One of the many reasons that I love my role as a nurse practitioner in the Hereditary Cancer Clinic is that it encompasses so many aspects of both the art and science of nursing. When I meet with a patient, I review their family history, using at least a three generation pedigree, assessing for the ‘red flags’ that would indicate a hereditary cancer syndrome (e.g. young age at cancer diagnosis). My role also involves explaining age-adjusted cancer risks over a lifetime, and going over screening and risk reducing measures such as prophylactic surgery and chemoprevention. In this advanced practice role, I also manage surveillance for ‘high risk’ patients.
It is stressful for patients to face the possibility that they may have a syndrome that increases their likelihood of getting another cancer (for survivors), or a much higher likelihood of a cancer in their lifetime (for previvors). Part of my role is to explain inheritance patterns. The fear of passing on a mutation to their children is usually particularly painful.
I enjoy the challenge of making difficult genetic concepts understandable, while at the same time being an empathetic provider. I may spend up to 2 hours with a new patient which allows ample time to build good rapport. I offer genetic testing, when appropriate, and interpret the results. A key concept to explain to patients is that a ‘negative’ test doesn’t necessarily mean there isn’t a genetic predisposition to cancer in the family. They may have a gene mutation but it was not detectable with today’s technology, or there could be a mutation in a different gene.
Cancer genetic testing has changed dramatically in the past couple of years. Instead of testing for one or two genes, we often test over twenty genes at the same time. This has changed the way we counsel patients. In addition to high-risk cancer genes like BRCA1/2, we now test for moderate risk and newly discovered genes. This has created new challenges as national screening guidelines for many syndromes and lifetime risks for newly discovered genes are lacking. Ethical challenges come in many forms, including the “duty to recontact” when a genetic test result is reclassified from a ‘variant of unknown clinical significance’ to a ‘pathogenic mutation’ which often occurs many months or years after initial genetic test results were given.
I am originally from the United Kingdom. After going to graduate school for cancer genetics in London, I returned to school for another master’s degree to become a NP to continue my career in genetics in the states. It’s been a long, but very worthwhile journey. There are few NPs practicing in this field, where others are trained as genetic counselors or physicians. In order to give back, and to interest other NPs in the practice of genetics, I am honored to be serving as vice chair on the American Nurses Credentialing Center’s (ANCC) ‘content expert panel’ that is developing the Advanced Genetics Nursing certification. This will be offered for the first time by the ANCC in 2015.
Although I miss my family who remains in the UK, I don’t miss the rain and traveling to work on the underground. I enjoy spending time with Nashville friends, meeting new people, cooking and creating custom cards in my spare time.