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Oncologist-led BRCA counselling improves access to cancer genetic testing in middle-income Asian country, with no significant impact on psychosocial outcomes

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 bee...

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Main 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
Format: Article
Published: BMJ Publishing Group 2022
Subjects:
Medical technology
RG Gynecology and obstetrics
Online Access:http://eprints.um.edu.my/33851/
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Summary: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.

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