Help Patients Understand Genomic Variants of Unknown Significance
Patients approach genetic testing, either for germline (inherited) or somatic (tumor) alterations, hoping it will provide valuable information about their cancer risk, prognosis, or treatment options. Next-generation sequencing makes it possible to test for panels of 40 or more genes simultaneously. By testing more genes, the possibility of finding an actionable, informative result improves, but so does the chance of having a result with one or more variants of unknown clinical significance.
An Oncology Nurse’s Primer on Genomics and Biomarker Terminology
With the massive paradigm shift in cancer therapy to precision medicine, the use of biomarkers and biomarker testing has also rapidly evolved to guide treatment selection. However, the terminology used in genomics is complex and inconsistent, and patient advocacy organizations recommend using a common taxonomy to prevent confusion among patients and providers alike. Nurses spend more time with patients and families than any other member of the healthcare team and can reinforce common language and terminology. As a nurse, here are the terms you need to understand.
Family Risk Factors May Indicate Need for Genetics Counseling Referrals
Genetics testing is not just about one family member; the results have implications for an entire family. Results of genetic testing can be confusing, and families often need assistance understanding what it means for them. Genetics counseling before and after testing is very important to help individuals and families understand the results of genetic testing when they are received and over time.
What Happens During a Genetics Counseling Session?
When referring patients for genetics counseling and possible testing for hereditary risk, oncology nurses can help relieve their trepidation and anxiety by explaining what to expect during the visit. See the sidebar for key indications for referral.
Genomic Data Changes Care for Cancer Survivors
Further understanding of the human genome and the proliferation of genetic data has spurred significant advancement in the understanding of the way cancer impacts individuals. To share the crucial work in genetics, the National Institutes of Health (NIH), led by the National Institute for Cancer (NCI), has compiled survivor stories from patients who have benefited from cutting-edge genomic technology. Their stories illustrate and contribute to the ongoing successes brought on by NIH’s genomic efforts.
World Gets Closer to Identifying Cancer’s Genomic Drivers
Although most cancers contain four to five driver mutations, those drivers remain unknown for about 5% of cancers, according to results of a series of studies examining genomes from 38 different cancer types. The international Pan-Cancer Analysis of Whole Genomes Consortium reported the findings in a collection of 23 articles published in Nature and other affiliated journals.
How DNA Sequencing Technologies Are Used in Cancer Care, Now and in the Future
Genomic testing identifies germline or inherited DNA changes that increase a person’s cancer risk, and it also can identify or profile the somatic or acquired changes in a tumor that guide selection of appropriate targeted therapies. The latter type of genomic testing is an analysis of DNA sequence information.
Germline and Somatic Mutations: What Is the Difference?
Cancer occurs from mutations, or harmful changes from an alteration in a gene’s DNA sequence. Most mutations involve changes in the order of the base pairs, including substitutions, deletions, additions, or shifts. Mutations can be divided into broad categories based on the tissue where they occur.
Multigene Testing Is Cost Effective for All Women With Breast Cancer
According to findings from a new analysis published in JAMA Oncology, multigene testing should be expanded to all women with breast cancer and not just those with certain family histories or clinical factors.
What Is the Difference Between Genetics and Genomics?
Genetics versus genomics: Is there a difference? Does it even matter? There is, and it does. In our era of precision medicine, also referred to as individualized or genomic medicine, being able to differentiate the terms is a first step in establishing a foundational understanding of what they mean for cancer care from prevention to treatment.
Advanced Cancer Screening Coverage; ACA Remains Strong; Medicare for All Cost
Precision medicine has a been a hot topic in health care for years now, but costs and coverage issues have created challenges to get patients the genetic testing they need at an affordable cost. In a memo from October 29, 2019, the Centers for Medicare and Medicaid Services (CMS) proposed extending Medicare coverage to pay for genetic sequencing tests for certain hereditary types of ovarian and breast cancer.
