Integrating Germline Genetics Into Precision Oncology Practice in the Veterans Health Administration: Challenges and
Maren T Scheuner1, Kenute Myrie1, Jane Peredo1
1is a Professor in Medicine and Pediatrics at the University of California, San Francisco School of Medicine and the Director of the Clinical Genetics Program, San Francisco US Department of Veteran Affairs (VA) Health Care System. is a Portfolio Manager for Oncology and Lead for Precision Oncology, Clinical Science Research and Development Service, VA Office of Research and Development is a Genetic Counselor at the Greater Los Angeles VA Healthcare System in California. is Program Manager for the Veterans Health Administration (VHA), National Center for Health Promotion and Disease Prevention in Durham, North Carolina, and National Oncology Clinical Advisor for the Office of Nurses Services in Washington, DC. is a Nurse Practitioner and is a Staff Physician with the Genomic Medicine Service, VHA Central Office. is an American Association for the Advancement of Science (AAAS) and Science and Technology Policy Fellow, VA Office of Research and Development.
The Department of Veterans Affairs (VA) is developing strategies to integrate germline genetic testing into cancer care. This initiative addresses workforce, education, and organizational challenges for precision oncology.
Area of Science:
- Oncology
- Genetics
- Health Services Research
Background:
- Germline testing is becoming standard for specific cancers, presenting new challenges.
- Germline information has significant implications for patients and families.
- Existing healthcare systems face barriers to integrating germline testing.
Purpose of the Study:
- To outline strategies for integrating germline genetic testing into precision oncology within the Department of Veterans Affairs (VA).
- To address workforce capacity, organizational structure, and genetics education needs.
- To provide a model applicable to other healthcare systems.
Main Methods:
- The study identifies challenges in germline testing implementation.
- It considers health, reproductive, and psychosocial implications.
- It examines workforce shortages and clinician knowledge gaps.
Main Results:
- Challenges include complex interpretation, a shortage of genetics professionals, and limited clinician awareness.
- Organizational barriers, such as EHR integration issues, hinder genetic test ordering and results.
- Thoughtful planning is required for high-quality genetic services in precision oncology.
Conclusions:
- The VA is well-positioned to lead germline genetic testing integration.
- The VA's role in veteran cancer care and workforce training is significant.
- Innovative models for clinical care delivery are being developed and tested.
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