Oncology Clinic-Based Hereditary Cancer Genetic Testing in a Population-Based Health Care System

Abstract

New streamlined models for genetic counseling and genetic testing have recently been developed in response to increasing demand for cancer genetic services. To improve access and decrease wait times, we implemented an oncology clinic-based genetic testing model for breast and ovarian cancer patients in a publicly funded population-based health care setting in British Columbia, Canada. This observational study evaluated the oncology clinic-based model as compared to a traditional one-on-one approach with a genetic counsellor using a multi-gene panel testing approach. The primary objectives were to evaluate wait times and patient reported outcome measures between the oncology clinic-based and traditional genetic counselling models. Secondary objectives were to describe oncologist and genetic counsellor acceptability and experience. Wait times from referral to return of genetic testing results were assessed for 400 patients with breast and/or ovarian cancer undergoing genetic testing for hereditary breast and ovarian cancer from June 2015 to August 2017. Patient wait times from referral to return of results were significantly shorter with the oncology clinic-based model as compared to the traditional model (403 vs. 191 days; p < 0.001). A subset of 148 patients (traditional n = 99; oncology clinic-based n = 49) completed study surveys to assess uncertainty, distress, and patient experience. Responses were similar between both models. Healthcare providers survey responses indicated they believed the oncology clinic-based model was acceptable and a positive experience. Oncology clinic-based genetic testing using a multi-gene panel approach and post-test counselling with a genetic counsellor significantly reduced wait times and is acceptable for patients and health care providers.

Burden of hereditary cancer susceptibility in unselected patients with pancreatic ductal adenocarcinoma referred for germline screening

“…However, given the overall suboptimal testing uptake in the genetics referral based protocol and in light of emerging treatment implications of BRCA1 / BRCA2 PV, mismatch repair deficiency and potentially other defects in DNA repair, another avenue to improve genetic testing rates in patients with PDAC may be oncologist‐directed genetic testing, similar to the mainstreaming approach undertaken in breast and ovarian cancer or upfront tumor or tumor normal sequencing approaches, which may have different considerations for consent . Local experience with the oncologist‐directed genetic testing model resulted in similar patient‐reported outcomes, was acceptable to health care providers, and significantly reduced wait times for genetic testing as compared to a traditional 1‐on‐1 approach …”

Health system interventions to integrate genetic testing in routine oncology services: A systematic review

“…of included studies (44%) were from North America [34-39, 41, 44-47, 54] (Table 2). The 25 studies [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][51][52][53][54][55] (93%) described interventions to increase access to GC and GT through mainstreaming or UTS initiatives (S4 Table ). The study designs found were retrospective or prospective cohort studies with concurrent or historical controls (44%) [34, 36, 37, 42-47, 54, 55] or case series that reported on intervention outcomes (56%) [29-33, 35, 38-41, 48, 51-53] (Table 2).…”

“…Interventions, setting and framework. The majority of studies used complex interventions (Table 1, S4 Table ) to increase access to GC and GT, either in the routine oncology setting [29][30][31][32][33][34][35][36][37][38][39][40][51][52][53][54][55] or optimizing referral to genetic services for GC and GT [45][46][47] for ovarian or breast cancers and through optimizing access to genetic services after UTS in colorectal and endometrial cancer [39,[41][42][43][44]. The 25 studies spanned a variety of health systems (Table 2) with six studies (24%) included either a quality improvement or process model [35-37, 39, 40] or an implementation science framework [42] to guide implementation.…”

“…The implementation strategies used were varied and classified under complex intervention type of education, documentation, interdisciplinary practice or electronic systems domains (Table 1). Twenty studies mapped to Proctor's evaluative framework [21] at the service or client level measuring effectiveness through the outcomes outlined above [29][30][31][32][33][34][35][36][37][38][39][40], [43][44][45][46][51][52][53][54][55] (Table 3). CFIR [22] mapped to implementation process factors through the executing and engaging constructs with five studies using a quality PLOS ONE…”

“…Reflecting & Evaluating Quantitative and qualitative feedback about the progress and quality of implementation accompanied with regular personal and team debriefing about progress and experience [22] • Healthcare professionals' feedback about the intervention [40,42,54] 3/25 (12%)…”