Mainstreaming genetic counselling for genetic testing of BRCA1 and BRCA2 in ovarian cancer patients in Malaysia (MaGiC Study)

Date 24 November 2018
Event ESMO Asia 2018 Congress
Session Mini Oral - Gynaecological cancers
Topics Ovarian Cancer
Personalised/Precision Medicine
Presenter Sook Yee Yoon
Citation Annals of Oncology (2018) 29 (suppl_9): ix173-ix178. 10.1093/annonc/mdy483
Authors S.Y.Y. Yoon1, N.S. Ahmad Bashah1, S.W. Wong1, S. Mariapun2, H. Padmanabhan1, T. Hassan1, J. Lim2, S.Y. Lau2, N. Rahman3, M.K. Thong4, G.S. Ch'Ng5, S.H. Teo2, E. Bleiker6, Y.L. Woo7
  • 1Familial Cancer, Cancer Research Malaysia, 47500 - Subang Jaya/MY
  • 2Breast Cancer Programme, Cancer Research Malaysia, 47500 - Subang Jaya/MY
  • 3Division Of Genetics And Epidemiology, Institute of Cancer Research, SW73RP - London/GB
  • 4Genetic Medicine Unit, University of Malaya Medical Centre, 59100 - Kuala Lumpur/MY
  • 5Genetics Department, Hospital Kuala Lumpur, 50586 - Kuala Lumpur/MY
  • 6Division Of Psychosocial Research And Epidemiology, Netherlands Cancer Institute, 1066 - Amsterdam/NL
  • 7Department Of Obstetrics And Gynaecology, University of Malaya Medical Centre, 59100 - Kuala Lumpur/MY

Abstract

Background

Identification of BRCA mutations in ovarian cancer patients is important for their medical management and preventative measures for their relatives. However, due to cost, lack of genetic counsellors, clinical geneticists and awareness among clinicians, there is inadequate genetic testing in most parts of Asia. Mainstreaming genetic counselling may improve access to BRCA genetic testing. The MaGiC study aims to determine the prevalence of BRCA1/BRCA2 mutations, feasibility of mainstreaming and the psychosocial impact of genetic testing in Malaysian ovarian cancer patients.

Methods

This is a prospective observational study of 800 patients with non-mucinous ovarian cancer irrespective of family history, recruited via mainstreaming or the traditional genetic pathway. Genetic Counselling Satisfaction Scale, Decisional Conflict Scale, Psychosocial Aspect of Hereditary Cancer (PAHC) and Cancer Worry Scale are used to measure the feasibility and psychosocial outcomes. Mainstreaming clinicians provide feedback on their experience and intention for mainstreaming through a questionnaire.

Results

47 clinicians from 25 sites nationwide recruited 426 patients (46% Malay, 37% Chinese, 8% Indian, 9% Indigenous). 383 patients were tested. 52 (13.6%) pathogenic mutations, 52 (13.6%) VUS and 279 (72.8%) negatives were identified. Most patients were satisfied with their counselling experience. Most felt informed of benefits and risks, and felt less conflicted in making decision after counselling. However, the PAHC showed 72% of patients after pre-counselling and 55%, after result disclosure reported to have issue in at least one domain. 24% of patients reported to feel some distress after the pre-counselling. 77% of mainstreaming clinicians reported that they are confident of their BRCA knowledge to counsel patients and 80% would want to incorporate BRCA testing into their clinic.

Conclusions

Interim results showed satisfaction in the genetic counselling services and reduction in the decisional conflict. Majority of the clinicians active in mainstreaming want to continue the service. Mainstreaming cancer genetics may be possible to improve access to genetic counselling and testing in Malaysia.

Editorial acknowledgement

Clinical trial identification

Legal entity responsible for the study

Cancer Research Malaysia.

Funding

AstraZeneca.

Disclosure

N. Rahman: Non-executive director of AstraZeneca. All other authors have declared no conflicts of interest.