Counselling For Change In Customised Clinical Care

Prevention is better than cure. That may be a commonly heard refrain and one that seems to embody the very concept of genetic counselling: using genetic tests to screen an individual’s genetic makeup for health risks. But genetic counselling encompasses far more than just prevention. Genetic counsellors can also use genetic information to determine the best treatment options for highly variable diseases like cancer while providing much-needed support for patients, something that has been practised at Tan Tock Seng Hospital (TTSH) since December 2017.

TTSH’s genetic counselling service first began with a focus on supporting medical oncology, seeking to empower cancer patients and at-risk individuals to make more informed choices. This service expanded to a full-fledged Cancer Genetics and Genomics Clinic in January 2020 but delayed its official launch to 22 October 2021 due to the COVID-19 pandemic.

The new Cancer Genetics and Genomics Clinic is situated in the Clinic 1C space in Tan Tock Seng Hospital.

From Diagnostics to Treatment

At the inaugural Hereditary Cancer Symposium commemorating the clinic’s official opening, leading scientists and physicians highlighted that the complex nature of cancer requires a holistic, detailed approach to improve prevention, early detection and treatment. After all, how rapidly a tumour grows and spreads is influenced by a myriad of factors, from DNA mutations to external risks like pollution exposure. Besides biological and environmental factors, some tumours may be more or less vulnerable to certain drugs than others.

Given this variability even amongst patients of the same cancer type, analysing relevant patient data is key to drawing the links between the array of tumour drivers and treatment effectiveness. A precision medicine (PM) approach that curates genetics, medical history, behavioral and environmental information can therefore guide clinical decision-making to tailor interventions amid such complexity. “This information enables doctors and healthcare professionals to better predict patients’ disease risks and improve accuracy in diagnosis and prescribing treatment,” explained Adjunct Associate Professor Chong Yew Lam of TTSH in his introduction to the symposium.

Enabling through Counselling

From disease prevention to remission, clinical genetics services such as genetic counselling are emerging as a critical pillar for ushering in the era of PM. But while genetic testing gathers valuable genetic information for PM efforts, such initiatives also depend on another crucial aspect: genetic counselling.

Whether to accelerate research or transition to clinical implementation, the promise of PM can only be fulfilled by mapping thousands upon thousands of individuals’ genetic information. Because of the inherently sensitive nature of this massive undertaking, initiatives like genetic counselling that provide specialized information to individuals are an instrumental facet of PM adoption.

By helping individuals understand the risks and potential benefits of using genetics for clinical management, these counselling services can overcome barriers like stigma and lack of awareness, ideally leading to the increased uptake of genetic screening.

After testing, genetic counselling also plays an important role in supporting patients as they seek to make sense of their results. Equipped with relevant knowledge about their genetic data and clinical histories, individuals can take better steps towards prevention, such as changing lifestyle habits. The information provided by counselling can also help patients feel empowered in living with their conditions and corresponding treatments.

“This service has improved treatment options for patients and has enabled early cancer detection through appropriate cancer screening,” shared Adjunct Assistant Professor Jens Samol, Senior Consultant in Medical Oncology.

Adjunct Assistant Professor Samol, who has headed the Cancer Genetics and Genomics Clinic since its inception in December 2017, added that genetic counselling aims to fulfill TTSH’s vision of adding years of healthy life.

A Future of Precision Healthcare

For Singapore’s ageing population, deploying genetic testing and PM on a national scale could be a turning point for tackling chronic diseases. Moreover, the lack of Singapore-specific or even Asia-specific data on genetic drivers and disease outcomes are a significant knowledge gap that the National Precision Medicine (NPM) programme aims to bridge. “There is an opportunity to use genetic information for interception of disease early on,” said Professor Patrick Tan, Executive Director of NPM. “By integrating data and identifying triggers that will manifest disease early, we can keep people healthier for longer.”

For PM to advance from bench to bedside, Professor Tan emphasised that concerted efforts are needed to identify persisting barriers and address unmet needs. Researchers and clinicians are meticulously refining the model for implementing such services, carefully evaluating the risks and benefits as well as devising strategies to bolster the workforce with capabilities like genetic counselling training.

“At a societal level, precision medicine will allow early intervention, thereby reducing the incidence of late-stage cancers and improving overall population health,” concluded Adjunct Associate Professor Leong Khai Pang, Head of TTSH’s Personalised Medicine Service. By reinforcing the value of data-driven clinical management and making these solutions more accessible, services like TTSH’s Cancer Genetics and Genomics Clinic are laying the groundwork to embed PM in the healthcare system for the benefit of all.