FDA Approves Entrectinib for NTRK Solid Tumors and ROS-1 NSCLC
On August 15, 2019, the U.S. Food and Drug Administration (FDA) granted accelerated approval to entrectinib (RozlytrekTM) for adults and pediatric patients 12 years of age and older with solid tumors that have a neurotrophic tyrosine receptor kinase (NTRK) gene fusion without a known acquired resistance mutation, are metastatic or where surgical resection is likely to result in severe morbidity, and have progressed following treatment or have no satisfactory standard therapy.
Continued Conversation Shows That Nurses Need More Genetics Education
During the 44th Annual ONS Congress in April 2019, some sessions featured a Continuing the Conversation event following the main session. As a speaker, this might have been the best part for me. It was filled with unexpected, wonderful surprises and great conversations with oncology nursing colleagues.
NIH All of Us Campaign Celebrates First Anniversary
As part of the rising wave of precision medicine initiatives, the National Institutes of Health (NIH) launched the All of Us campaign in 2018. This one-of-a-kind research program aimed to collect data from more than one million Americans, including factors about lifestyle, environment, and biology, to understand impacts on health and well being. The information would help researchers to better understand the individual nature of health to ultimately inform decisions about delivering precision medicine.
Beta Data Browser Puts Precision Medicine Cohort at Researchers’ Fingertips
The future of cancer care is here: precision medicine has led to many of today’s newest cancer treatments and has made incredible progress since former President Barak Obama first announced the U.S. Precision Medicine Initiative (PMI) in 2015.
U.S. Rep Cummings Introduces Henrietta Lacks Enhancing Cancer Research Act
After recent a best-selling book-turned-movie detailed her story, Henrietta Lacks’ extraordinary impact on cancer research. However, many more are still unaware of how her story, struggle with cancer, and tumor cells changed the face of cancer care. For that reason, Representative Elijah Cummings (D-MD), along with a congressional delegation from both chambers, introduced legislation to both honor her role in history and improve access to medical research to traditionally underrepresented groups.
New Genetics Service Delivery Models Help Patients Access Genetic Counseling
As genetic and genomic testing become more common—and complex—in cancer diagnosis and treatment decisions, more efficient and accessible ways of providing comprehensive genetic care are needed. In their article in the February 2019 issue of the Clinical Journal of Oncology Nursing, Pierle and Mahon discussed the findings from their literature review, specifically pertaining to genetics care services across the cancer continuum, patient and system barriers to accessing care, new service delivery models, and oncology nurses’ role in providing comprehensive cancer genetics care services.
Guidelines Insufficient for Prostate Cancer Germline Genetic Testing
According to researchers, only 43.8% of positive genetic variants detected in men with prostate cancer had corresponding recommendations for germline testing in National Comprehensive Cancer Network (NCCN) guidelines. The findings were published in JAMA Oncology.
The Case of the Belated BRCA Test
Eighteen months after completing surgical debulking and chemotherapy for stage III high-grade serous ovarian cancer, 56-year-old Lily experienced a rising CA-125 level. At her oncologist’s recommendation, Lily started an aromatase inhibitor, but it did not stop the rising tumor marker. After she began experiencing symptoms of bloating and mild abdominal pain, Lily and her oncologist decided to proceed with second-line chemotherapy. As she left the office, Lily remarked that she did not complete genetic testing when she was originally diagnosed because she does not have any children or a family history of ovarian cancer and she was concerned that her insurance would not cover the testing.
What Genetics Means in Hereditary Cancer
Genetic testing and genetics care are playing an increasingly important role in oncology and are continually evolving, Suzanne M. Mahon, DNSc, RN, AOCN®, AGN-BC, of the School of Nursing at Saint Louis University in Missouri, said during a session on Thursday, April 11, 2019, at the ONS 44th Annual Congress in Anaheim, CA.
