%0 Journal Article
%T Clinical exome sequencing vs. usual care for hereditary colorectal cancer diagnosis: A pilot comparative effectiveness study.
%A Niu X
%A Amendola LM
%A Hart R
%A Bennette CS
%A Heagerty P
%A Horike-Pyne M
%A Trinidad SB
%A Rosenthal EA
%A Comstock B
%A Nefcy C
%A Hisama FM
%A Bennett RL
%A Grady WM
%A Gallego CJ
%A Tarczy-Hornoch P
%A Fullerton SM
%A Burke W
%A Regier DA
%A Dorschner MO
%A Shirts BH
%A Robertson PD
%A Nickerson DA
%A Patrick DL
%A Jarvik GP
%A Veenstra DL
%J Contemp Clin Trials
%V 84
%N 0
%D 09 2019
%M 31400517
%F 2.261
%R 10.1016/j.cct.2019.105820
%X Clinical exome sequencing (CES) provides the advantage of assessing genetic variation across the human exome compared to a traditional stepwise diagnostic approach or multi-gene panels. Comparative effectiveness research methods offer an approach to better understand the patient-centered and economic outcomes of CES.<BR>To evaluate CES compared to usual care (UC) in the diagnostic work-up of inherited colorectal cancer/polyposis (CRCP) in a randomized controlled trial (RCT).<BR>The primary outcome was clinical sensitivity for the diagnosis of inherited CRCP; secondary outcomes included psychosocial outcomes, family communication, and healthcare resource utilization. Participants were surveyed 2 and 4 weeks after results return and at 3-month intervals up to 1 year.<BR>Evolving outcome measures and standard of care presented critical challenges. The majority of participants in the UC arm received multi-gene panels [94.73%]. Rates of genetic findings supporting the diagnosis of hereditary CRCP were 7.5% [7/93] vs. 5.4% [5/93] in the CES and UC arms, respectively (P = 0.28). Differences in privacy concerns after receiving CRCP results were identified (0.88 in UC vs 0.38 in CES, P = 0.05); however, healthcare resource utilization, family communication and psychosocial outcomes were similar between the two arms. More participants with positive results (17.7%) intended to change their life insurance 1  month after the first return visit compared to participants returned a variant of uncertain significance (9.1%) or negative result (4.8%) (P = 0.09).<BR>Our results suggest that CES provides similar clinical benefits to multi-gene panels in the diagnosis of hereditary CRCP.