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Yoon SY, Wong SW, Lim J, Ahmad S, Mariapun S, Padmanabhan H, Hassan NT, Lau SY, Ch'ng GS, Haniffa M, Ong WP, Rethanavelu K, Moey LH, Keng WT, Omar J, Mohd Abas MN, Yong CM, Ramasamy V, Md Noor MR, Aliyas I, Lim MCK, Suberamaniam A, Mat Adenan NA, Ahmad ZA, Ho GF, Abdul Malik R, Subramaniam S, Khoo BP, Raja A, Chin YS, Sim WW, Teh BH, Kho SK, Ong ESE, Voon PJ, Ismail G, Lee CL, Abdullah BZ, Loo KS, Lim CS, Lee SJ, Lim KJL, Shafiee MN, Ismail F, Latiff ZA, Ismail MP, Mohamed Jamli MF, Kumarasamy S, Leong KW, Low J, Md Yusof M, Ahmad Mustafa AM, Mat Ali NH, Makanjang M, Tayib S, Cheah N, Lim BK, Fong CK, Foo YC, Mellor Abdullah M, Tan TS, Chow DSY, Ho KF, Raman R, Radzi A, Deniel A, Teoh DCY, Ang SF, Joseph JK, Ng PHO, Tho LM, Ahmad AR, Muin I, Bleiker E, George A, Thong MK, Woo YL, Teo SH. Oncologist-led BRCA counselling improves access to cancer genetic testing in middle-income Asian country, with no significant impact on psychosocial outcomes. J Med Genet 2021; 59:220-229. [PMID: 33526602 DOI: 10.1136/jmedgenet-2020-107416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/28/2020] [Accepted: 11/29/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Identifying patients with BRCA mutations is clinically important to inform on the potential response to treatment and for risk management of patients and their relatives. However, traditional referral routes may not meet clinical needs, and therefore, mainstreaming cancer genetics has been shown to be effective in some high-income and high health-literacy settings. To date, no study has reported on the feasibility of mainstreaming in low-income and middle-income settings, where the service considerations and health literacy could detrimentally affect the feasibility of mainstreaming. METHODS The Mainstreaming Genetic Counselling for Ovarian Cancer Patients (MaGiC) study is a prospective, two-arm observational study comparing oncologist-led and genetics-led counselling. This study included 790 multiethnic patients with ovarian cancer from 23 sites in Malaysia. We compared the impact of different method of delivery of genetic counselling on the uptake of genetic testing and assessed the feasibility, knowledge and satisfaction of patients with ovarian cancer. RESULTS Oncologists were satisfied with the mainstreaming experience, with 95% indicating a desire to incorporate testing into their clinical practice. The uptake of genetic testing was similar in the mainstreaming and genetics arm (80% and 79%, respectively). Patient satisfaction was high, whereas decision conflict and psychological impact were low in both arms of the study. Notably, decisional conflict, although lower than threshold, was higher for the mainstreaming group compared with the genetics arm. Overall, 13.5% of patients had a pathogenic variant in BRCA1 or BRCA2, and there was no difference between psychosocial measures for carriers in both arms. CONCLUSION The MaGiC study demonstrates that mainstreaming cancer genetics is feasible in low-resource and middle-resource Asian setting and increased coverage for genetic testing.
