作者
Sook-Yee Yoon,Siu Kei Wong,Joanna Lim,Syuhada Ahmad,Shivaani Mariapun,Heamanthaa Padmanabhan,Nur Hasyareeda Hassan,Shao Yan Lau,Gaik-Siew Ch'ng,Muzhirah Haniffa,Winnie Peitee Ong,Kavitha Rethanavelu,Lip Kean Moey,Wee Teik Keng,Jamil Omar,Mohd Azman Abas,Chee Weng Yong,Vickneswaren Thever Ramasamy,Mohd Hezmee Mohd Noor,Ismail Aliyas,Michael Lim,Anuradha Suberamaniam,Noor Azmi Mat Adenan,Zatul Akmar Ahmad,Gwo Fuang Ho,Rozita Abdul Malik,Suguna Subramaniam,Boom Ping Khoo,Arivendran Raja,Yeung Sing Chin,Wee Wee Sim,Beng Gwan Teh,Swee Kiong Kho,Eunice Ong,Pei Jye Voon,Ghazali Ismail,Chu-I Lee,Badrul Zaman Abdullah,Kwong Sheng Loo,Chun Soo Lim,Saw Joo Lee,Keng Gat Lim,Mohamad Nasir Shafiee,Fuad Ismail,Zarina Abdul Latiff,Mohd Razi Ismail,M.R. Jamli,K. Suresh,Kin Fon Leong,John N. Low,Mastura Md Yusof,Ahmad Mustafa,Nor Muhainiah Mohd Ali,M.J. Makanjang,Shahila Tayib,Nellie L C Cheah,Boon Leong Lim,Chee Kin Fong,Yoke Loong Foo,Matin Mellor Abdullah,Teck Leong Tan,Doris Hiu-Mei Chow,Kean F Ho,Rakesh Raman,Ahmad Afif Safwan Mohd Radzi,Azura Deniel,Daren Cy Teoh,Soo Fan Ang,Joseph K. Joseph,Paul K. Ng,Lye-Mun Tho,A. Ahmad,Irwan Muin,Eveline M. A. Bleiker,Angela George,Meow-Keong Thong,Yin Ling Woo,Soo Hwang Teo
摘要
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.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.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.The MaGiC study demonstrates that mainstreaming cancer genetics is feasible in low-resource and middle-resource Asian setting and increased coverage for genetic testing.