Biosimilars, Oral Agents, and Drugs Targeting Genetic Mutations Are Creating a Paradigm Shift in Cancer Treatment
New treatment options continue to emerge for diseases that until recently had limited, if any, treatment choices. Nurses are seeing more changes in the way treatment regimens come together, biosimilars are presenting viable options for patients, and genetic mutations, as opposed to disease sites, are at the forefront of drug development.
What Does the Research Say About Genetic Testing and Underserved Populations?
Underserved communities largely have low rates of cancer genetic testing. Although the reasons vary, they can include lack of referrals, no or underinsurance, prohibitive cost, lack of trust, lack of knowledge, discrimination issues, or competing health needs.
How Do You Address Unanticipated Genomic Testing Results?
Genomic testing—identifying variants, like mutations, in tumor cells to inform patient treatment options—occasionally comes with unanticipated results that clinicians have to address with their patients. Clinicians and patients alike are often hopeful that tumor genomic testing will identify a personalized cancer treatment. Indeed, many patients have benefited from being candidates for new targeted therapies identified through genomic testing.
Testing in the Era of Precision Oncology
Every cancer diagnosis is as individualized and unique as the person receiving it. From family history to societal and economic background to a patient’s genetic make-up and composition, cancer affects each person with cancer differently. Initiatives like precision medicine are based in data that suggest that a personalized disease should have its own personalized treatment. As a subset of precision medicine, precision oncology assesses a patient’s unique genetic profile to help align targeted therapies to hit the right cancer subtypes.
Epigenetic Cervical Cancer Test May Be More Accurate Than Pap or HPV Tests
An S5 methylation test detected 100% of grade 2 cervical intraepithelial neoplasms or worse, compared to a 50% detection rate for Pap or human papillomavirus (HPV) tests, according to the results of a recent study reported in the International Journal of Cancer.
BRCA Is Not the Only Common Mutation for Breast and Ovarian Cancer
Multigene testing for hereditary breast and ovarian cancer has increased the detection predisposition genes beyond BRCA1 and BRCA2, according to study findings presented at the San Antonio Breast Cancer Symposium on December 7, 2018.
Trastuzumab Remains Standard HER2+ Breast Cancer Therapy Despite Cardiac Risks
Trastuzumab can improve disease-free survival (DFS) and overall survival (OS) in patients with human epidermal growth factor receptor 2-positive (HER2+) breast cancer. Although some studies suggest that short-term treatment (less than one year) may reduce cardiac toxicity and cost without compromising outcomes, the results of a new study presented at the disagree.
On-Treatment Genetic Testing Improves Accuracy of Tumor Response Prediction
Genetic testing during treatment can improve accuracy of response and outcome prediction compared to other prognostic tests, according to results from a study assessing on-treatment changes in gene expression in patients receiving chemotherapy. Researchers from Oikonomidou O Institute of Genetics and Molecular Medicine in Edinburgh, United Kingdom, presented the findings at the .
Genetics Plays a Role in Treatment Response for Relapsed or Refractory Multiple Myeloma
No molecular-informed personalized therapies are currently available for patients with relapsed/refractory multiple myeloma (MM); however, cytogenetics and next-generation sequencing (NGS) can identify molecular abnormalities to provide guidance for more targeted therapy. Tarek Assi, MD, of Gustave Roussy Cancer Campus in Villejuif, France, discussed his research team’s findings that tumor genotyping is associated with higher response rates and prolonged duration of therapy at the ASH Annual Meeting on December 1, 2018.
FDA Approves Larotrectinib for Solid Tumors With NTRK Gene Fusions
On November 26, 2018, the U.S. Food and Drug Administration (FDA) granted accelerated approval to larotrectinib for adult and pediatric patients with solid tumors that have a neurotrophic receptor tyrosine kinase (NTRK) gene fusion without a known acquired resistance mutation, that are either metastatic or where surgical resection is likely to result in severe morbidity, and who have no satisfactory alternative treatments or whose cancer has progressed following treatment.
