Clinical Connection - Winter 2022

Genetic Risk Assessment Program

Community Hospital of the Monterey Peninsula created the Genetic Risk Assessment Program to help fill a community need for screening, detecting, diagnosing, and treating individuals who have a high risk of developing a disease, such as cancer.

The goal of this program is to educate and empower patients, providers, and the community to understand and reduce the risk for developing disease.

RED FLAGS FOR HEREDITARY CANCER RISK

y Personal or family history of cancer diagnosed before age 50

y Personal or family history of two primary breast cancers (bilateral or ipsilateral)

y Personal or family history of ovarian cancer, regardless of age

y Personal history of Triple Negative Breast Cancer (TNBC)

y More than one primary cancer diagnosed in an individual

y Rare cancers, such as fallopian tube and male breast cancers

y More than one childhood cancer, such as sarcoma or leukemia

y Gene mutation identified in a family member

y Multiple cancers in an individual, or on one side of the family, that suggest a hereditary syndrome:

» Example: Breast, ovarian, pancreatic, and prostate — hereditary breast and ovarian cancer syndrome (HBOC)

» Example: Ovarian, colon, endometrial, pancreatic, and gastric — hereditary non-polyposis colorectal cancer (HNPCC) or Lynch syndrome

Community Hospital of the Monterey Peninsula Montage Health

HOW TO REFER TO THE GENETIC RISK ASSESSMENT PROGRAM

Providers with access to Epic can make a referral there.

Providers without access to Epic will need to fax a paper referral with:

1. Test results, if available

2. Clinical notes

3. Demographic sheet

Fax referral to (831) 622-2771, along with pertinent notes and previous testing results, if any.

Once the referral is received, our staff will reach out to the patient to schedule an appointment.

DOES INSURANCE COVER THE VISIT?

A visit with our genetics nurse practitioner is generally covered as an office visit and the co-pay will apply if indicated.

The majority of private insurances will cover the cost of testing as long as the patient meets societal guidelines. Generally, we use National Comprehensive Cancer Network (NCCN) guidelines. However, there are other guidelines that we use, as needed, to get coverage for

patient testing.

Some patients can choose to not use insurance and pay an out-of-pocket expense of no more than $250.

WHAT HAPPENS DURING THE VISIT

Once an appointment is scheduled, our office staff provides a link to a questionnaire that the patient is required to fill out prior to their appointment. The questionnaire includes personal and family history of cancers.

During the appointment, the nurse practitioner will review the questionnaire with the patient and make adjustments or changes, as needed.

They will discuss the patient’s risk of developing cancer based on personal and family history. Those that do not meet the criteria for testing may still benefit from additional screenings (i.e. an MRI, in addition to an annual screening mammogram) or more frequent screenings (i.e. more frequent colonoscopies than every 10 years).

For those individuals that meet criteria for testing, a discussion around the risks, benefits, and limitations of genetic testing will occur. If the patient

consents, a blood or saliva specimen is collected and sent to the laboratory. Most results are available within 3–4 weeks. Our staff will schedule a followup appointment to review the results.

NEW SCREENING AT CAROL HATTON BREAST CARE CENTER

When patients schedule an annual screening mammogram, they are now sent a screening questionnaire to complete prior to their appointment. For those that do not complete the questionnaire at home, they have the opportunity to complete it at their mammogram appointment using a supplied tablet.

Patients that are at an elevated risk and meet criteria for genetic counseling and testing are given a brochure about the program. Our staff is also given a list of these patients and will contact them within 24–48 hours to assist in making an appointment.

Identifying patients for cochlear implantation

WHO CAN USE COCHLEAR IMPLANTS?

Cochlear implants are now available to a wide range of patients. Initially only for those with severe to profound hearing loss, continued innovations in the device and surgical techniques have made cochlear implants an excellent option for hearing rehabilitation. Cochlear implants are unique in their ability to restore the sounds of speech and everyday life to those who have hearing loss. Many with age-related hearing loss lose hearing clarity, along with hearing sensitivity, making speech and conversation difficult even with hearing aids. Medicare recently has expanded coverage for cochlear implants to include those with moderate hearing loss. The Food and Drug Administration (FDA) also has included single-sided deafness as an approved indication for implantation. Together, cochlear implantation is becoming the standard of care for those who cannot access the sounds of speech.

HOW DO COCHLEAR IMPLANTS WORK?

A cochlear implant (CI) differs from hearing aids in the way sound is delivered. Rather than transmitting sound acoustically, a CI uses the cochlea’s sound-location map to process and deliver sounds electronically to the hearing nerve and the brain. A CI has two components: one internal and one external. The external portion houses the microphone, processor, and battery. The internal component is placed under the skin during an outpatient surgery by an otolaryngologist/ ENT, which is now available for patients at Community Hospital of the Monterey Peninsula. After the healing process, the device is activated, and patients begin their aural rehabilitation. Current research has shown that, while those with long standing hearing loss will benefit from implantation, the rehabilitation is often easier in those with recent or progressive loss.

PATIENT EVALUATION

Patients are best evaluated by a specialized audiologist who can determine if the hearing loss is amenable to implantation. Under Medicare guidelines, patients with a range of moderate to profound hearing loss may be eligible. As a comparison, hearing aids are available to those with moderate hearing loss but are not covered by Medicare. For patients with progressive hearing loss or in those who are not receiving benefit from hearing aids, an audiogram to determine CI candidacy is indicated. These patients can now be referred locally without needing to travel.

View Clinical Connection online: montagehealth.org/ clinicalconnection

Community Hospital of the Monterey Peninsula Montage Health