Oncologist-led BRCA counselling improves access to cancer genetic testing in middle-income Asian country, with no significant impact on psychosocial outcomes
Authors: Yoon Sook-Yee , Wong Siu Wan , Lim Joanna , Ahmad Syuhada , Mariapun Shivaani , Padmanabhan Heamanthaa , Hassan Nur Tiara , Lau Shao Yan , Ch'ng Gaik-Siew , Haniffa Muzhirah , Ong Winnie P , Rethanavelu Kavitha , Moey Lip Hen , Keng Wee Teik , Omar Jamil , Mohd Abas Mohd Norazam , Yong Chee Meng , Ramasamy Vickneswaren , Md Noor Mohd Rushdan , Aliyas Ismail , Lim Michael C K , Suberamaniam Anuradha , Mat Adenan Noor Azmi , Ahmad Zatul Akmar , Ho Gwo Fuang , Abdul Malik Rozita , Subramaniam Suguna , Khoo Boom Ping , Raja Arivendran , Chin Yeung Sing , Sim Wee Wee , Teh Beng Hock , Kho Swee Kiong , Ong Eunice S E , Voon Pei Jye , Ismail Ghazali , Lee Chui Ling , Abdullah Badrul Zaman , Loo Kwong Sheng , Lim Chun Sen , Lee Saw Joo , Lim Keng Joo Lim , Shafiee Mohamad Nasir , Ismail Fuad , Latiff Zarina Abdul , Ismail Mohd Pazudin , Mohamed Jamli Mohamad Faiz , Kumarasamy Suresh , Leong Kin Wah , Low John , Md Yusof Mastura , Ahmad Mustafa Ahmad Muzamir , Mat Ali Nor Huda , Makanjang Mary , Tayib Shahila , Cheah Nellie , Lim Boon Kiong , Fong Chee Kin , Foo Yoke Ching , Mellor Abdullah Matin , Tan Teck Sin , Chow Doris S Y , Ho Kean Fatt , Raman Rakesh , Radzi Ahmad , Deniel Azura , Teoh Daren C Y , Ang Soo Fan , Joseph Joseph K , Ng Paul Hock Oon , Tho Lye-Mun , Ahmad Azura Rozila , Muin Ileena , Bleiker Eveline , George Angela , Thong Meow-Keong , Woo Yin Ling , Teo Soo Hwang 
Published: February 2021

Background

Identifying patients with BRCA mutations is clinically important to inform on the potential response to treatment and for risk management of patients and their relatives. However, traditional referral routes may not meet clinical needs, and therefore, mainstreaming cancer genetics has been shown to be effective in some high-income and high health-literacy settings. To date, no study has reported on the feasibility of mainstreaming in low-income and middle-income settings, where the service considerations and health literacy could detrimentally affect the feasibility of mainstreaming.

Methods

The Mainstreaming Genetic Counselling for Ovarian Cancer Patients (MaGiC) study is a prospective, two-arm observational study comparing oncologist-led and genetics-led counselling. This study included 790 multiethnic patients with ovarian cancer from 23 sites in Malaysia. We compared the impact of different method of delivery of genetic counselling on the uptake of genetic testing and assessed the feasibility, knowledge and satisfaction of patients with ovarian cancer.

Results

Oncologists were satisfied with the mainstreaming experience, with 95% indicating a desire to incorporate testing into their clinical practice. The uptake of genetic testing was similar in the mainstreaming and genetics arm (80% and 79%, respectively). Patient satisfaction was high, whereas decision conflict and psychological impact were low in both arms of the study. Notably, decisional conflict, although lower than threshold, was higher for the mainstreaming group compared with the genetics arm. Overall, 13.5% of patients had a pathogenic variant in BRCA1 or BRCA2, and there was no difference between psychosocial measures for carriers in both arms.

Conclusion

The MaGiC study demonstrates that mainstreaming cancer genetics is feasible in low-resource and middle-resource Asian setting and increased coverage for genetic testing.