Genomics and Precision Oncology Learning Library

Next Generation Sequencing Discussion Tool
Biomarker testing through NGS technology has driven precision oncology by delivering faster, cheaper, and more accurate biomarker data. Results from NGS testing can help to diagnose cancer, personalize treatment, determine prognosis, or evaluate hereditary cancer risk. This nurse-patient discussion tool reviews common questions and answers to educate a patient about the biomarker testing process and what the results could mean for their treatment.
_{This resource was produced by ONS and sponsored by Foundation Medicine.}

Understanding Genetic Variants Discussion Tool
Nurses support patients through the biomarker testing process and describe possible outcomes that might come from testing. Nurses also translate findings to patients. Use this discussion tool to explain different types of variants identified by biomarker testing using easy-to-understand baking analogies. Analogies are helpful tools to educate patients about complex topics. Also, available for download is the facilitator guide to help when presenting this information in a group setting.
_{This resource was developed by ONS through a sponsorship from AstraZeneca.}

Patient Video: Genetic Counseling and You
This patient facing video resource helps prepare patients for visits with a genetics professional by explaining what to expect and what to bring to their appointment.
_{This resource was developed by ONS through a sponsorship from AstraZeneca.}

How do I talk to patients about genomics?
This video is part of the Genomic "Glad You Asked" Video Series.
_{This resource was developed by ONS through a sponsorship from AstraZeneca.}

Is My Cancer Hereditary? Discussion Tool
Utilize this tool to discuss hereditary cancer risk with a patient. It provides a list of hereditary risk red flags and helps in educating the patient on why they may need to be referred to a genetics professional.
_{This resource was developed by ONS through a sponsorship from AstraZeneca.}

Biomarker Testing in Non-Small Cell Lung Cancer Discussion Tool
Explaining the complex biomarker testing process to your patients can be made simple by utilizing the Biomarker Testing in Non-Small Cell Lung Cancer Discussion Tool to guide this conversation with your patients. It provides patient friendly language to describe biomarker testing and the why, when, and how of the process. It gives the patient space to write notes and capture their cancer’s biomarkers.  Also, available for download is the facilitator guide which describes two models you may use when reviewing the discussion tool with a group of nurses.
_{This resource was developed by ONS through a sponsorship from Amgen.}

Clinical practice resources support the integration of the latest evidence into practice and assist in the translation of this information to patients and families.

Genomics Case Study: Precision Medicine in the Setting of Metastatic Non-Small Cell Lung Cancer
Quickly test your knowledge in this eight-question quiz that follows a patient from workup of metastatic non-small cell lung cancer (NSCLC) with an epidermal growth factor receptor (EGFR) Exon 20 insertion biomarker through multiple therapy lines. 

^{This resource was produced by ONS and is supported by a sponsorship from Janssen Oncology. ONS is solely responsible for the criteria, objectives, content, quality, and scientific integrity of its programs and publications.}

Next-Generation Sequencing Toolkit 
Biomarker testing through next-generation sequencing (NGS) technology has enabled precision oncology to deliver faster, cheaper, and more accurate tumor data. Results from NGS testing can help providers to diagnose cancer, personalize treatment, determine prognosis, or evaluate hereditary cancer risk. Identification of biomarker or driver variants can match patients to approved targeted therapies and clinical trials. This toolkit educates oncology nurses about NGS with a sample report, glossary of terms, and patient education.
_{This resource was produced by ONS and sponsored by Foundation Medicine.}

Next-Generation Sequencing Sample Report
Nurses should understand how NGS test results influence patient care and education. This sample report highlights the sections of the report that affect your oncology nursing practice.
_{This resource was produced by ONS and sponsored by Foundation Medicine.}

Nursing Implications Based on Somatic Biomarker Testing Outcomes 
Somatic biomarker testing reports can be complex, yet nurses need to understand possible outcomes and their implications for practice. This easy-to-read table outlines some of the potential outcomes of somatic biomarker testing, clarifies the meaning of the findings, and relates those to actions nurses can implement.
_{This resource was developed by ONS through a sponsorship from AstraZeneca.}