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Affiliation(s)
- Sook-Yee Yoon
- Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Siu Wan Wong
- Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Joanna Lim
- Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Syuhada Ahmad
- Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Shivaani Mariapun
- Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | | | - Nur Tiara Hassan
- Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Shao Yan Lau
- Genetic Counselling, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Gaik-Siew Ch'ng
- Genetics, Penang Hospital, Penang, Penang, Malaysia.,Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Muzhirah Haniffa
- Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Winnie P Ong
- Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Kavitha Rethanavelu
- Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Lip Hen Moey
- Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Wee Teik Keng
- Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Jamil Omar
- Gynaeoncology, Institut Kanser Negara, Putrajaya, Wilayah Persekutuan Putra, Malaysia
| | | | | | | | - Mohd Rushdan Md Noor
- Gynaeoncology, Hospital Sultanah Bahiyah, Alor Setar, Kedah Darul Aman, Malaysia
| | - Ismail Aliyas
- Gynaeoncology, Hospital Sultanah Bahiyah, Alor Setar, Kedah Darul Aman, Malaysia
| | - Michael C K Lim
- Department of O&G, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Anuradha Suberamaniam
- Gynaeoncology, University of Malaya Medical Centre, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Noor Azmi Mat Adenan
- Department of O&G, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Zatul Akmar Ahmad
- Department of O&G, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Gwo Fuang Ho
- Clinical Oncology, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Rozita Abdul Malik
- Clinical Oncology, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Suguna Subramaniam
- Gynaeoncology, Hospital Wanita Dan Kanak-Kanak Sabah, Kota Kinabalu, Malaysia
| | - Boom Ping Khoo
- Gynaeoncology, Hospital Wanita Dan Kanak-Kanak Sabah, Kota Kinabalu, Malaysia
| | - Arivendran Raja
- Gynaeoncology, Hospital Wanita Dan Kanak-Kanak Sabah, Kota Kinabalu, Malaysia
| | - Yeung Sing Chin
- Gynaeoncology, Hospital Wanita Dan Kanak-Kanak Sabah, Kota Kinabalu, Malaysia
| | - Wee Wee Sim
- Gynaeoncology, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
| | - Beng Hock Teh
- Gynaeoncology, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
| | - Swee Kiong Kho
- Oncology, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
| | - Eunice S E Ong
- Oncology, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
| | - Pei Jye Voon
- Oncology, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
| | - Ghazali Ismail
- Gynaeoncology, Hospital Sultan Ismail, Johor Bharu, Johor Darul Ta'zim, Malaysia
| | - Chui Ling Lee
- Gynaeoncology, Hospital Sultan Ismail, Johor Bharu, Johor Darul Ta'zim, Malaysia
| | | | - Kwong Sheng Loo
- Gynaeoncology, Hospital Sultan Ismail, Johor Bharu, Johor Darul Ta'zim, Malaysia
| | - Chun Sen Lim
- Gynaeoncology, Hospital Sultan Ismail, Johor Bharu, Johor Darul Ta'zim, Malaysia
| | - Saw Joo Lee
- Gynaeoncology, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | | | - Mohamad Nasir Shafiee
- Gynaeoncology, Hospital Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Fuad Ismail
- Oncology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Zarina Abdul Latiff
- Clinical Genetics, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Mohd Pazudin Ismail
- Gynaeoncology, Hospital Universiti Sains Malaysia, Kota Bahru, Kelantan, Malaysia
| | | | | | - Kin Wah Leong
- Oncology, Gleneagles Penang, Penang, Penang, Malaysia
| | - John Low
- Oncology, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Mastura Md Yusof
- Oncology, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | | | - Nor Huda Mat Ali
- Gynaeoncology, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia
| | - Mary Makanjang
- Gynaeoncology, KPJ Sabah Specialist Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Shahila Tayib
- Gynaeoncology, Penang General Hospital, Georgetown, Pulau Pinang, Malaysia
| | - Nellie Cheah
- Oncology, Loh Guan Lye Specialist Centre, Penang, Malaysia
| | - Boon Kiong Lim
- Department of O&G, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Chee Kin Fong
- Gynaeoncology, Subang Jaya Medical Centre, Subang Jaya, Malaysia
| | - Yoke Ching Foo
- Oncology, Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
| | | | - Teck Sin Tan
- Gynaeoncology, Subang Jaya Medical Centre, Subang Jaya, Malaysia
| | - Doris S Y Chow
- Oncology, Mount Miriam Cancer Hospital, Tanjong Bungah, Penang, Malaysia
| | - Kean Fatt Ho
- Oncology, Mount Miriam Cancer Hospital, Tanjong Bungah, Penang, Malaysia
| | - Rakesh Raman
- Oncology, Mount Miriam Cancer Hospital, Tanjong Bungah, Penang, Malaysia
| | - Ahmad Radzi
- Oncology, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Azura Deniel
- Oncology, KPJ Ampang Puteri Specialist Hospital, Ampang, Kuala Lumpur, Malaysia
| | - Daren C Y Teoh
- Oncology, KPJ Sabah Specialist Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Soo Fan Ang
- Oncology, Penang Adventist Hospital, Penang, Penang, Malaysia
| | - Joseph K Joseph
- Oncology, Sunway Medical Centre, Bandar Sunway, Selangor, Malaysia
| | - Paul Hock Oon Ng
- Oncology, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Lye-Mun Tho
- Oncology, Beacon Hospital Sdn Bhd, Petaling Jaya, Malaysia
| | | | - Ileena Muin
- Oncology, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Eveline Bleiker
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Angela George
- Oncology, Royal Marsden Hospital Chelsea, London, London, UK
| | - Meow-Keong Thong
- Genetic Medicine Unit, University of Malaya Medical Centre, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Yin Ling Woo
- Department of O&G, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Soo Hwang Teo
- Cancer Prevention and Population Science, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia.,University Malaya Cancer Research Institute, Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
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