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

Yoon SY 1 , Wong SW 2 , Lim J 2 , Ahmad S 2 , Mariapun S 2 , Padmanabhan H 2 Show all authors , Hassan NT 2 , Lau SY 2 , Ch'ng GS 3 , Haniffa M 4 , Ong WP 4 , Rethanavelu K 4 , Moey LH 4 , Keng WT 4 , Omar J 5 , Mohd Abas MN 5 , Yong CM 6 , Ramasamy V 6 , Md Noor MR 7 , Aliyas I 7 , Lim MCK 8 , Suberamaniam A 9 , Mat Adenan NA 8 , Ahmad ZA 8 , Ho GF 10 , Abdul Malik R 10 , Subramaniam S 11 , Khoo BP 11 , Raja A 11 , Chin YS 11 , Sim WW 12 , Teh BH 12 , Kho SK 13 , Ong ESE 13 , Voon PJ 13 , Ismail G 14 , Lee CL 14 , Abdullah BZ 14 , Loo KS 14 , Lim CS 14 , Lee SJ 15 , Lim KJL 16 , Shafiee MN 17 , Ismail F 18 , Latiff ZA 19 , Ismail MP 20 , Mohamed Jamli MF 21 , Kumarasamy S 22 , Leong KW 23 , Low J 24 , Md Yusof M 24 , Ahmad Mustafa AM 25 , Mat Ali NH 25 , Makanjang M 26 , Tayib S 27 , Cheah N 28 , Lim BK 8 , Fong CK 29 , Foo YC 30 , Mellor Abdullah M 30 , Tan TS 29 , Chow DSY 31 , Ho KF 31 , Raman R 31 , Radzi A 24 , Deniel A 32 , Teoh DCY 33 , Ang SF 34 , Joseph JK 35 , Ng PHO 24 , Tho LM 36 , Ahmad AR 36 , Muin I 37 , Bleiker E 38 , George A 39 , Thong MK 40 , Woo YL 8 , Teo SH 41

Affiliations 

  • 1 Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia sookyee.yoon@cancerresearch.my
  • 2 Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
  • 3 Genetics, Penang Hospital, Penang, Penang, Malaysia
  • 4 Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
  • 5 Gynaeoncology, Institut Kanser Negara, Putrajaya, Wilayah Persekutuan Putra, Malaysia
  • 6 Gynaeoncology, Hospital Ampang, Ampang, Malaysia
  • 7 Gynaeoncology, Hospital Sultanah Bahiyah, Alor Setar, Kedah Darul Aman, Malaysia
  • 8 Department of O&G, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
  • 9 Gynaeoncology, University of Malaya Medical Centre, Kuala Lumpur, Wilayah Persekutuan, Malaysia
  • 10 Clinical Oncology, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
  • 11 Gynaeoncology, Hospital Wanita Dan Kanak-Kanak Sabah, Kota Kinabalu, Malaysia
  • 12 Gynaeoncology, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
  • 13 Oncology, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
  • 14 Gynaeoncology, Hospital Sultan Ismail, Johor Bharu, Johor Darul Ta'zim, Malaysia
  • 15 Gynaeoncology, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
  • 16 Gynaeoncology, KPJ Johor Specialist Hospital, Johor, Malaysia
  • 17 Gynaeoncology, Hospital Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
  • 18 Oncology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Wilayah Persekutuan, Malaysia
  • 19 Clinical Genetics, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Wilayah Persekutuan, Malaysia
  • 20 Gynaeoncology, Hospital Universiti Sains Malaysia, Kota Bahru, Kelantan, Malaysia
  • 21 Gynaeoncology, Hospital Tuanku Ja'afar Seremban, Seremban, Negeri Sembilan, Malaysia
  • 22 Gynaeoncology, Gleneagles Penang, Penang, Malaysia
  • 23 Oncology, Gleneagles Penang, Penang, Penang, Malaysia
  • 24 Oncology, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
  • 25 Gynaeoncology, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia
  • 26 Gynaeoncology, KPJ Sabah Specialist Hospital, Kota Kinabalu, Sabah, Malaysia
  • 27 Gynaeoncology, Penang General Hospital, Georgetown, Pulau Pinang, Malaysia
  • 28 Oncology, Loh Guan Lye Specialist Centre, Penang, Malaysia
  • 29 Gynaeoncology, Subang Jaya Medical Centre, Subang Jaya, Malaysia
  • 30 Oncology, Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
  • 31 Oncology, Mount Miriam Cancer Hospital, Tanjong Bungah, Penang, Malaysia
  • 32 Oncology, KPJ Ampang Puteri Specialist Hospital, Ampang, Kuala Lumpur, Malaysia
  • 33 Oncology, KPJ Sabah Specialist Hospital, Kota Kinabalu, Sabah, Malaysia
  • 34 Oncology, Penang Adventist Hospital, Penang, Penang, Malaysia
  • 35 Oncology, Sunway Medical Centre, Bandar Sunway, Selangor, Malaysia
  • 36 Oncology, Beacon Hospital Sdn Bhd, Petaling Jaya, Malaysia
  • 37 Oncology, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
  • 38 Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
  • 39 Oncology, Royal Marsden Hospital Chelsea, London, London, UK
  • 40 Genetic Medicine Unit, University of Malaya Medical Centre, Kuala Lumpur, Wilayah Persekutuan, Malaysia
  • 41 Cancer Prevention and Population Science, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
J Med Genet, 2022 Mar;59(3):220-229.
PMID: 33526602 DOI: 10.1136/jmedgenet-2020-107416

Abstract

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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