in advancing your career by furthering your education with a masters or PhD, I encourage you to apply for one of ONS’s educational scholarships. Applying involves an online application, which asks about your professional and community involvement and how you plan to contribute to the advancement of evidence-based practice.

 
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Cancer Genetics

Special Interest Group Newsletter  November 2014  
   

Save Time and Money Maintaining Oncology
Policies and Procedures


Each year, hospitals in the United States spend thousands of dollars in labor hours writing and revising policies and procedures for program accreditation. Why start from scratch when you don’t have to? The Oncology Policies and Procedures CD-ROM from ONS saves you time and money by providing a collection of current standards of practice for use in the clinical setting. Each document has a box for custom identification and policy number insertion appropriate for your institution. Simply enter your institution’s name and customize your choices and preferences, and the policy or procedure is ready to use. You can even personalize it with your institution’s logos.

The resources on the CD are divided into six sections: administration, electronic health records, human resources, nursing, safety and pharmacy, and supportive services.

Each policy contains a bibliography that gives a broad view into the latest body of work for further reading and education. The human resources section also contains job descriptions to help cancer program administrators with access to roles and duties for members of the cancer team. References to certifications and national organizations for credentialing will help administrators and hiring personnel to select the most appropriate level of staff for the position.

An additional folder includes sample forms, checklists, and consent documents that can be used as is or modified for use in the clinical area.

Don’t spend another year doing unnecessary work. Get the resources you need from a source you trust.

Institutions interested in the purchase of a multiuser license should email institutions@ons.org. Pricing is based on the number of users multiplied by the regular price of the CD minus a discount based on the quantity of full-time employees identified as oncology nurses or related fields within that institution. A purchasing institution is required to provide a list of users accessing the content prior to completion of sale.

Use code POPPC10 through November 1 and save 10% on your order of the Oncology Policies and Procedures CD-ROM!

To order, visit the ONS Store or contact customer service at 866-257-4ONS. ONS member price is $99, and nonmember price is $139.

 
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Cancer Genetics

Special Interest Group Newsletter  November 2014  
   

Evidence-Based Symptom Management
Resources at Your Fingertips


From the team that has brought you the Putting Evidence Into Practice (PEP) resources since 2006 comes Putting Evidence Into Practice: A Pocket Guide to Cancer Symptom Management, the first-ever pocket-sized book containing everything you need to immediately improve patient care. Get the most current evidence-based information on 19 symptoms in this new, easy-to-carry guide.

Putting Evidence Into Practice: A Pocket Guide to Cancer Symptom Management updates the popular ONS PEP oncology symptom management resources into a portable pocket guide. Featuring the latest evidence on 19 symptom management topics, this book provides a quick-reference guide to help clinicians identify which interventions have demonstrated effectiveness against symptoms. The book is an essential tool for ensuring quality care of patients with cancer and was designed for easy carrying and referencing during direct patient care.

Each chapter outlines the nature, incidence, and impact of the symptom for patients with cancer; factors that create the highest risk; key aspects of assessment and identification of some assessment tools; intervention evidence; and suggestions for application in practice.

Anorexia, anxiety, caregiver strain and burden, chemotherapy-induced nausea and vomiting, cognitive impairment, constipation, depression, diarrhea (chemotherapy- and radiation-induced), dyspnea, fatigue, hot flashes, lymphedema, mucositis, pain (acute, breakthrough, chronic, and refractory/intractable), peripheral neuropathy, prevention of infection (general and transplant), radiodermatitis, skin reactions, and sleep-wake disturbances are covered.

Use code PPEPC10 through November 1 and save 10% on your order of Putting Evidence Into Practice: A Pocket Guide to Cancer Symptom Management! To order, visit the ONS Store or contact customer service at 866-257-4ONS. ONS member price is $59 (nonmember price is $82.60).

 
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Cancer Genetics

Special Interest Group Newsletter  November 2014  
   

Exclusive Articles Available Before Print

The Oncology Nursing Forum (ONF) and the Clinical Journal of Oncology Nursing (CJON) have unveiled advanced print exclusive articles to give our readers access to important, cutting-edge content ahead of print. Articles from the journals are available on the main ONF and CJON pages. These articles are open access, meaning they are available to members and non-members alike, until they appear in print at a later date. At that time, the content will become password-protected like other articles that appear in print as online exclusives in the journals.

The latest article to receive the advanced print exclusive designation is “Sleep in Mother and Child Dyads During Treatment for Pediatric Acute Lymphoblastic Leukemia” by Ellyn E. Matthews, PhD, RN, AOCNS®, CBSM; Madalynn Neu, PhD, RN; Paul F. Cook, PhD; and Nancy King, MSN, RN, CPNP®, CPON®. The purpose of this ONF article is to compare the sleep of children with acute lymphoblastic leukemia during maintenance treatment with controls and to measure the effect on maternal sleep. Check out this timely and informative article today.

 
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Cancer Genetics

Special Interest Group Newsletter  November 2014  
   

Check Out the ONS Connect Blog

The official blog of ONS is written by oncology nurses for oncology nurses on a variety of topics of interest, including facing day-to-day challenges at work, juggling busy lives at home, and keeping up to date with the magnitude of information available for practicing nurses.
This month, you’ll find the following new discussions.

As a reader, join in on the conversation and connect with other oncology nurse readers by posting your own stories, tips, ideas, and suggestions in the comments section at the end of each blog post.

