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Knight SJ (San Francisco VA Medical Center), Green GL
(San Francisco VA Medical Center), Bertenthal D
(San Francisco VA Medical Center), Chren MM
(San Francisco VA Medical Center), Phillips KA
(University of California, San Francisco)
Objectives:
Published clinical guidelines recommend screening for hereditary non-polyposis colon cancer (HNPCC) among those diagnosed with colon cancer and HNPCC-related cancers (e.g., stomach, renal pelvis) based on age at cancer diagnosis (50 and younger) and family history. We sought to understand documentation of guideline-adherent care for young veterans who would be expected to receive a genomic service (family history, genetic counseling, genetic testing) related to possible HNPCC.
Methods:
We used a retrospective cohort design including veterans age 50 and younger with diagnoses of colon cancer and HNPCC-related cancers. National VA administrative data were examined for evidence of ICD-9 and CPT coding for family history, genetic counseling, and any type of genetic/molecular analysis. Sources consisted of 2003 to 2007 VA administrative data including outpatient, inpatient, and non-VA files. Thirty charts from the San Francisco VA Medical Center were examined to provide evidence of validation of administrative data and to identify potential barriers to documentation.
Results:
Of veterans age 50 and younger diagnosed with colon cancer (n = 3,282), documentation of family history, genetic counseling, or any genetic/molecular analysis was present for 6.7%, 0.12%, and 2.71%, respectively. Among those with HNPCC-related cancers (n = 3,148), the rates for these services were 2.45%, 0.03%, and 2.26%, respectively. There were few differences in documentation of genomic services according to sociodemographic characteristics, with the exception of greater genetic/molecular analyses in those who were not married (p < 0.05) for both colon cancer and HNPCC-related cancers and greater documentation of family history in women for HNPCC-related cancers (p < 0.009). For those with colon cancer, those with greater comorbid conditions were more likely to have documentation of family history and genetic/molecular analyses (p < 0.001). Consistent with administrative data, medical records showed little documentation that HNPCC or other familial colon cancer had been considered consistently in patient care.
Implications:
While published guidelines recommend family history taking, genetic counseling, and in some cases genetic/molecular analysis based on colon cancer diagnosed at age 50 and younger, there is little documentation of these services in VA administrative data.
Impacts:
Additional work is needed to understand documentation of genomic services in VA before more extensive studies of utilization are conducted using VA administrative data.
