Patients with elevated cancer risks are often unidentified within healthcare systems for a variety of reasons, including fragmented workflows and limited access to cancer risk assessment tools.
Danielle Rogers recently shared her experience with providing personalized assessments of cancer risks before and after implementation of the Ambry CARE Program® (CARE). Danielle currently serves as an oncology and genetics nurse practitioner and as a genetic counseling resource for patients from a variety of clinics in Florida. She is often referred patients from clinical settings including primary care, OB/GYN, and breast imaging. She is passionate about oncology care and has previously practiced in medical, surgical, and radiation oncology settings.
Here are the main takeaways from my interview with Danielle.
Why High-Risk Identification Matters
Patients can have increased cancer risks for a variety of reasons, including personal health and lifestyle, family history, and genetic predisposition. Identifying patients who are at high risk for developing certain types of cancer can help providers guide screening to help identify cancer at earlier stages that may be easier to treat. In some cases, steps can be taken to prevent cancer from ever developing. Identifying high-risk patients may also extend to identifying family members who could also benefit from personalized management.
CARE collects and analyzes medical and family history information to determine if someone meets national guidelines for hereditary cancer testing. It also calculates a Tyrer-Cuzick, or TC score, for women without a history of breast cancer. This score is an estimate of someone’s lifetime risk to develop breast cancer.
“Identifying a genetic mutation in a patient gives them the opportunity to better understand their risk and empowers them with the choices to help reduce that risk or even prevent those cancers. With elevated TC scores, we can also complement patient care with increased breast screening even if they had negative genetic testing. And these are all risks that likely had not been realized by the patient before.”
Impact Before and after CARE
Danielle shared how workflow improvements through digital history collection and risk assessment improved clinical quality and patient-provider interactions. Streamlining this process has also helped them reach more patients.
“Before the implementation of CARE, everything was manual and time-consuming. CARE allows patients to answer risk assessment questions ahead of time and notifies the provider when a patient may be high-risk. If you’re tied up in the first half of the patient’s appointment asking about personal and family history, there is less time to answer their questions about genetic testing and what it means to be high-risk. With CARE, we have streamlined the process, and we can reach a larger number of patients. It has helped cast our net a little bit further, identify even more high-risk patients and families. This helped us transition to a more proactive approach in which cancer may be prevented or detected at earlier stages.”
From Hesitation to Routine Practice
Danielle was transparent that it is normal to have some hesitation when implementing a new program within already established workflows. When she pitched the idea of bringing CARE to her healthcare system, some of her colleagues felt unsure about what CARE entails, how it could benefit their patients, and how it may disrupt existing workflows.
“I think the hesitancy came from the lack of understanding of what the program was going to look like. Once we started, the team saw that the new workflow clicked organically. People got more and more comfortable having conversations with patients about CARE and how it can inform cancer risks and management. They got more comfortable with using CARE’s technology. And the Ambry team is extremely supportive to the staff in making sure things run seamlessly.”
Danielle’s advice for clinicians who are interested in implementing a smarter workflow for high-risk screening? “Be open to being uncomfortable as is natural with any changes. We only grow with pressure. If we stay the same, we will never get any further than we are today. We have to be willing to adopt new ideas that will benefit patients and their family members.”
Final Thoughts: Protecting Families and Shaping the Future
Danielles sees that the work her team is doing has generational impacts.
“We are proud of our high-risk program in our clinic because we are saving lives. And it goes beyond singular patients to their families. Families are important—they are our future. We’re protecting our future and empowering these individuals to make informed choices and giving them the opportunity to live full and thriving lives.”