 
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Cancer Genetics

Special Interest Group Newsletter  November 2014  
   

Five-Minute In-Service

The latest Five-Minute In-Service explains how to Manage Immune-Related Adverse Events Associated With Cancer Immunotherapies.
 
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Cancer Genetics

Special Interest Group Newsletter  November 2014  
   

Ask a Team Member

The latest Ask a Team Member column answers the question What Is an Adaptive Trial Design, and When Is It Used?
 
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Cancer Genetics

Special Interest Group Newsletter  November 2014  
   

Membership Information

SIG Membership Benefits

  • Network with colleagues in an identified subspecialty area around the country.
  • Contribute articles for your SIG’s newsletter.
  • Participate in discussions with other SIG members.
  • Contribute to the future path of the SIG.
  • Share your expertise.
  • Support and/or mentor a colleague.
  • Receive information about the latest advancements in treatments, clinical trials, etc.
  • Participate in ONS leadership by running for SIG coordinator-elect or join SIG work groups.
  • Acquire information with a click of a mouse at http://ons.org/membership including
    • Educational opportunities for your subspecialty
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Join a Virtual Community

A great way to stay connected to your SIG is to join its Virtual Community. It’s easy to do so. All you will need to do is

  • Visit the "Find a SIG" page.
  • Locate and click on the name of your SIG from the list of all ONS SIGs displayed.
  • Once on your SIG’s main page, click “Join Group,” and log in using your ONS Profile. Don’t have an ONS Profile? Create one today, and then return to your SIG to join.

Subscribe to Your SIG’s Virtual Community Discussion Forum
Once you have your log-in credentials, you are ready to subscribe to your SIG’s Virtual Community discussion forum. To do so,

  • Select "Log In," located next to "New User," and enter your information.
  • Next, click on the "Discussion" tab on the top right of the title bar.
  • Locate and select "Subscribe to Discussion"
  • Enter e-mail address.
  • Click "Finish."
  • You are now ready to begin participating in your SIG’s discussion forum.

Participate in Your SIG’s Virtual Community Discussion Forum

  • First, log in. (This allows others to identify you and enables you to receive notification [via e-mail] each time a response or new topic is posted.)
  • Click on "Discussion" from the top title bar.
  • Click on any posted topic to view contents and post responses.

Sign Up to Receive Your SIG’s Virtual Community Announcements
As an added feature, members also are able to register to receive their SIG’s announcements by e-mail.

  • From your SIG’s Virtual Community page, locate the "Sign Up Here to Receive Your SIG’s Announcements" section.
  • Select the "Click Here" feature, which will take you to a link to subscribe.
  • Once the "For Announcement Subscription Only" page appears select how you wish to receive your announcements.
    • As individual e-mails each time a new announcement is posted
    • One e-mail per day comprised of all new daily announcements posted
    • Opt-out, indicating that you will frequently browse your SIG’s Virtual Community page for new postings
  • Enter your e-mail address.
  • Click on "Next Page."
  • Click "Finish"
  • You are now subscribed to receive announcements.
 
 
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Cancer Genetics

Special Interest Group Newsletter  November 2014  
   

Cancer Genetics SIG Officers

Coordinator (2014-2016)
Catherine Belt, RN, MSN, AOCN®
Hatfield, PA
cathy.belt@uphs.upenn.edu

Ex-Officio (2014-2015)
Jacqueline Hale, RN, APN-C, AOCN®, APNG
Flemington, NJ
Hale.jacqueline@hunterdonhealthcare.org

Editor
Patricia Kelly, DNP, APRN, CNS, AOCN®
Dallas, TX
Pakelly1027@sbcglobal.net

 

Co-Editor
Julie Eggert, RN, PhD, GNP-C, AOCN®
Greer, SC
jaegger@clemson.edu

Web Administrator
Lisa Aiello, RN, MSN, APN-C, AOCNS®
North Cape May, NJ
llaws@eviti.com

ONS Copy Editor
Jessica Moore, BA, BS
Pittsburgh, PA
jmoore@ons.org

Know someone who would like to receive a print copy of this newsletter?
To print a copy of this newsletter from your home or office computer, click here or on the printer icon located on the SIG Newsletter front page. Print copies of each online SIG newsletter also are available through the ONS National Office. To have a copy mailed to you or another SIG member, contact Membership/Leadership Specialist Carol DeMarco at cdemarco@ons.org or 866-257-4ONS, ext. 6230.

View past newsletters.

ONS Membership & Component Relations Department Contact Information

Brian K. Theil, CAE, Director of Membership and Component Relations Department
btheil@ons.org
412-859-6244

Diane Scheuring, MBA, CAE, CMP, Manager of Member Services
dscheuring@ons.org
412-859-6256

Carol DeMarco, Membership Specialist—SIGs
cdemarco@ons.org
412-859-6230

The Oncology Nursing Society (ONS) does not assume responsibility for the opinions expressed and information provided by authors or by Special Interest Groups (SIGs). Acceptance of advertising or corporate support does not indicate or imply endorsement of the company or its products by ONS or the SIG. Web sites listed in the SIG newsletters are provided for information only. Hosts are responsible for their own content and availability.

Oncology Nursing Society
125 Enterprise Dr.
Pittsburgh, PA 15275-1214
866-257-4ONS
412-859-6100
www.ons.org

 
 
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