Have You Seen This?
Mainstream Germline Genetic Testing Feasible in Routine Cancer Care
June 22, 2022
DELRAY BEACH, FL – The use of germline genetic testing is rapidly changing cancer care and treatment. New therapy options that are dependent on patients’ germline variants have increased quality of life and survival rates. The standard genetic testing pathway, which involves genetic counselors or clinical geneticists giving pre-test counseling and ordering the genetic test, can no longer meet the needs of the growing number of patients eligible and in need of germline genetic testing for individualized treatment. “In a mainstream genetic testing pathway, non-genetic healthcare professionals (NGHCPs) provide pre-test counseling (e.g., review cancer family history, discuss possible implications of a genetic test) and order the genetics test after obtaining informed consent.”1 NGHCPs, unfortunately, have general apprehension about implementing germline genetic testing into their patients’ routine cancer care stating the time commitment necessary is unrealistic, they have inadequate genetics knowledge and lack of patient focused resources.
Because of NGHCP reluctance coupled with obvious patient benefits, a recent systematic review from Cancers wanted to uncover the feasibility of the implementation of mainstream genetic testing pathways into routine cancer care. The researchers compiled data from 17 different studies all considering different barriers to implementation for NGHCPs.
The studies concluded that the basic concerns of NGHCPs may not be actual barriers. The review specifically states that the extra time for the explanation and ordering of genetic test is not significant and is approximately an average of 8 minutes for both pre-test counseling and a post-test results discussion. NGHCPs within the studies strongly agreed that discussing genetic testing was possible without increasing the workload.1 The studies also showed that increase in genetics knowledge may not be necessary for implementation, instead that NGHCPs need skills in how to present the testing to their patients and an understanding of how it might affect their treatment. It was vital, however, that this conversation was partnered with accurate and informative patient resources and materials that the NGHCP could give to the patient as a part of their pre-counseling appointment, as well as access to a genetics professional when necessary (e.g., when a pathogenic variant is detected).
As a result of this review, the researchers came up with four main suggestions when attempting to implement germline genetic testing in routine cancer care:1
- Include a training module that discusses key topics for pre-test counseling and informed consent
- Provide clear instructions for patient eligibility and patient-centered materials
- Collaborate closely with a genetic professional for post-test counseling involving a pathogenic variant
Current studies do show that mainstream genetic testing is not only feasible in routine cancer care, but necessary. “The proportion of NGHCPs not willing to participate in mainstream genetic testing initiatives and their arguments for this should be studied further, as mainstream genetic testing initiatives can only be successful when a significant proportion of NGHCPs are [willing to participate]. Mainstream genetic testing [is] the new standard of care for specific patient populations, and therefore all NGHCPs should be participating.”1
- Bokkers K, Vlaming M, Engelhardt EG, et al. The Feasibility of Implementing Mainstream Germline Genetic Testing in Routine Cancer Care-A Systematic Review. Cancers (Basel). 2022;14(4):1059. Published 2022 Feb 19. doi:10.3390/cancers14041059