P-0215 Patient Factors Involved in Referral for Lynch Syndrome

Introduction Approximately 3% of all colorectal cancer cases are attributable to Lynch Syndrome (LS). The identification of LS, will lead to altered screening for malignancies, and provides the opportunity to also identify probands. We attempted to determine factors that impacted referral to a cancer genetics clinic following a new diagnosis of colorectal cancer, evaluating differences in younger and older patients. Methods A retrospective chart review was performed at a tertiary care cancer centre for all new colorectal cancer diagnoses over a 4 year period (1/2006 - 12/2010). From a total of 1586 new patients, there were 183 patients under 50 years old; a random sample of 184 patients over 50 years old was also retrieved. We abstracted patient demographics, tumour and family history characteristics. The primary outcomes were the proportion of patients who met criteria for genetics referral with a family history suggestive of LS, and the proportion of patients who were actually referred. Potentially prognostic factors were evaluated using logistic regression analysis. All results are two-sided. Results Baseline characteristics of the 367 patients were as follows: age range 20-91 years old, 56% male, 98.4% adenocarcinoma, and 24% were stage IV at diagnosis. Family history was documented the majority of the time (86.9%), however of the 124/367 patients whose family history would have met criteria for a genetics consultation, only 29/124 (23.4%) were referred. For the 15 patients with mucin or signet cell histology who met criteria for referral, 6 (40%) were referred. In univariate analyses both age and stage appeared significant for referral of suspected LS (Table). In the multivariate model, age was the only significant variable (Table); 53% of patients <35 years old were seen for a genetics consultation, however above 55 years or old this decreased to <5%. Conclusion The cause of poor referral rates to a cancer genetics clinic are likely multifactorial. Although we found that family history is routinely documented at a tertiary care cancer centre, this does not consistently result in a genetics referral. The main factor driving age as a prognostic factor appears to be extreme young age, with referral rates diminishing drastically above this. It would appear clinicians routinely miss opportunities for referral to genetics, and evaluation of approaches to improve this need to be examined. Table 1 Table 1 Unlabelled Image