Genomics

The East of England Regional Genomic Clinical Practitioner Service

An Introduction to the service

Comprehensive genomic sequencing offers patients with cancer the ability to receive a more precise diagnosis at the start of their treatment pathway. This can provide prognostic information, guide faster access to precision treatments or surgical intervention based on the complete genomic profile of the cancer together with other diagnostic information, avoid drug toxicities and enable access to molecularly stratified clinical trials. Equally important, it may also identify at risk family members who may be eligible for risk stratification and cancer prevention strategies.

Over the next ten years, the NHS plans to routinely offer genomic testing to all people with cancer for whom it would be of clinical benefit, and it is expected that most future cancer therapies will be targeted to tumours based on specific genomic and other biomarkers.

Pathways will need to be redesigned to enable, for example the collection of biopsies for cancer genomics early in the diagnosis pathway to ensure the timely return of genomic test results to inform clinical care and decision making.

Furthermore, genomics will be routinely used in the ‘healthy population’ to accurately predict the risk of cancer within national screening programmes for at-risk populations.

Adoption of genomics into cancer care needs a clinical workforce with understanding of how and where genomic testing fits into current clinical pathways and how to use it.

Not all healthcare professionals need to become genomic experts, but the workforce will need sufficient, up-to-date knowledge of genomics within their speciality to ensure equity of care for patients on cancer pathways.

The East of England Cancer Alliance has used National Targeted Funding to develop a novel service that will not only support the sustainability and roll out of mainstreaming for patients diagnosed with Lynch Syndrome but embrace the wider programme of work that is changing how we diagnose, treat and monitor patients with cancer.

Placing a team of Genomic Clinical Practitioners that work across the East of England Cancer Alliances geography will be key to delivering the genomics agenda and their role will include the embedding of pathways, supporting clinical teams and providing timely information and guidance to enable a seamless service user pathway across cancer specialties.

The Genomic Clinical Practitioners will be aligned to the East Genomic Medicine Service Alliance (GMSA), the Genomic Laboratory Hub (GLH) and the East of England Medical Genetics Service and will facilitate, support and engage with primary and secondary care colleagues to develop pathways and embed genomic testing and/or advice for all service users in cancer care.

The role of this service will include, but not be limited to:

• Supporting colleagues in cancer teams in relation to the management of service users that might be affected by inherited cancers and facilitate genomic testing and referral to clinical genetics if required.
• Supporting clinical teams in the care of service users with less complex needs through the provision of expert advice by phone, video link or e-mail, directly supporting hospital specialties until genomic-informed care is consistent, pathways are embedded, and the delivery of services can be managed effectively through mainstream hospital specialities.
• Standardisation in consent processes, increasing consistency and familiarity for clinicians and patients.
• Supporting programmes of work that look to address health inequalities and understanding of the importance of genetic testing in populations we know to have health disparities.
• Providing a mechanism for communications between the GMSA, GLH, Regional Clinical Genetics Services and providers in secondary & primary care
• Support workforce development and engagement with genomics through training, education, and new standards of care.
• Supporting audit and data collection where it provides evidence of service improvement.