Genetic Testing for Cancer Patients

Cathy Goetsch

Today ahead of the Oncology Nursing Society (ONS) Annual Congress, held April 23–26 in Orlando, Florida, we are speaking with Cathy Goetsch, MSN, ARNP, AOCNP, an oncology certified practitioner who provides hereditary cancer risk services at the Virginia Mason Hospital & Medical Center’s Cancer Institute in Seattle, Washington, about the role of the oncology nurse in genetic counseling for cancer patients.

 -Interviewed by Anna Azvolinsky 

Cancer Network: Let’s start with the types of genetic tests that are available for cancer patients. Can you describe some of these?

Cathy Goetsch: The kinds of tests that are available for cancer patients fall into two categories. One has to do with inherited cancer risk and one has to do with tests we do on tumors themselves. So, as cancer becomes more cancerous, a lot of genetic changes happen and sometimes looking at those genetic changes helps us know about a prognosis and how to best treat the cancers.

Cancer Network: Who are the patients that undergo genetic testing and what is the goal of genetic testing?

Cathy Goetsch: When we are talking about inherited cancer risk testing, testing for a mutation that you inherit from one parent or the other, the people that we think need testing have cancer at a younger age than expected, have a larger number of family members with cancer, and have had more than one cancer themselves. Sometimes it’s also the pattern of cancers in the family that tips us off.

Cancer Network: Could you talk about what roles oncology nurses play in genetic testing? And what functions should nurses serve in the genetic testing process that perhaps are not that common?

Cathy Goetsch: I would say that there is more than one category. There are specialists who have experience and special training in genetics issues and they would be actually providing genetic services. But the average oncology nurse needs to be aware of their patients’ personal history and ask about the family history, recognize the red flags for [genetic testing] referral, and find what the referral resources are and encourage the people and their family members in that process.

Cancer Network: What are some of the ethical issues encountered by nurses that provide cancer genetics services?

Cathy Goetsch: I think one of the big ones is just family dynamics. In some families, family members may not talk to each other, they may not have told each other that they have cancer, or know their family history and don’t want to ask. Sometimes there is a person in the family who is the most helpful to be tested and that person does not want to be tested; then the other family members are limited in their ability in getting their family genetic information. Other things fall under confidentiality, which we deal with all the time. People worry about where their genetic information is going to go once the testing is done. Also, I think, people worry about insurance issues. Is their insurance going to cover the testing? Testing is still pretty expensive, even though it is less expensive than it used to be. Part of the disparity in healthcare is that people who do not have insurance or who do not have good insurance coverage might need testing but can’t necessarily get it because of financial issues.

Cancer Network: Could you give some examples of patient situations where oncology nurses who are not specialized in cancer genetics can incorporate genetic information into their practice?

Cathy Goetsch: I am a specialty genetics nurse. I see, primarily, patients who need genetic services. The kinds of patients I see are people who are newly diagnosed, especially with breast or colon cancer, since those are the most recognized by the primary care community. We get referrals that way and also through family members that recognize their own risk. One of the things that has happened in the recent past, as Angelina Jolie is a public figure that has come forward with her own personal story, has made a lot of people aware that they may also have that kind of risk and then want to ask their healthcare providers about that. A general practice oncology nurse needs to be aware of these things and know what resources are available, and to be able to recognize risk factors themselves and assist patients in getting services if they need them.

Cancer Network:And lastly, at academic and community cancer centers, how prevalent are nurses such as yourself who specialize in cancer genetics? Are nurses such as yourself becoming more accessible to patients?

Cathy Goetsch: I will make a stab at an estimate-there are probably 300 nurses nationally, and of course, these specialty services are more available in large academic centers and larger urban areas. There are actually resources on the Internet and lots of information is available. That is another role for nurses, helping people understand what the good information sources on the Internet are.

Cancer Network: Thank you so much for joining us today, Cathy.

Cathy Goetsch: Thank you.