Telehealth Genetic Services Can Improve Genetic Counseling and Testing Uptake in Childhood Cancer Survivors
March 4, 2026
A study published in The Lancet on February 13, 2026, evaluated whether offering telehealth-based genetic services could improve access to guideline recommended genetic risk assessment for survivors at elevated risk of subsequent malignancies. The ENGAGE trial, led by PC3I Faculty Angela Bradbury, MD along with Tara Henderson, MD, MPH (Lurie Children’s Hospital of Chicago) and a multi-institutional research team, showed that centralized, remote telehealth genetic services can substantially increase the uptake of genetic counseling and testing among adult survivors of childhood cancer.
Childhood cancer survivors face a lifelong risk of developing secondary cancers, yet many lack access to genetic testing services due to geographic, financial, and health system barriers. In this randomized clinical trial, 391 adult survivors of childhood cancer were assigned to either in-home telehealth genetic services or usual care, which required seeking genetic services locally. At six months, 43% of participants offered telehealth genetic services completed genetic counseling and or testing, compared to just 15% in the usual care group, representing a fourfold increase in uptake. Participants in the telehealth group were significantly more likely to receive both genetic counseling and genetic testing, and 10% of those tested were found to carry actionable cancer predisposing genetic variants.
These findings, originally presented at the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting, suggest that centralized telehealth genetic services can meaningfully improve access to preventive survivorship care, particularly for individuals living in rural areas or receiving care outside of cancer centers. To maximize the impact of these services, Dr. Bradbury and team recommend addressing barriers through targeted interventions, such as personalized risk communication, policy reform, and sustainable models. Addressing these gaps can lead to advancing survivorship care, improving long-term health outcomes, and ensuring equitable access for childhood cancer survivors and their families.
Angela Bradbury, MD is an Innovation Faculty member at the Penn Center for Cancer Care Innovation (PC3I), Professor of Medicine (Hematology-Oncology) at the Hospital of the University of Pennsylvania, and Professor of Medicine in Medical Ethics and Health Policy at the Perelman School of Medicine. Also the Kevin Reitnauer Fox, MD Professor in Oncology, Dr. Bradbury is an NIH-funded physician-scientist focused on ELSI (ethical, legal and social implications of genetic medicine) and the clinical implementation of genetic medicine who founded a novel nationwide Telegenetics Program, serving as a model for telehealth services and genetic delivery research.
This trial was registered with ClinicalTrials.gov (NCT04455698), and accrual has closed.
Featured PC3I Faculty:
Angela Bradbury, MD
Professor, Hematology/Oncology, Medical Ethics & Health Policy, Perelman School of Medicine