Biosimilars and Gene Therapy Are Making Great Strides in Cancer Care
As researchers learn more about how combination therapy combats drug resistance and lessens the changes of tumor evasion of the immune system, immune checkpoint inhibitors are receiving approval for a broader range of indications. However, recent U.S. Food and Drug Administration (FDA) approvals have centered around hematologic malignancies and the emergence of two new biosimilars.
How Patients Can Benefit From Hereditary Cancer Support
My story, like many of your patients, is unfortunately not that uncommon: I’m a motherless daughter. I lost my mom to breast cancer when I was 26 years old; she lost her mother to the disease before she graduated high school. The BRCA1 mutation has been passed down in my family, and I, too, carry the mutation. Even though it was expected, I was devastated and desperately looking for resources to help manage my cancer risk. It was scary not knowing where to turn. I needed to know that I wasn’t alone.
NINR Study Identifies Genes for Fatigue in Cancer Treatment
Radiation therapy can be an incredibly draining form of treatment for patients with cancer. Side effects such as fatigue can be debilitating for many before, during, and after treatment. Because symptom management is a crucial component to cancer care and central role of oncology nursing, ensuring that patients are able to mitigate their symptoms and side effects can help improve their quality of life. Recently, a team at the National Institute of Nursing Research (NINR) identified certain genes associated with fatigue in men being treated for prostate cancer.
Genomics Is Revolutionizing Cancer Care Now and For the Future
As precision oncology continues to expand, so does the ability to use less-toxic targeted therapies. James Chen, MD, assistant professor of biomedical informatics and assistant professor of internal medicine at the division of medical oncology at Ohio State University in Columbus, described his work with genomics in cancer care and the challenges in precision medicine at the 43rd Annual Congress in Washington, DC.
Why Pretesting Counseling Is Critical in the Age of Consumer Genetic Tests
On March 6, 2018, 23andMe—an at-home genetic testing company—announced their direct-to-consumer genetic test (DTCGT) would include DNA results for the three common founder BRCA mutations commonly seen in people with Ashkenazi Jewish ancestry. This was big news because DNA results for the BRCA mutations had been previously available on the 23andMe panel report until the U.S. Food and Drug Administration removed them in 2013.
New Gene-Based Tests Screen and Monitor for Bladder, Endometrial, and Ovarian Cancers
Researchers have developed two new gene-based tests that detect DNA mutations that lead to bladder, endometrial, and ovarian cancers. The tests, which are not yet U.S. Food and Drug Administration approved, could be used to identify a new or relapsed cancer earlier, when it is easier to treat.
Study Gives a Better Understanding of ARID1A Mutations in Colorectal Cancer
A component of the SWI/SNF chromatin remodeling complex, AT-rich interactive domain 1A (ARID1A), regulates gene expression. Data on the characteristics and associated clinicopathologic features of ARID1A in colorectal cancer (CRC) are limited, even though its mutations are reported in a variety of other cancers. In study findings presented at the 2018 American Society of Clinical Oncology Annual Meeting, researchers explained an increased understanding of the ARID1A mutation in CRC.
BRCA Mutations Point to Hereditary Breast and Ovarian Cancer Syndrome
Although all cancers have a genetic basis, a subset result from an inherited (i.e., germline) mutation that puts a person at increased risk for certain cancers. Unfortunately, the signs of hereditary cancer are often overlooked or misunderstood. Here’s what oncology nurses need to know about BRCA mutations, one of the more common mutations you’ll see in practice.
Understanding Genomics and Using Precision Medicine to Advance Cancer Survival
During the American Association for Cancer Research/ONS Bench to Bedside session at the 43rd Annual Congress in Washington, DC, Victor Velculescu, MD, PhD, of Johns Hopkins University School of Medicine, and Maura Kadan, RN, MSN, of Personal Genome Diagnostics, dissected the science behind precision oncology, including an understanding of genetic alterations, the use of immunotherapy, and how to advance survival with these clinical breakthroughs.
