Abstract P2-09-21: HBOC genetic counseling: A genetic counselor-physician partnership model
Authors: Oliver JB , Cronister A 
Published: May 2016

Background: In 2003, the American Society of Clinical Oncology (ASCO) issued a policy statement that addressed the oncologist's role in integrating cancer genetic risk assessment and management into clinical practice. ASCO supports access to genetic counseling for patients offered genetic testing and after results disclosure. In 2014, Integrated Genetics (IG) began offering genetic counseling in partnership with OBGYNs and oncologists whose patients have a personal or family history of breast or ovarian cancer. The goal of the program was to provide an easily accessible and comprehensive genetic counseling service for Hereditary Breast and Ovarian Cancer (HBOC) to meet the needs of patients and to support clinicians who currently provide pre- and post-test counseling.

Methods: In this study we describe IG's HBOC genetic counseling service and in a retrospective analysis, describe the characteristics of patients referred to the program in 2014. Clinicians were provided a toll free number for patients to call to schedule a genetic counseling session. The scheduling staff facilitated medical record requests and emailed a family history questionnaire. In person or telegenetic counseling (via WebEx) was offered. Telegenetic counseling allowed the patient and genetic counselor to see one another via webcam and view counseling visual aids and relevant medical records. Pedigree analysis and cancer genetic risk assessment were performed and genetic testing options discussed based on National Comprehensive Cancer Network (NCCN) testing criteria. Information discussed at the session, including patient decisions about testing, was documented for the referring physician and patient in the Genetic Counseling Consultation Report. The physician ordered testing and managed patient screening and surveillance.

Results: During 2014, 247 counseling sessions were provided to patients from 23 states. All patients had a personal or family history of breast or ovarian cancer and the average age of patients was 44 years (range: 16-85). Sixty four percent (64%) of sessions were done via WebEx and 36% in person. Of the 247 sessions, 198 (80.2%) were for pre-test genetic counseling; of those, 173 (87.4%) met NCCN HBOC genetic testing criteria and genetic testing for BRCA1/2 was offered. Of this group, 70.52% desired testing, 27.75% declined and 1.73% were undecided. The remaining sessions (n=49) included post-test counseling for pathogenic mutations or variants of unknown significance (n=39), and patients who had accepted testing but whose results were pending (n=10).

Conclusions: The IG HBOC genetic counseling program extended comprehensive genetic counseling to patients at increased risk for BRCA1/2 mutations who might not otherwise have access to this service. Physicians appropriately selected patients for referral (87% met NCCN testing criteria). The genetic counselors provided cancer genetic risk assessment, time-intensive patient education to facilitate informed decision making, and counseling about the implications of results, including the complexities of variants of unknown significance. This partnership model allowed physicians to retain patient care oversight, including management of screening and surveillance, while leveraging genetic counselor expertise.

Citation Format: Oliver JB, Cronister A. HBOC genetic counseling: A genetic counselor-physician partnership model. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-09-21.