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Integrating Genetic Testing and Counseling In Routine Cancer Care
A session at the 6th annual Oncology Clinical Pathways Congress explored ways in which clinical pathways can incorporate genetic testing and counseling into routine cancer care.
Defining malignant tumors by their specific genetic mutations allows for the implementation of precision medicine with targeted therapies. This means that patients with cancer can receive high-quality individualized care, hopefully giving them the highest chances for remission.
Beth Karlan, MD, UCLA Jonsson Comprehensive Cancer Center, joined Mary Daly, MD, PhD, Fox Chase Cancer Center, Philadelphia, PA, to discuss the role of clinical genetics in the management of cancer, identify benefits and barriers to integrating genetic counseling and testing into cancer care, and propose opportunities to overcome challenges in this arena.
“While we have had a great revolution in genetics and genomics with relation to cancer over this last decade, integrating these advances into clinical care is hard and the implementation of these findings has been challenging,” said Dr Karlan.
There are many reasons for underutilization of genetic testing and counseling, including limited patient identification and referral, limited clinical resources, limited genetics provider workforce, additional burden on patients and providers, testing, costs, and more.
“The bottom line, no matter what the reason, is that the underutilization of cancer genetic services can have perilous health consequences that we'd like to improve,” said Dr Karlan.
In order to integrate genetic testing and counseling into routine cancer care, Dr Karlan provided a few suggestions, including finding ways to operationalize workflows, deploying clinical services to guide management and identify opportunities for clinical trials, expanding coverage for telehealth services to increase access, and working toward greater health equity.
The COVID-19 pandemic brought about the wide use and acceptance of telemedicine. Telegenetics provides an opportunity for the wide dissemination of the genetic services and counseling. Randomized trials looking at telegenetics vs in-person counseling prior to the pandemic demonstrated no difference in patient satisfaction.
“Assuming we will have better broadband access, telegenetics will provide services to underserved areas and underserved populations that might not have experts in this area in their communities,” said Dr Karlan.
Nonetheless, disparities in cancer genetics still need to be addressed. “It's really important for us to focus on reaching populations vs just having bigger panels and testing for more genes, to really achieve the desirable result of being able to act on cancer genetics to improve patient outcomes,” said Dr Karlan.
Population-based implementation is hard. UCLA Jonsson Comprehensive Cancer Center began to pilot an implementation experiment to cancer genetic testing risk and assessment that addresses their entire population using pretest educational counseling videos for guideline-indicated patients. The pilot started in the pancreatic cancer clinics since all patients with pancreatic cancer should be undergoing genetic testing.
In 2019, about 21% of patients in the pancreatic cancer clinic had undergone genetic testing. After implementation of the pilot, between December 2020 and August 2021, 96% of patients in the pancreatic cancer clinic had undergone genetic testing. UCLA is currently rolling this program out to all of their oncology clinics.
“Integrating genetic testing… I believe the time is now, if not, it can have perilous health consequences,” said Dr Karlan.
“We want to work towards overcoming systemic barriers in access to cancer genetic counseling and testing. It's not one-size-fits-all. There are many ways for each health care system to try to seamlessly integrate genetic services into clinics,” she concluded.