Somatic Biomarker Test Report Checklist 
Somatic biomarker testing reports can be complex. As a nurse, you will review these reports and identify pertinent content to provide optimal patient care. Use this checklist to get familiar with the reports to ensure you are reviewing the applicable information. The Nursing Implications Based on Somatic Biomarker Testing Outcomes resource can be used to complement the checklist and increase your understanding of test findings.
_{This resource was developed by ONS through a sponsorship from AstraZeneca.}

The Oncology Nurse’s Role in Somatic Biomarker Testing
Nurses play an essential role in supporting the somatic biomarker testing process from specimen collection to providing education on treatment decisions based on the outcomes. This resource outlines the implications for nursing practice and defines the role of the oncology nurse in this process.
_{This resource was developed by ONS through a sponsorship from AstraZeneca.}

Talking to Your Patient About a Germline Variant of Uncertain Significance
A variant of uncertain significance (VUS) detected through germline biomarker testing can be challenging to explain to patients. When a variant is classified as a VUS, there is not enough information available to determine whether it is pathogenic or benign. A VUS is not actionable. Use this FAQ sheet to learn about a VUS, so the next time your patient has questions about this finding, you are prepared to provide guidance. 
_{This resource was developed by ONS through a sponsorship from AstraZeneca.}

Biomarker Testing Nursing Process
Apply the biomarker testing nursing process to your practice to guide the delivery of genomic care to all patients with cancer. The process begins with reviewing biomarker testing results to understand how those results will influence patients’ treatment decisions and nursing care. It provides guidance on both germline and somatic testing processes. Also, available for download is the facilitator guide to help when presenting this information in a group setting.
_{This resource was developed by ONS through a sponsorship from AstraZeneca.}

Paired Somatic and Germline Testing Resource
Paired somatic and germline testing is simultaneous genomic sequencing of a somatic and germline sample from a patient to inform cancer treatment. This emerging testing approach is being seen more frequently in oncology care, so it is important that oncology nurses understand it. This resource answers frequently asked questions about paired somatic and germline testing and reviews the risks, benefits, and limitations of using this type of test.
_{This resource was developed by ONS through a sponsorship from AstraZeneca.}

Biomarker Testing for Genomic Variants: What to Know From the Laboratory Performing the Test
Nurses may need to collect additional information from the laboratory being used for biomarker testing to help educate patients and families and inform nursing practice. Use these already formulated questions to guide your conversation with the laboratory to ensure you have all the information needed to support your practice. 
_{This resource was developed by ONS through a sponsorship from AstraZeneca.} 

Biomarker Testing Quick Guide
Use this clinical practice resource to understand biomarker testing and the difference between germline and somatic variants. This easy-to-use guide includes definitions, implications for testing, indications to test, and outcomes of testing.
_{This resource was developed by ONS through a sponsorship from AstraZeneca.}

When to Refer to a Genetics Professional Quick Guide
Refer to this infographic to recall the red flags of hereditary cancer risk and identify when a patient would be appropriate to refer to a genetics professional. Additional information gathering could lead to more individualized treatment options for the patient and cascade testing for family. 
_{This resource was developed by ONS through a sponsorship from AstraZeneca.}

Genomic Foundations for Precision Oncology
The free Genomic Foundations for Precision Oncology course was designed by genomic nursing experts to supplement nurses’ knowledge of foundational concepts in genomics, including how genomic alterations drive cancer growth and progression and how identification of genomic biomarkers directs targeted therapy decisions.
_{This resource was developed by ONS through a sponsorship from AstraZeneca. ONS is solely responsible for the criteria, objectives, content, quality, and scientific integrity of its programs and publications.}

Biomarker Testing: A Roadmap for Cancer Care Webinar New!
Review the growing role of biomarker testing in personalized cancer care with expert Dr. Danielle Fournier, DNP, APRN, AGPCNP-BC, AOCNP.

