Purpose: The New Mexico Veterans Affairs Health Care System (NMVAHCS) is striving to improve personalized cancer care and prevention through early identification of hereditary cancer syndromes. Detection of genetic syndromes remains vital for the implementation of precise therapeutic options and prevention measures offering improved veteran-centered care.
Background: Numerous genomic discoveries have provided personalized therapeutic options for improving clinical management of hereditary disease. However, the NMVAHCS lacks professionally trained genetic counselors to appropriately assess and address genetic testing. Primary care physicians lack specialized knowledge regarding appropriate use, application of genetic architectures, and an understanding of result interpretation. This lack of knowledge leaves providers reluctant to apply genomics in clinical practice or utilize testing on inappropriate patients, which remains costly and increases risk for litigation.
Methods: Increasing NMVAHCS access to appropriate genetic counseling involved initiating telehealth consults through the Veteran Affairs Genomic Medicine Service (VAGMS) in Salt Lake, Utah. After seeking stakeholder input and addressing availability of telehealth equipment, VAGMS was contacted. Telehealth service agreements, memorandum of understanding, and information security was obtained to allow offsite access into veterans’ charts. Clinics and consults were built into the computerized patient record system (CPRS), and staff training occurred to learn the intricacies of coordinating virtual appointments and awareness of available service. Initially, consults were limited for breast cancer risk evaluation (BRCA1 and BRCA2 mutations), to establish process flow, before opening all genetic counseling consults.
Results: Five appropriately identified veterans received breast cancer risk consults within the first week with fee-based cost savings of over $25,000. Counseling empowered veterans and families with information providing personalized therapeutic options and improving satisfaction and overall outcomes. Although the cost of breast-conserving surgery vs mastectomy remains relatively equal, prophylactic therapies reduce overall associated costs and the psychosocial distress of treating breast cancer, which is estimated to be well over $100,000.
Implications: Increasing access to genetic counseling and testing through partnering with a proven VA genetic program provides veterans with personalized, proactive therapeutic options. The role of genetics will continue to evolve and require collaboration to insure optimal application of precision care for prevention and management of veterans and family members at risk for disease.
