Natalie Taylor

Standardization, Education, and Resourcing: The Way Forward for Implementing Polygenic Risk Scores in Hereditary Breast and Ovarian Cancer

ABSTRACTThe clinical utility and implementation of polygenic risk scores (PRS) in the setting of personalized risk assessment for hereditary breast and ovarian cancer (HBOC) continues to be investigated. We aimed to explore and analyze genetic healthcare providers' perspectives toward national implementation in Australia, acknowledging the vitality of provider knowledge, priorities, and support. A two‐phase exploratory, cross‐sectional, mixed‐method study was conducted, consisting of semistructured interviews and a national online survey. Participants were recruited through professional networks. Interview schedule, survey design, and analyses were informed by the Consolidated Framework from Implementation Research (CFIR), the Theoretical Domains Framework (TDF) and the Expert Recommendations for Implementing Change (ERIC) compilation of facilitative strategies. Surveys were analyzed using descriptive and inferential statistics. Twenty‐seven participants were interviewed and forty completed the survey. Participants were supportive of clinical implementation of PRS, with implementation enablers in sector culture, compatibility with practice and professional role, and providers' knowledge and skills. Concerns were raised on insufficient resourcing, equity and timeliness of delivery, and the safety and effectiveness of ovarian cancer PRS. Training and educating stakeholders and achieving standardization, including establishing an accredited test, national guidelines, care and funding models, and results reports, were implementation priorities. Findings will support the design of a provider‐informed model or framework to plan and prioritize the next steps toward national implementation. Resourcing will be a key challenge. Current enablers in the sector, evidence‐based implementation strategies, and direction of efforts toward these priorities of education and standardization will enhance implementation readiness and efficiency.

Cervical cancer treatment outcomes and survival in Botswana by human immunodeficiency virus status: Ipabalele study results

Abstract Background Cervical cancer is a leading morbidity/mortality cause, frequently co-occurring with human immunodeficiency virus (HIV) positivity, in Botswana. We examined long-term outcomes for Ipabalele study participants receiving curative chemoradiation for locally advanced cervical cancer (2015-2019) by HIV status. Methods Clinical and outcome data were collected at baseline, treatment completion, and 3 months thereafter. Patients were followed for up to 5 years. Overall survival (OS) was evaluated using Kaplan-Meier curves and Cox regression. Results The cohort comprised 295 patients (73.8% with HIV, younger at diagnosis [P < .001]) followed for a median of 44.2 months. Complete response was seen in 217/278 (76.1%) patients. Two- and 5-year OS rates were 73.4% and 59.9%, respectively, with no difference by HIV status. OS was associated negatively with advanced disease stage (III: hazard ratio [HR] 13.23, P < .001; IV: HR 7.8, P = .008) and positively with increased radiation (HR 0.977, P = .0005) and chemotherapy (HR 0.85, P = .005). Clinical response was associated negatively with advanced disease (IV: HR 0.113, P = .002) and positively with increased radiation (P = .009). Toxicity did not differ by HIV status. The most common grade-≥-2 non-hematological and hematological toxicities were radiation dermatitis (39.8%) and reduced white blood cell count (66.05%), respectively. Conclusions In this cervical cancer cohort with good HIV status control, treatment outcomes and OS were associated with disease and treatment factors, not the HIV status. Early screening and education regarding treatment protocols are crucial to improve cervical cancer outcomes in Botswana.