Program seeks to improve rate of genetic testing among patients with breast cancer
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The University of Kansas Cancer Center has launched a telementoring program designed to improve community oncology providers’ knowledge of genetic testing in breast cancer.
The program, Efficacy of Point of Service Testing in Breast Cancer (ePOST BC), is based on the model of Project ECHO, which connects specialists at academic institutions with cancer care clinicians and teams in local communities. In addition to the educational component, ePOST BC provides tools to allow providers to incorporate genetic counseling and testing into their clinical practice.
“Conducting germline genetic testing in those with breast cancer can help determine optimal treatment and prevention strategies,” Jennifer R. Klemp, PhD, MPH, associate professor of medicine in the division of clinical oncology at University of Kansas Cancer Center, and founder and CEO of Cancer Survivorship Training, said in a press release. “With the availability of next-generation sequencing, we have access to convenient and low-cost genetic testing ... however, a significant number of [patients with] breast cancer meeting testing criteria have not been tested, and this burden will continue to grow.”
HemOnc Today spoke with Klemp about how the program works, the benefits it offers and what others can do to implement a similar initiative.
Question: What was the rationale for this program?
Answer : This program focuses on the movement in cancer care delivery to a more personalized approach to treatment planning, risk management and survivorship. With updated National Comprehensive Cancer Network guidelines and recommendations from the American Society of Breast Surgeons (ASBS), the number of women who qualify for hereditary breast cancer testing is expanding faster than cancer care teams can handle, and there is a shortage of genetic experts. If we implement the most recent recommendation from the ASBS, an estimated 250,000 new cases of invasive breast cancer and ductal carcinoma in situ will need to be tested each year, plus the tens of thousands of patients who now meet guidelines and did not previously undergo testing. We do not have the workforce to do this. There is a need for real-time treatment decisions, and it is imperative that we provide the vital information for these patients.
Q: What does the program provide?
A: I have been working in cancer genetics for more than 20 years. My practice has been primarily in-person, but with expanding regional needs, I converted to telemedicine a few years ago. I also have been working with practices across the U.S. on building a better process point-of-service; for example, increasing our ability to identify, educate and consent to test real-time when patients are in clinic and still use genetic experts for more complicated cases and cascade testing.
The program also empowers the care team with the tools they need to facilitate shared decision-making. In an ideal world, we would have enough genetic counselors to be of service everywhere and for everyone. We do not have those experts available today, so the program is using Project ECHO. In April, the first cancer genetics project was initiated in the United States. This has allowed us to recruit 12 sites across Kansas, with an average of about 30 clinical care team members. We cover five topics, including workflow analysis, interpretation of results, treatment planning and managing patients at risk for a hereditary cancer.
Q: Who can participate and how can they participate?
A: We encourage the entire care team to participate, including physicians, nurses, advanced practice providers, navigators, cancer registrars and others. It is difficult to implement practice change when the team is not engaged, so this promotes a community of practice and supports transition of care.
Q: What is your ultimate hope for the program?
A: My ultimate hope is that testing is improved, and we set a lofty goal of improvement by at least 50%. This still does not get us to the current guideline, but it is getting practice to realize that the number of patients they are testing is nowhere near the number they should be testing, as well as how this information impacts treatment and management decisions. We are working on a sustainable model through which we will be able to allow cancer care teams from across the country to participate in an ongoing cancer genetics Project ECHO.
Q: How can other s implement a similar initiative?
A: One of the key elements of Project ECHO is to build a community, and we have developed tools for participants and those interested in developing a cancer genetics Project ECHO. For more information, visit www.midwestcanceralliance.org/epost-breast-cancer-genetics.html.
Q: Is there anything else that you would like to mention?
A: We have learned that it takes a team with passion and expertise to deliver evidence-based instruction and keep care team members engaged month after month. A priority must be placed on providing high-quality content and tools to engage members in using technology as an integral part of the experiences. This community has shared other topics of interest, and we will conduct an ongoing Project ECHO, funded by the CDC, to address survivorship issues, from the time of diagnosis through the lifespan. We will be able to use this format as another platform to engage partners across the state and country. – by Jennifer Southall
For more information:
Jennifer R. Klemp, PhD, MPH, can be reached at University of Kansas Cancer Center, 2650 Shawnee Mission Parkway, Suite 1105, Westwood, KS 66205; email: jklemp@kumc.edu.
Disclosure: Klemp reports research funding from Myriad Genetic Laboratories. The program is supported by The Association of Community Cancer Centers and Pfizer Inc.