Avoiding long waits in the public system

Some public familial cancer clinics continue to have long waiting lists, particularly if patients are considered non-urgent.

This document was written at the request of some of our rural GP’s, after they were informed that waiting times for their patients to be seen at a regional centre would be 6 to 12 months. They wanted more doctors and patients to be aware that a high quality alternative was available.

We’ve reproduced the document below. You can also download a copy here to print or to email to colleagues, patients or friends.

Dear General Practitioner,

Sydney Cancer Genetics has been providing bulk billed telehealth consults throughout rural and regional Australia since 2013. As the cost of the actual genetic test continues to fall, we thought it was timely to provide you with a review of our services.

Telehealth is a truly local service. We see patients where they live, either at your practice or even in their homes. This allows more family members to attend and avoids lengthy travel times to regional hospitals. It also allows you, your students and/or your staff to attend. As a result, the whole community benefits.

We are happy to see your patients at your practice (eg via Skype) without a staff member being present. However if you do have the time, you can claim for the consult, either for your time (5 mins = $22.90 or if you stay for 40 mins, $142.50) or the time your practice nurse or nurse practitioner spends assisting your patient.

If you are new to telehealth, Dr Hilda High recently gave an entertaining and informative presentation at the RACP workshop on Telehealth. The link (http://www.sydneycancergenetics.com.au/for-drs/) is available on our FAQ page as well as a link to the MBS item numbers for GPs (“Patient-End”).

Our website has a list of who “should” be seen by a cancer genetics service but we are also happy to review those individuals or families who don’t fit neatly into a high risk category. We believe that providing accurate screening advice is important. Moreover, reassuring low risk patients and encouraging them to follow population based screening advice can save precious community resources.

At Sydney Cancer Genetics all patients are seen by an experienced, skilled consultant – every time. Following a consult, you and your patient received a detailed letter (with a brief summary at the top!) outlining the family history, what was discussed at the consult, the likelihood of an inherited genetic mutation and risk management strategies for the patient and their family.

The cost of genetic testing has become considerably cheaper as technology has improved. As a guide, high quality Australian laboratories such as The Peter MacCallum Cancer Centre now charge under $500 for a BRCA1 and BRCA2 mutation search. For financially disadvantaged patients, Pink Hope, with support from the charity Barbells for Boobs, provides a subsidised 30 gene panel for $200. There is even an MBS item number providing fully funded BRCA testing for patients with ovarian cancer that is “high grade, serous, platinum sensitive and recurrent”.

Still, some genetic testing remains expensive. This is mainly due to complexities associated with the gene in question. In these circumstances, or when $200 is still too much, the patient can be referred to the nearest public familial cancer clinic. Although there may be a wait list (6 to 12 months is commonly quoted), the patient will already have an interim risk management strategy in place and most of their work up will have been done.

Understanding the implications and limitations of the different types of genetic testing and interpreting the unexpected or uncertain results is where our specialist knowledge comes to the fore. Genetic testing has changed over the years. It used to be performed almost exclusively to detect a germline (inherited) mutation. This testing was done slowly gene by gene. Now, multiple genes may be screened at the same time, using panels containing 3, 30 or even 300 hundred genes. Somatic (tumour) testing is another new technique. It can help to identify targeted treatments for affected patients. And, as a tumour block is stored for 7 to 10 years by law, genetic testing can even be performed when a patient is deceased where such testing would provide important genetic information for at-risk relatives. Informed consent is always obtained before any genetic testing is organised and all costs clearly explained.

Sydney Cancer Genetics does not make any money or obtain commissions from genetic testing. Payment is made to the laboratory directly, usually by credit card. Blood or saliva can be collected locally, regardless of which laboratory undertakes the testing. Results are usually available in under 8 weeks. We can organise a rapid turnaround of less than 3 weeks when clinically needed.

Sydney Cancer Genetics always gives genetic results in person, via a follow up Telehealth consult. This avoids any confusion over what the result itself or what the result means for your patient and their family. At this consult, screening and other risk management advice is fine-tuned. If a mutation is detected, we facilitate the assessment and testing of at-risk blood relatives, regardless of where they live.

Our wait times are minimal, with almost all patients seen within 3 week of referral (sometimes urgent referrals can be seen on the same day!). As a private service we are flexible and able to expand our services to suit demand. Also, we don’t do any lengthy behind-the-scenes reviews. We prefer to meet the patient first and then secure the necessary permissions to acquire relevant document such as pathology reports and death certificates.

Referring your patients to Sydney Cancer Genetics is simple. We have one, centralised contact:
phone: 02 8964 9977
fax: 02 8095 9421
email: info@SydneyCanceGenetics.com.au
postal address: Sydney Cancer Genetics, PO Box 845, Broadway, NSW, 2007.

Please address your referral to Dr Hilda High, provide a contact number for your patient and provide any cancer related pathology reports if available. For more information on who or how to refer, see http://www.sydneycancergenetics.com.au/for-drs/. Please note: we only see patient for cancer genetics issues. For general clinical genetics, please use the link to the Human Genetics Society of Australasia on our website.

Our motto is Hereditary Health and Hope. We look forward to supporting you, your patients and your community.

Dr Hilda High
Genetic Oncologist, Head, Sydney Cancer Genetics.

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