Development of multidisciplinary committees for decision making and care management in hereditary colon cancer: the Fren
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COUNTRY REPORT
Development of multidisciplinary committees for decision making and care management in hereditary colon cancer: the French state of the art Souria Aissaoui & Hanaa Aissaoui & Sophie Giraud & Stéphane Pinson & Alain Calender
Received: 7 June 2013 / Accepted: 28 August 2013 / Published online: 10 September 2013 # Springer-Verlag Berlin Heidelberg 2013
Abstract Multidisciplinary Committees (MDC) in France were established by the Institut National du Cancer for the management of therapeutic cancer treatment. We wanted to know if this approach is being utilized in Cancer Genetics, in particular for patients with a digestive cancer predisposition. A questionnaire was sent to the 33 French oncogenetic centers. Responses were received from all clinics. We found that 76 % of centers regularly use MDCs for the management of hereditary digestive cancers. Familial colon cancer cases were the most common situation, in which MDCs were utilized. Participation of various medical specialists was reported as follows: geneticists (100 %), gastroenterologists (76 %), genetic counselors (84 %), surgeons (32 %), and biologists (36 %). Twenty percent of centers consult MDCs for every patient compared to 80 % of centers that use MDCs only for select cases. MDCs represent a multidisciplinary approach for patients affected by inherited cancers and may optimize follow-up for genetic screening and further care management. Keywords Risk assessment . Colorectal cancer . Genetic diagnosis . Multidisciplinary decision making . Familial cancer management
Introduction The use of multidisciplinary committees (MDC) was introduced by the Institut National du Cancer (INCa; French National Institute of Cancer) in their 2004–2005 National Cancer Plan. The aim of MDCs is to bring together the best medical cancer specialists to assist in the development of a treatment S. Aissaoui (*) : H. Aissaoui : S. Giraud : S. Pinson : A. Calender Hôpital Edouard Herriot, Lyon 03, France e-mail: [email protected]
plan for patients. In cancer genetics, the number of oncogenetic consultations has steadily increased since 2003. For example, an increase of 12.1 % was observed between 2008 and 2009 (7,734 consultations in 2009 compared with 6,901 in 2008) (French INCa 2009). Specific recommendations and criteria for patient follow-up in oncogenetics are given by the INCa report. But there are also various rare cases to study and think over. Genetic testing must be decided and patient care monitored. We were interested to analyze how geneticists manage their cases in the Lyon region, as well as nationwide. Oncogenetic MDC is shown to be paramount to follow-up familial cases in France and covers the whole territory. It is simple to categorize at risk families, to manage the cases, and provide advice; however, there are some borderline and atypical cases to think over. There exists a heterogeneity in the points of view of clinical experts from one case to another. In order to synchronize our methods and standardize the genetic counseling, the French
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