NIH Wants 1 Million Americans to Contribute to New Pool of Gene Data; FDA Takes Action Against Misleading Companies Marketing to Kids; Conservative Groups Hope to Release New Obamacare Replacement This Month
With hopes for more than 1 million participants, the National Institutes of Health (NIH) has launched the All of Us initiative, a radical precision medicine campaign to amass a collective gene pool data repository. The NIH is aiming to shrink our differences and expand on the similarities found in our genetic data. For some, compiling genetic data of an entire country’s citizens may sound very reminiscent of Big Brother from the book 1984. But the amount of information that could be shared and learned from such a massive health database is remarkable.
FDA Approves Dabrafenib Plus Trametinib for Adjuvant Treatment of Melanoma With BRAF V600E or V600K Mutations
On April 30, 2018, the U.S. Food and Drug Administration (FDA) granted regular approval to dabrafenib (Tafinlar ®) and trametinib (Mekinist®) in combination for the adjuvant treatment of patients with melanoma with BRAF V600E or V600K mutations, as detected by an FDA-approved test, and involvement of lymph node(s), following complete resection.
How DNA Revolutionized Oncology Care
April 25, 2018, marks National DNA Day. Why the hype? National DNA Day commemorates the successful completion of the Human Genome Project in 2003, and the discovery of DNA's double helix in 1953. Without DNA, understanding the diseases and treatments for cancer would be nearly impossible. Genetics and genomics play huge roles in treating malignancy, and it’s crucial to the care of patients with cancer for oncology nurses to understand genetics and genomics.
Labs Differ Widely in BRCA Testing Protocols
An international survey of 86 genetic testing labs showed inconsistent protocols and standards for analyzing the BRCA1 or 2 cancer susceptibility genes and their variations. The results were reported in NPJ Genomic Medicine.
NIH Completes In-Depth Genomic Analysis; Senate Panel Unveils Draft Opioid Bill; Teenagers Struggle to Quit Vaping
Researchers for the PanCancer Atlas, a genomic data set reference tool, recently completed an analysis of molecular and clinical information from more than 10,000 different tumors spanning more than 33 cancer types. The PanCancer Atlas is the result of nearly a decade’s worth of work associated with the Cancer Genome Atlas—a multi-institutional program driven by the National Human Genome Research Institute and the National Cancer Institute (NCI). The results of the analysis were published as a set of 27 papers.
FDA Authorizes Direct-to-Consumer Test for BRCA Cancer Gene
Genetic testing is becoming more recognized among the general public, due in part to news reports and celebrity endorsements. Now, people are seeking to understand cancer risks and prevention measures through genetic information. There are many companies that ask for a mere mouth swab and deliver insight into a person’s DNA. As this becomes more commonplace, those with familial predisposition to cancer will look for ways to understand their own genetic results. Recently, the U.S. Food and Drug Administration (FDA) approved an at-home test identifying some—but not all—breast cancer genes.
Oncology Nurses Play Key Role in Genetics Education, Testing for Patients
Identifying genetically predisposed women with breast cancer who could benefit from risk assessment and genetic counseling is an important competency for oncology nurses. However, a recent study published in the Journal of Clinical Oncology (JCO) reported that fewer than 50% of newly diagnosed patients with breast cancer who should have been given formal genetic counseling actually received the appropriate genetic testing.
Newly Approved Cancer Treatments Indicate Growing Role of Genomics and Oral Therapies
It is becoming more commonplace for nurses to find orders for agents with which they are unfamiliar or quite possibly have never administered. Following is a summary of the latest new U.S. Food and Drug Administration (FDA) approvals or indications to keep you up to date in your practice. Of note, this summary contains the approval of yet another biosimilar in trastuzumab-dkst and rolapitant for chemotherapy-induced nausea and vomiting, which includes a safety alert. Early experiences with rolapitant, a NK-1 inhibitor, indicated a risk of hypersensitivity reactions.