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Improving Access to Genetic Cancer Screening in a Medically Underserved Community

TOP - March 2020, Vol 13, No 2

Genetic cancer screening and testing are valuable tools that can be used for the early detection of familial/hereditary cancer syndromes. However, people living in rural, medically underserved areas may have difficulty accessing these potentially life-saving services.

Yuma Regional Medical Center Cancer Center, AZ, is located in a southwestern border town with limited healthcare resources. This comprehensive cancer center recently joined forces with Myriad Genetics, a genetic testing company, to implement a genetic screening and testing process for appropriate patients. At the Association of Community Cancer Centers 36th National Oncology Conference, Erica Martinez, RN, CHPN, OCN, Oncology Nurse Navigator, Yuma Regional Medical Center Cancer Center, shared the success of this program.

“Referring patients to genetic testing has entailed significant financial costs and transportation hurdles for patients,” said Ms Martinez. “Many of our patients are elderly, Spanish-­speaking, uninsured or underinsured, and have limited financial resources. Patients were having to travel hundreds of miles out of town to receive genetic counseling and testing services, and unfortunately that’s just not feasible for most of our patients.”

She explained how the implementation of a program to improve access to this type of testing for patients in medically underserved regions is removing financial, cultural, and geographical barriers to care, and is paving the way for improving patient care and outcomes on a broader scale.

The first step in the process involves screening, which helps providers to identify patients who should be referred to tele-education with a genetic counselor, and subsequently, genetic testing.

Screening begins at check-in for all new appointments. Patients are given a hereditary cancer quiz, which they complete on a tablet provided by ­Myriad Genetics. The results of the quiz determine whether patients require further assessment by a genetic counselor. If patients are flagged as needing further assessment, they are given a blue laminated card that lets their provider know that a genetic testing consultation is needed.

A tele-education follow-up appointment is then scheduled, during which the patient watches a short video on genetics and hereditary cancer screening in a designated room at the center, and then undergoes a comprehensive assessment with a genetic counselor. Results of this assessment are sent to the medical assistants and nurse navigators, and if the patient meets the National Comprehensive Cancer Network’s guidelines for genetic testing, he or she is escorted to a room for collection of a blood specimen.

In the 8 months before the program was implemented, only 24 patients were referred for genetic testing. However, in the 4-month period following implementation, 222 patients completed the hereditary cancer quiz, and 108 were flagged as appropriate to proceed with genetic education. Within that first 4 months, there was a 4-fold increase in genetic testing of patients with cancer.

According to Ms Martinez, this dramatic increase in testing is a direct result of providing genetic cancer screening and education to patients. The program has affected the clinical management of approximately 20% of tested patients at the center.

The model can be replicated by other programs and can help to expand genetic screening and testing services to clinical settings beyond cancer, she said. In fact, a similar program was launched at Yuma Regional Medical Center’s Women’s Health Clinic after they observed the success at the cancer center.

“Also, it’s important to know that zero [full-time equivalent] was needed by the cancer program to implement this service,” Ms Martinez noted.

Looking to the future, Ms Martinez and her colleagues hope to expand the reach of the program to all patients who have been consulted at the cancer center, as well as to other areas of the institution. Eventually, they hope to be able to provide testing to family members of patients who test positive.

“We need to figure out how best to notify relatives and get them tested too,” she said. “We are working on creating a streamlined process.”

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