Navigating ethical challenges of integrating genomic medicine into clinical practice: Maximising beneficence in precision oncology

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Published: Apr 23, 2024
DOI: https://doi.org/10.7196/sajbl.2024.v17i1.2071

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M J Kotze
Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University; and the National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
https://orcid.org/0000-0002-6050-2876
K A Grant
Department of Biomedical Sciences, Faculty of Health and Wellness, Cape Peninsula University of Technology, Cape Town, South Africa
N C van der Merwe
Division of Human Genetics, School of Pathology, Faculty of Health Sciences, University of the Free State, South Africa; and the National Health Laboratory Service, Universitas Hospital, Bloemfontein, South Africa
https://orcid.org/0000-0001-8880-2099
N W Barsdorf
Office of Research Integrity and Ethics, Division for Research Development, Stellenbosch University, Stellenbosch, South Africa
M Kruger
Department of Paediatrics and Child Health and Human Research Ethics Committee 2, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

Abstract





The development of gene expression profiling and next-generation sequencing technologies have steered oncogenomics to the forefront of precision medicine. This created a need for harmonious cooperation between clinicians and researchers to increase access to precision oncology, despite multiple implementation challenges being encountered. The aim is to apply personalised treatment strategies early in cancer management, targeting tumour subtypes and actionable gene variants within the individual’s broader clinical risk profile and wellbeing. A knowledge-generating database linked to the South African Medical Research Council’s Genomic Centre has been created for the application of personalised medicine, using an integrated service and research approach. Insights gained from patient experiences related to tumour heterogeneity, access to targeted therapies and incidental findings of pathogenic germline variants in tumour DNA, provided practice-changing evidence for the implementation of a cost-minimisation pathology-supported genetic testing strategy. Integrating clinical care with genomic research through data sharing advances personalised medicine and maximises precision oncology benefits.





Article Details

How to Cite
Navigating ethical challenges of integrating genomic medicine into clinical practice: Maximising beneficence in precision oncology. (2024). South African Journal of Bioethics and Law, 17(1), e2071. https://doi.org/10.7196/sajbl.2024.v17i1.2071
Issue
SAJBL Vol 17 No. 1
Section
Research Articles
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Author Biographies

M J Kotze, Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University; and the National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa

Prof Maritha Kotze is a principal medical scientist focused on addressing the ethical challenges and knowledge gaps created by the implementation of genomic medicine in clinical practice, through the establishment of a pathology-supported genetic testing platform that enables the integration of research and service delivery in training program design.

K A Grant , Department of Biomedical Sciences, Faculty of Health and Wellness, Cape Peninsula University of Technology, Cape Town, South Africa

Dr Kathleen Grant is a senior lecturer committed to advancing medical knowledge, with a particular interest is tumour genetics of breast carcinomas and translational research exploring microRNA expression as potential biomarkers for early diagnosis and treatment of disease, while maintaining a strong commitment to ethical principles in laboratory medicine.  

N C van der Merwe, Division of Human Genetics, School of Pathology, Faculty of Health Sciences, University of the Free State, South Africa; and the National Health Laboratory Service, Universitas Hospital, Bloemfontein, South Africa

Dr Nerina van der Merwe is principal medical scientist and member of the Ethics Committee of the University of the Free State, with translational research and diagnostics in the field of breast and ovarian cancer as her main interests to ultimately provide better testing strategies for patients in the public healthcare sector.

N W Barsdorf, Office of Research Integrity and Ethics, Division for Research Development, Stellenbosch University, Stellenbosch, South Africa

Dr Nicola Barsdorf is an ethicist specialising in research ethics, qualitative research, international research ethics, global research resources, and distributive justice as key principles applied in the development and introduction of an ethics framework for health technology assessment using the South African Values and Ethics for Universal Health Coverage (SAVE-UHC) Approach.

M Kruger, Department of Paediatrics and Child Health and Human Research Ethics Committee 2, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

Prof Mariana Kruger is a paediatric oncologist, and ethicist, serving as chair of the Health Research Ethics Committee (HREC) 2, Stellenbosch University, clinical member of the Advisory Clinical Committee of SAHPRA, co-director of the Fogarty funded South African Research Ethics Training Initiative Leadership programme at UKZN and international discipline related organizations

How to Cite

Navigating ethical challenges of integrating genomic medicine into clinical practice: Maximising beneficence in precision oncology. (2024). South African Journal of Bioethics and Law, 17(1), e2071. https://doi.org/10.7196/sajbl.2024.v17i1.2071

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