Living in southern Delaware used to mean being some distance away from highly specialized medical care. For example, Milford is about 100 miles and almost two hours’ drive away from the research hospitals in Philadelphia. But residents of Sussex and Kent counties no longer have to miss out on the diagnostics knowledge and medical care available in urban areas. For example, the Bayhealth Cancer Center, located at its hospital in Dover, provides anyone in southern Delaware with access to first-rate cancer genetics counseling via its Telegenetics videoconferencing program, offered through Bayhealth’s affiliation with the University of Pennsylvania’s Abramson Cancer Center. [caption id="attachment_200372" align="aligncenter" width="1015"] Dr. Rishi Sawhne consulting patients | Photo c/o Bayhealth[/caption] “Bayhealth’s genetics collaboration with Penn started in 2013, when a real need arose for genetics counseling for cancer patients,” says Dr. Rishi Sawhney, medical director of the Bayhealth Cancer Institute. “Patients with higher genetic risk really need to undergo counseling, and such counseling is generally available only in major population centers.” Bayhealth and Penn decided early in their collaboration to stage a formal clinical trial to evaluate whether genetic counseling via teleconferencing would be successful, and, if so, how such counseling would be conducted. “We needed to know if it would work and whether the patients in the trials would be satisfied,” Sawhney says. Once both institutions reviewed the outcome of the trial, a formal setup was established in 2015. The first step is taken at the local level by Bayhealth’s medical staff, who need to decide which patients might benefit from genetics testing, whether they are currently being treated by Bayhealth physicians or referred by other doctors. “For example, one of the red flags might be with younger patients who develop multiple cancers,” Sawhney says. “Another red flag would be a patient who has multiple family members who have had cancer.” Once a patient has been identified, the first Telegenetics session lasts an hour to 90 minutes, with a discussion of the patient’s medical and family background and the pros and cons of genetic testing. “There might be a menu of options discussed, and, if a decision is made to move to testing, a program would eventually be customized for the patient,” Sawhney says. A nurse then draws samples from the patient to be diagnosed. The next session requires the presence of an oncology physician from Bayhealth at the teleconference. “Results of the testing would be discussed, as well as how the patient should be medically managed,” Sawhney says. A treatment roadmap would be sent to the physician overseeing the patient’s treatment. “Our Telegenetics program is rapidly expanding,” Sawhney continues, “and our cancer patients are eligible for any of Penn’s clinical trials. Sometimes, we find a rarer mutation in a patient, and we can leverage Penn’s expertise and that of its genetic tumors board.” The Telegenetics program is only one part of the cooperative care arrangement between Bayhealth and Penn, which also includes working together in orthopedic and cardiovascular care. Additionally, Penn’s graduates often serve their medical residencies at Bayhealth. “We see other possibilities for Telegenetics beyond cancer,” Sawhney says, “including possible pre-natal counseling.”

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—Roger Morris