Experts Introduce Biomarker Testing: Biomarker Basics
Dr. Friend reviews biomarker basics, which sets an important foundation to understand how biomarkers and biomarker testing informs treatment decisions and oncology nursing care. 
_{This resource was developed by ONS through a sponsorship from AstraZeneca.}

Experts Introduce Biomarker Testing: Germline Testing
Dr. Mahon provides an overview of germline testing and implications for nursing practice. 
_{This resource was developed by ONS through a sponsorship from AstraZeneca.}

Experts Introduce Biomarker Testing: Paired Somatic and Germline Testing
Dr. Calzone provides an overview of the emerging use of paired somatic and germline testing to inform cancer treatment decisions. 
_{This resource was developed by ONS through a sponsorship from AstraZeneca.}

Experts Introduce Biomarker Testing: Liquid Biopsy
Dr. Kelly provides an overview of liquid biopsy and its applications to oncology nursing care. 
_{This resource was developed by ONS through a sponsorship from AstraZeneca.}

Genomics Case Study: Understanding the Essentials to Prepare for Tumor Board
In this interactive case study, you will prepare for a tumor board discussion that will determine whether your patient is a candidate for biomarker testing and eligible for biomarker-directed therapy. 
_{This case study was developed by ONS through a sponsorship from AstraZeneca.}

Do You Know How to Talk to Your Patients About At-Home Genetic Testing?
Engage in the case of a young breast cancer patient of Ashkenazi Jewish descent that completed at-home genetic testing to inform her inherited risk for cancer. Find out what that test told her and the misconceptions many patients have about their at-home genetic testing results.
_{This resource was developed by ONS through a sponsorship from AstraZeneca}

In a recent survey, we asked ONS members what they wanted to know more about as it relates to genomics. In these short videos, members of our Genomics Advisory Board answer those questions and topics that were identified through that survey. 

Genomic "Glad You Asked" Video Series Introduction

What is the correct genomics terminology?

Can pathogenic variants skip a generation?

Where can I find more information about genomics?

Is a variant the same as a mutation?

What happens to my genetic information?

What are key indicators of hereditary risk for cancer?

How do you create a pedigree?

Is there a difference between clinical genetic testing and consumer-focused testing?

What is meant by wild-type?

What is the difference between germline and somatic variants?

What is the role of the KRAS biomarker in NSCLC?
_{This resource was developed by ONS through a sponsorship from Amgen.}

How do I talk to patients about genomics?
_{This resource was developed by ONS through a sponsorship from AstraZeneca.}

How are DNA testing technologies used in cancer care?
_{This resource was developed by ONS through a sponsorship from AstraZeneca.}

What is the purpose of biomarker testing for somatic variants?
_{This resource was developed by ONS through a sponsorship from AstraZeneca.}

What are biomarkers?
_{This resource was developed by ONS through a sponsorship from AstraZeneca.}

Clinical Journal of Oncology Nursing and Oncology Nursing Forum

ONS Voice Articles

ONS Voice has published over 75 articles on the topic of genomics in cancer care. Review the library of articles. Highlighted articles and information:

Learn How to Read a Germline Genomic Testing Report

An Oncology Nurse’s Guide to Cascade Testing

The Case of the Biomarker Database Discoveries

How DNA Sequencing Technologies are Used in Cancer Care Now and In the Future

The Oncology Nurse’s Role in Identifying Patients for Cancer Genetic Counseling

Oncology Nurses Have a Role in Genomics Throughout the Cancer Care Continuum

What is a Genomic Variant?

Understanding Genomic Variants to Confidently Educate Your Patients

Oncology Nurses’ Role in Translating Biomarker Testing Results

Germline and Somatic Variants: What Is the Difference?

Help Patients Understand Genomic Variants of Unknown Significance

Genetic Counselors Help Patients and Oncology Nurses Predict Current and Future Cancer Diagnoses

As True Detectives, Genetics Professionals Uncover the Meaning of True or Noninformative Negative Results

Genetic Disorder Reference Sheets
These concise and comprehensive genetic disorder reference sheets include details about the disorder, cancer risk, recommendations for care, and nursing implications. Below are the sheets that are currently available and more will be released every other month.

