Learning about the influence of genetic and genomic factors on health and disease is resulting in earlier diagnosis, more effective and individualized prevention and treatment of disease, better response to treatments, and improved health. In their article, Lea and Calzone highlight many aspects and applications of genomics in cancer screening and management. Nurses are increasingly being called upon to apply genetic- and genomic-based approaches and technologies in client care. The significant impact of genomics on oncology care has arrived.
Implementation of genomics in oncology care potentially impacts a much larger segment of the oncology patient population, and on many different levels. The authors provide several excellent examples of how genomics is influencing cancer screening, especially in the area of colorectal cancer. Undoubtedly, in the future genomics-based screening will be utilized to manage other cancer types as well.
Genomics frequently guides cancer treatment decisions. It is no longer considered investigational. For example, the NCCN (National Comprehensive Cancer Network) Guidelines for the Treatment of Breast Cancer discuss the role of microarray analysis in decisions related to whether or not offer adjuvant therapy to selected women with breast cancer, based on the risk profile from microarray analyses such as Oncotype DX, a decision-making tool discussed by Lea and Calzone in their article.
Oncology nurses also need to rethink how genomics affects care. An emerging example includes the drug tamoxifen(Drug information on tamoxifen). Oncology nurses have administered this drug for treatment and more recently for prevention, and have provided tamoxifen-related patient education to breast cancer patients for decades. Genomics may be rapidly changing how this medication is utilized, and which patients are selected to receive tamoxifen as treatment. Data are emerging about the influence of the major cytochrome P450 2D6 (CYP2D6) genotypes and CYP2D6 inhibitors on tamoxifen metabolism and effectiveness. Although routine testing for CYP2D6 is not yet justified by the current evidence, research continues. In the future it will be possible to test for a panel of genes that promote or inhibit drug metabolism and determine, based on specific genetic mutations, whether a patient is likely to benefit from a given drug.