UCLA Health’s virtual genetic counseling tool has markedly increased the percentage of cancer patients who are undergoing recommended germline testing through a point-of-care model.
Beth Karlan, MD, director of Cancer Population Genetics at the UCLA Health Jonsson Comprehensive Cancer Center, said GENETECA™ (Genetics Education and Testing for Cancer), provides widely accessible, faster and more streamlined access. Patients with cancer can use a secure online portal to learn about testing and give consent without first seeing a genetic counselor.
The point-of-care high-throughput access to genetic testing has been a boon for patients and providers. For patients with a positive result, the information can shape their treatment and eligibility for clinical trials. The model also allows genetic counselors to focus their time on those individuals who test positive and those who have further questions, an important consideration in light of the limited genetics workforce.
“Bottom line, more patients are getting medically indicated testing,” said Dr. Karlan, a gynecologic oncologist. “And more physicians are now able to use that information to prescribe effective targeted treatments.”
The genetic testing results also inform patients’ family members about their own cancer risks so they can be proactive in their own cancer screening and prevention. For now, GENETECA™ is only available to people with cancer, but their family members can also seek genetic counseling and testing at UCLA Health through the standard process.
Expanding access for patients and physicians
A 2023 study published in the Journal of the American Medical Association found that only 6.8% of more than 1 million cancer patients underwent genetic testing within two years of diagnosis. The rates were especially low among Asian, Black and Latino patients.
At UCLA Health, only 22% of patients with pancreatic cancer were undergoing recommended genetic testing when they had to use the traditional model of having an in-person appointment with a genetic counselor. Getting a timely appointment, taking time off work, driving to a medical center and paying a parking fee were all potential barriers, especially for cancer patients on active treatment.
Within 18 months of launching GENETECA™ in late 2020, the figure jumped to 94%, Dr. Karlan said.
“That’s more patients who find out that they have a BRCA mutation and can get a PARP inhibitor, or a Lynch syndrome gene mutation and can get immunotherapy,” Dr. Karlan said. “It’s really opened up access and provided physicians with important information for patients and their families.”
UCLA Health sees approximately 17,000 new cancer patients a year, with roughly two-thirds of them meeting current criteria for genetic testing based on National Comprehensive Cancer Network (NCCN) Guidelines, said Dr. Karlan, who serves as the NCCN Guidelines Steering Committee chair.
Patients referred for testing use the MyChart portal to access GENETECA™ from a doctor’s office or at home where family members can participate too. They watch a short, animated video, available in multiple languages, that explains genetic testing in simple, clear terms. They can then give consent and go to the lab without delay or have a saliva test kit sent to their home.
If people have additional questions before deciding to get tested, they can still meet with a genetic counselor. But most patients prefer the expedited process, Dr. Karlan said.
GENETECA™ allows genetic counselors to primarily meet with the people who test positive, which is only 5%-10% of the cancer patients, and they can focus their efforts on assuring the health implications of the testing results are understood
“This way, the genetic counselors can focus their time and use health system resources to have the greatest impact on improving patient outcomes,” she said.
Dr. Karlan said UCLA Health computer engineers are working to expand GENETECA™ to include an interactive virtual assistant that can answer questions and offer the most current scientific data to patients in real time.
“Large language models and AI can really ‘learn’ newly published data and incorporate new guidelines more quickly,” she said.
Power of personalized medicine
Dr. Karlan, who is also professor and vice chair of Obstetrics and Gynecology at the David Geffen School of Medicine at UCLA, said targeted therapies have already significantly improved outcomes in ovarian, fallopian tube and uterine cancers with hereditary components.
“Personalized medicine is the right drug for the right patient at the right time,” she said. “Genetic testing empowers patients to get the best medicine and make the best choices to improve their lives.”
For instance, nearly a quarter of ovarian cancer patients have a genetic predisposition and qualify for a PARP inhibitor.
“PARP inhibitors have improved overall survival for individuals with a BRCA mutation who take it as maintenance therapy after completing their standard surgery and chemotherapy,” Dr. Karlan said.
For uterine cancers, Lynch syndrome and other genes typically make tumors more susceptible to immunotherapy that has improved outcomes and longer-term survival for those patients as well, she said.
In addition to shaping treatment, GENETECA™ can allow patients to qualify for clinical trials of new targeted therapies.
“Our goal is to use GENETECA™ as a model to marry emerging technology with this very human piece of personalized medicine to allow broader access and better outcomes,” Dr. Karlan said.