• ATM
• CDH1 and Hereditary Diffuse Gastric Cancer
• CHEK2
• BAP1
• BRCA1 and BRCA2 Hereditary Cancers
• Familial Adenomatous Polyposis
• HOXB13
• Lynch Syndrome (Hereditary Nonpolyposis Colorectal Cancer)
• Multiple Endocrine Neoplasia Type 1
• Multiple Endocrine Neoplasia Type 2
• MUTYH-Associated Polyposis
• PALB2
• PTEN Hamartoma Tumor Syndrome
• Von Hippel-Lindau Syndrome

Genomic Biomarkers

Genomic Testing Method 

Key Genomic Terms and Resources

ONS Biomarker Database 

Pharmacogenomics 

Referring for Germline Biomarker Testing

Genomics Taxonomy
The ONS Genomics Taxonomy is compiled of 106 foundational genomic terms categorized into six groups that provide standardized genomic language for oncology nursing practice and promotes understanding of genomic concepts that reflect the state of the science.

Using a Genomics Taxonomy: Facilitating Patient Care Safety and Quality in the Era of Precision Oncology

Oncology Nursing Society Call to Action: Using the Appropriate Genomic Terminology for Safety and Quality

Understanding Genomic and Hereditary Cancer Risk: A Handbook for Oncology Nurses
This practical handbook provides nurses with the essentials to understand genomic and hereditary cancer risk, to assist in facilitating care with genetics and other oncology professionals, and to provide patients with accurate and reassuring information.
 

Earn FREE contact hours of NCPD for recent episodes and learn on-the-go by listening to ONS podcasts. Individual episode pages will indicate if NCPD is available. Explore additional podcasts in the Oncology Nursing Podcast Learning Library.

Episode 226: Patient Education for Next-Generation Sequencing to Guide Cancer Therapy
_{This resource was produced by ONS and sponsored by Foundation Medicine.}

Episode 189: Consider the Ethical Implications of Germline Testing
_{AstraZeneca sponsored this podcast episode, which is brought to you by ONS.}

Episode 180: Learn How Nurse Practitioners Use Biomarker Testing in Cancer Care
_{This resource was developed by ONS through a sponsorship from AstraZeneca.}

Episode 171: Genomics Must Be a Priority in Oncology Nursing Education
_{AstraZeneca sponsored this podcast episode, which is brought to you by ONS.}

Episode 157: Biomarker Testing Improves Outcomes for Patients With Non-Small Cell Lung Cancer
_{This resource was developed by ONS through a sponsorship from Amgen.}

Episode 156: The History of Genomics in Cancer Care
_{This resource was developed by ONS through a sponsorship from AstraZeneca.}

Episode 134: Nurse Innovators Increase Access to Biomarker Testing During ONS Hackathon

Episode 112: Navigating Genomics and Its Effect on Cancer Care

Episode 56: Hereditary Cancer Genetics—ONS Congress

Episode 39: Understanding Genomics in Oncology Nursing

Episode 13: What You Need to Know About At-Home Genetic Testing

Practice Resources

NIH U.S. National Library of Medicine – MedlinePlus
Genetics MedlinePlus adds detailed information about the effects of genetic variation on human health to its extensive collection of health and wellness information. Patients and their families and friends can now find even more easy-to-understand health information in one place at the NLM. MedlinePlus covers more than 1,300 genetic conditions and 1,400 genes, all of the human chromosomes, and mitochondrial DNA (mtDNA).

Cancer Genetics Overview (PDQ®)–Health Professional Version
Includes information on genetic counseling, familial cancer susceptibility syndromes, genetic analysis, clinical sequencing, and much more.

Global Genetics and Genomics Community (G3C)
The G3C (Global Genetics and Genomics Community) learning portal presents a bilingual collection of interactive cases that demonstrate how genetics and genomics link to health and illness. G3C is free to all users and encourages students and practicing healthcare providers to address the multi-dimensional needs of patients through various self-guided, video-taped "patient-provider" interview simulations.

Oncology focused cases include Gabe, Grace, Jeff and Maria, Luis, and Tom

Genetics/Genomics Competency Center (G2C2)

• Online repository of genomics educational materials
• Peer-reviewed collections for genetic counselors, nurses, pharmacists, physician assistants, and physicians
• Professional editorial board curates every resource
• Resources are mapped to discipline-specific genomic competencies

Nurse Genetics/Genomics Competencies
This document identifies the minimum knowledge and skill a nurse needs to be prepared to deliver competent genetic and genomic focused nursing care.

