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.
- genetic counseling
- genetic testing
- health services research
- medical oncology
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S-YY, SWW and JL are joint first authors.
M-KT, YLW and SHT are joint senior authors.
Contributors Study design: S-YY, YLW, SHT. Writing group: YSY, SHT, SWW, JL, NSAB, SM, HM, EB, AG. Genetic analyses: JL, SYL. Statistical analysis: SM, JL. Recruitment, counselling patients and provided DNA samples and/or phenotypic data: G-SC, MH, WO, KR, LHM, WTK, JO, MNMA, CMY, VR, MRMN, IA, ML, AS, NAMA, ZABA, GFH, RAM, SS, BPK, AR, YSC, WWS, BHT, SKK, EO, PJV, GI, CLL, BZMA, KSL, CSL, SJL, KJL, MNS, FI, ZAL, MPI, MFMJ, SK, KWL, JL, MMY, AMAM, NHMA, MM, ST, NC, BKL, CKF, YCF, MMA, TST, DC, KFH, RR, AR, AD, DT, SFA, FF, PN, L-MT, ARA, IM, EB, AG. Supervised the project: SHT, YLW, MKT. All authors read and approved the final version of the paper.
Funding Yayasan Sime Darby, Yayasan PETRONAS, Khind Starfish Foundation, AstraZeneca External Investigator Grant.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval This study was approved by the ethics committees of the Ministry of Health (NMRR-16-1322-31114), University Malaya Medical Centre (UMMC 20163-2255), Universiti Kebangsaan Malaysia (JEP 2017 814), Hospital Universiti Sains Malaysia (USM/JEPeM/17060286) and Subang Jaya Medical Centre (RSDH 201612.2).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request. The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
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