Applying Genetics and Genomics to Standard Cancer Care

Jennifer R. Klemp, PhD, MPH, Founder/Chief Executive Officer, Cancer Survivorship Training, Associate Professor, Department of Medicine, Division of Clinical Oncology, Director, Cancer Survivorship Center, University of Kansas Cancer Center, The Richard and Annette Bloch Cancer Care Pavilion, Westwood, presented “Genetics and Genomics: How Does Navigation Fit In?” at the Sixth Annual Academy of Oncology Nurse & Patient Navigators (AONN+) Conference in Atlanta, GA. “The real role of genomic medicine and where we’re going is that we do want to be more personalized,” Dr Klemp said. “The larger panel in genomic testing is going to keep taking us in that direction.”

Dr Klemp focused on how navigators must be familiar with these terms, regardless of their role in their practice. “We need to be thinking about it during treatment and into posttreatment care, whether it’s lifestyle, surveillance, or dealing with disparities,” she said. “Risk assessment and genetic and genomic testing is part of that continuum of care, both for those who are disease- free, and for those who have been diagnosed with cancer and, as many of you know, other diseases.”

One gap in genetic testing that Dr Klemp highlighted includes follow-up time. “The biggest part of genetic testing, in my opinion, is that whether patients are positive or negative, they’re at high risk, or you wouldn’t have tested them,” she explained. “We need to have a system in place to help follow them and monitor them. We can collect blood or buccal; patients really like buccal— even our cancer patients—because it’s one less stick that they have to have. Those tests are equally as valid as those where we take the serum.”

Because genetic and genomic test results can determine whether a patient will need chemotherapy, Dr Klemp suggested allowing surgeons to order genetic testing to complete it earlier in the process so clinical decision- making can be more accurate. “It’s important because [even though] we are going to treat fewer patients with therapies…we are going to treat the right patients with the therapy,” she said. “If we wait until, unfortunately, they get to the oncologist, then there’s an additional lag time….The patient has expectations that once they see the oncologist, they’re going to get a plan. That doesn’t happen in a lot of these cases.”

She also proposed including genetic screening as part of wellness visits for the general population, as well as patients at high risk. “This process really needs to be thought of across the entire cancer continuum,” Dr Klemp emphasized. “It’s a very important push by the American Society of Clinical Oncology, as well. Not only are [we] talking about germline testing—really, we are talking about the whole gamut of genomic and genetic testing. This isn’t going away; it’s only going to be part of a standard of care.”