EONS 2012

Communication in genetics and genomics

Anne-Elizabeth Murphy – Hôpitaux Universitaires de Genève, Switzerland

Now we’re all what our genes make us, we all have a genome and we have lots of genes that give us different characteristics. Nurses have an awful lot to keep up with these days, don’t they, because these genes affect the molecular basis of disease and specifically we’re talking here in Geneva at this conference about cancer. What is the size of the challenge to nurses in understanding this genome, which is a whole person, and the genetics, the individual parts of the genome?

It’s quite a big challenge because it’s really like going back to school to molecular biology to understand the changes and the basis of this information. Young nurses are quite able to understand because they’ve been studying this at school but older nurses have to go back to biology to understand. But the most important message is that cancer is always a genetic disease.

And why do nurses need to have a firm grasp on this? If they’re handling the treatment can they not simply use the treatments?

Because most treatment will be now tailored to the genome of one person and this is the important point. Because the new discovery allows treatment to be targeted therapies, really, it’s not just killing the cancer, it’s trying to see which type of cancer, which genomic reaction is affecting this person and the treatment will be tailored to this modification.

Now you said that younger nurses may well already have a firm grip on this, older nurses maybe not. Is it as simple as that or what is the size of the challenge facing you in bringing nurses up to speed on all of this new knowledge?

It’s quite difficult because it’s very much an evolving field. For example in two or three the genome was totally sequenced and now we have total sequence of the exome, which is part of the genome. So it has been going so fast and now nearly everyone can just send a DNA sample and have a big amount of information about the risk of developing certain diseases like diabetes or Alzheimer’s. All this information, people have to deal with it really. And nurses also with the treatment, they’re really implicated in giving certain types of treatment with not the usual reaction they had to face before because chemotherapy it was nausea, vomiting, a certain kind of reaction. The reactions with the new molecular therapies are quite different now.

And of course nurses need to know that some molecular therapies will simply not work on the wrong patient.

Yes, exactly.

So that needs to be borne clearly in mind, which could help with informing the patients too.

Of course, because some patients… a lady will ask, “I’d like to have Herceptin,” and you have to explain to her that no, she will not benefit from Herceptin because she’s not HER2 positive, she hasn’t got the gene modification. But perhaps this lady thinks, “I want this treatment.” So you will have to be able to explain why she will not receive this treatment.

And of course this has all happened in the last ten years or so, targeted therapy?

Yes.

What measures are you putting in place, or would you like to put in place, to get nurses fully informed so that they can benefit their own patients?

It’s education really.

And how?

In the basic curriculum of nurses and also the postgraduate curriculum. A group of specialists in genetics has set up a core of competencies, really to push every country to put into the basic curriculum and also the postgraduate curriculum certain information about genetics and how it affects the individual and also the family. For example, being aware if someone is telling you about his father who died at a very young age from colon cancer, be aware this could be a hereditary syndrome.

And continuing education, of course, is very important because there is so much happening it changes almost every week.

A very good source is media, really – reading newspapers because a lot of information comes through newspapers.

So do you have any ways of introducing nurses to automatically continuing their education just out of sheer interest?

It varies a lot from country to country. Here in Geneva we have postgraduate teaching for nurses in cancer care; in other parts of Switzerland it’s the same. In other countries it’s not the same, it’s so different from one place to another, it’s difficult. But the aim would be really to give information all the time.

And the benefit, the harvest of this improved knowledge and communication with the patients and with the nurses about these factors, one benefit is treatment but also I think you’ve been discussing here at the conference in Geneva that things like prevention and early diagnosis can be improved if you actually understand the mechanisms at work.

Yes, for example, I’m working in genetic predisposition to cancer, if someone knows that he or she is at risk of developing cancer, of course this person will take preventive measures, will make early detection, early screening and will hopefully avoid developing cancer. But also there is a lot to do with basic prevention – smoking cessation, avoiding sunshine, food, there is a lot to do also in this field. Also there perhaps will be developed one day what we call chemoprevention which is a new concept, taking some medication to avoid developing certain types of cancer. There are a few studies around with colorectal cancer, aspirin for colorectal cancer, Tamoxifen for breast cancer, for example. People who haven’t developed cancer could take this medication in order to avoid developing cancer.

So what is the message for nurses of the world who are looking after cancer patients?

Keep informed about what’s going on.

Especially in genes.

Especially if a doctor asks you to give a treatment, try really to discuss with the doctor and with the team to ask what’s going on, why are you giving this treatment to this patient? What can be the effect for the patient? Really be aware of the new treatments.

Thank you very much.