COMMENTARY

A Simple Way to Make Genetic Counseling More Efficient and Accessible

Maurie Markman, MD

Disclosures

June 14, 2019

This transcript has been edited for clarity.

Hello. I'm Dr Maurie Markman from Cancer Treatment Centers of American in Philadelphia. I would like to briefly discuss a very provocative paper which recently appeared in the journal Gynecologic Oncology, entitled "Modified Panel-Based Genetic Counseling for Ovarian Cancer Susceptibility: A Randomized Non-Inferiority Study." I think all oncologists—certainly oncologists who care for women with ovarian cancer—are aware that there has been a true revolution in our management of this malignancy with the availability of poly ADP-ribose polymerase (PARP) inhibitors and recent data demonstrating a major impact on progression-free survival, even in the frontline setting, with their use. I'm obviously specifically speaking of the setting where an individual woman has a BRCA mutation.

The increasing availability of an agent like a PARP inhibitor that depends on knowledge of germline abnormalities—which are, of course, also relevant for families in terms of their [genetic] risk—raises the question of the availability of genetic counselors and genetic counseling to inform patients and families of the benefits but also the potential risks that this knowledge entails, such as genetic discrimination in employment efforts and health insurance efforts. Do family members want that knowledge known and do they want to know?

The problem is that this takes a tremendous amount of time.

In this particular study, they piloted sending information to the family beforehand for review. This 20-minute effort allowed patients to answer some questions before the counseling session. They asked patients who had either undergone the counseling with or without this material beforehand how they perceived it. They tried to measure the difference in patient stress and knowledge of ovarian cancer, and they basically found no difference between the groups that viewed this material before and those that had the counseling before learning that material. However, there was a reduction of almost half an hour in the time that was required to explain the material to patients who received this material [ahead of time].

Very provocative. Obviously, this is not the single or the sole answer for making genetic counseling available to our patients. It is absolutely necessary, but methods to improve the efficiency of the process are clearly going to be needed in the future. This is certainly one very provocative way of exploring an approach to providing essential information. If you have an interest in the general topic of genetic counseling or ovarian cancer management, I encourage you to read this very interesting paper. I thank you for your attention.

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