Over the past 20 years, advancements in research and the understanding of genetics have created a boom in patient demand for genetic tests. According to the National Library of Medicine, less than 300 genetic tests were available in the 1990s; in contrast, at the end of 2012, almost 3,000 genetic tests were available. This increase has led to the dramatic rise in the need for genetic specialists who can choose the proper test, as well as interpret testing results and guide patients through care plans and options.
With genetics specialists in high demand, researchers in Penn’s Abramson Cancer Center are turning to telemedicine to provide access to cancer genetic testing and counseling services to low-access populations. Much like video capabilities that make chatting with relatives and friends or conferencing with colleagues around the world instantaneous, “telegenetics” can be an effective way to expand genetic services to underserved patient populations.
Through an NIH-funded study, a team led by Angela R. Bradbury, MD, assistant professor of Hematology/Oncology, is bringing testing and counseling services typically available only at large, academic facilities to three community clinics in New Jersey and Delaware. As part of the Abramson Cancer Center’s Cancer Risk Evaluation Program, telegenetics is currently being offered to patients meeting with a genetic counselor to discuss their personal risk for mutations in the BRCA1 and BRCA2 genes. BRCA mutations are known to increase a patient’s risk of being diagnosed with various cancers, most notably breast and ovarian. Knowledge about the presence of increased risk for cancer can provide important, sometimes life-saving options, such as increased cancer screening, prophylactic surgeries, and medications.
“This program uses technology that many people are already using on their computers and phones every day, but we’re applying it to health care in a way that brings these valuable services to patients who may not have access in their communities,” said Bradbury. “By creating a bridge between the genetic counselors and patients in distant locations, we’re able to reach a much larger pool of people who may benefit from but not have access to these services.”
So far, the team has seen several benefits to both patients and providers, including saving patients time and costs, as well as reducing the disruption to a patient’s daily routine by limiting travel time or time off work that would otherwise be spent at a doctor’s office.
“During a genetic counseling session, we review a patient’s personal and family history of cancer and discuss options for genetic testing and cancer risk reduction,” said Shea Rauch, MS, CGC, genetic counselor. “By providing these services virtually, we are able to maintain the patient-provider relationship while making these services more convenient and accessible for patients who are unable to make the trip to Penn.”
Dr. Bradbury and her team have been working with the Penn Medicine Center for Health Care Innovation under an Innovation Grant to optimize the program as a clinical offering. Together with the Center, Dr. Bradbury’s team established a partnership with Bay Health Medical Center to access telegenetics services, and are testing various technologic and operational innovations to improve workflow, and ultimately, patient outcomes. The collective vision is that broad access to telegenetic counseling will ensure that the right person gets the right test at the right time – improving outcomes when disease is prevented or discovered early, and eliminating the extra procedures, screening and anxiety that often come with inappropriate testing.
Moving forward, the team has plans to continue expanding the telegenetics services to underserved populations with support of the Basser Research Center for BRCA. In the future, telegenetics may even be extended to a patient’s home environment, providing new levels of convenience and privacy.