Learning Tools

Jackson Laboratory
Jackson Labs offer free CNE and CME educational modules and mini courses for all healthcare providers related to genomics and applications in practice. Check out the Precision Oncology Online Education website. Topics include:

•  Genetic cancer risk assessment
•  Genetic testing technologies and understanding results
•  Breast cancer
•  Lynch syndrome/Colorectal cancer
•  Pediatric neurology
•  Germline and somatic testing

National Human Genome Research Institute (NHGRI): Cancer Genomics
Learn more about genomics, using the genome to treat cancer, blood tests to detect cancer, family risk and additional resources.

Precision Medicine Advisors (PMA)
PMA specializes in communicating precision medicine to lay professional audiences, providing scientifically sound, unbiased information to promote the responsible use of genomics in medicine. ‘Free’ and ‘For Pay’ CME/CNE education opportunities are available.

Learn Genetics
Interested in learning the basics of genetics? The University of Utah's Genetics Science learning Center provides a wide range of resources and short-engaging videos to help you learn about the basics of genetics, traits, DNA, chromosomes, genes, inheritance, and more.

Patient Education

Biomarker Discussion Guide: A simplified guide for patients and their healthcare team.

No One Missed campaign: A patient friendly site to with information to help patients better understand biomarker testing and what questions they need to ask their healthcare team.

National Cancer Institute – Biomarker Testing for Cancer Treatment
Patient friendly website that includes information on what is biomarker testing for cancer treatment, how is it used to select cancer treatment, different types of biomarkers, and much more.

What you need to know about biomarker testing (Lung Cancer Treatments)
This brochure will help the patient:

• Understand what a biomarker is
• Learn how biomarkers are used to make lung cancer treatment decisions
• Understand how biomarker testing is done
• Consider whether you should have biomarker testing

Biomarked
Patient friendly website for patients with colorectal cancer to understand their biomarkers and what that means for their treatment

Facing Our Risk of Cancer Empowered (FORCE)
A website geared for those with hereditary breast, ovarian and related cancers.  Learn about genes and cancer, signs of hereditary cancer, genetic counseling, types of genetic tests and what results mean for patients and their and families.

Cancer Support Community: Speaking Frankly about Precision Oncology
Patient-friendly videos on precision medicine, targeted therapies, inherited cancers and biomarkers are featured. Companion downloadable PDFs are provided. In addition to precision oncology resources, free patient education publications on other cancer topics are available to download in multiple languages including English, Spanish, Chinese, Korean, Russian, and Vietnamese.

Biomarker Collaborative
The Biomarker Collaborative is a community of biomarker groups dedicated to helping patients with a biomarker connect with others that have that same biomarker driving their cancer growth and allow them to be a support system for each other.

Understanding MSI/MMR

The ONS Genomics Advisory Board was established in May 2019 to guide the development of genomic education and practice resources for oncology nurses. Cancer care is in the midst of a massive paradigm shift. The cancer care workforce, both current and future, is under-prepared for the rapid application of genomic discoveries and the changes needed in cancer care delivery. We want to assure that the current and next generation of oncology nurses know the science, can apply the latest evidence in practice, and translate this information to patients and families.

The ONS Genomics Advisory Board invites you to share your stories, ideas, or needs in relation to integrating genomics into cancer care.  Submit your questions, comments and thoughts for consideration by the Genomics Advisory Board.

Advisory Board Members
 
Kathleen Calzone, PhD, RN, AGN-BC, FAAN
Patricia Friend PhD, APRN-CNS, AOCNS^®, AGN-BC
Patricia A. Kelly, DNP, APRN, CNS, AGN-BC, AOCN^®
Suzanne M. Mahon, DNS, RN, AOCN^®, AGN-BC, FAAN
Mary L. Schmitt, MS, APRN, FNP-BC, AOCNP^®
Kerensa Marty, RN, MSN/Ed, OCN^®