During personal and family medical history assessments, many patients report multiple cancer diagnoses in their family or concerns that other family members might be at increased risk for developing cancer. Patients and families might also ask their nurse about risk or parameters for genetic testing. Timely and appropriate referral to genetics professionals for counseling and possible testing for germline risk of malignancy enables individuals at increased risk to follow recommended surveillance and consider surgery and other preventive strategies, ultimately decreasing their risk of cancer-related morbidity and mortality.
The National Comprehensive Cancer Network and American Society of Medical Genetics recommend regular risk assessment and referral when a heredity cancer syndrome is suspected, and American College of Surgeons accreditation requires that cancer programs provide genetics services.
ONS Resources for Genetic Risk and Referrals
ONS developed two resources to guide oncology nurses through the genetics counseling referral process. The When to Refer to a Genetics Professional resource is a quick clinical guide for nurses to assess for hereditary red flags. A patient education tool, Is My Cancer Hereditary?, helps oncology nurses start a discussion with patient and their families.
Both resources account for patient characteristics, including age of diagnosis, malignancy type, tumor characteristics, and family history factors that suggest hereditary risk. The nursing resource includes risk assessments and frequency, and the patient tool outlines germline testing, the importance of communicating any changes in family history, and general indicators of hereditary risk.
How to Use the Resources
The quick-guide nursing resource includes a checklist for oncology nurses to apply to a patient’s history and three-generation history of maternal and paternal malignancy. It also reminds nurses to annually update patients’ family histories and reassess whether genetics referral is indicated.
The best opportunities to use the patient education resource are:
- At diagnosis, when patients and family members may have questions and concerns about hereditary predisposition, which they may or may not articulate
- When a patient is referred to a genetics professional for further assessment. Nurses should always walk patients through the teaching tool to explain what the information means, answer questions, and engage in a patient discussion.
- At the completion of definitive therapy in tandem with a survivorship care plan, when patients may ask about germline risk or be more open to exploring genetic testing
As patients prepare for genetics counseling, oncology nurses can advise them on why they are being referred and how it can help them better understand their cancer risks and potential hereditary risks, which has implications for themselves and their family members. The teaching tool is a starting point because it helps patients and families to understand the range of red flags suggestive of hereditary risk, and the guide helps oncology nurses understand the appropriate time to refer patients to genetics counseling.