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)
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.
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.
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.
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.
Additional work is needed to understand documentation of genomic services in VA before more extensive studies of utilization are conducted using VA administrative data.