Genomics and Precision Oncology Learning Library

Genomics Learning Library

Discover what you can learn on our Precision Oncology online learning library. Explore resources compiled of both ONS and external content such as practice tools, courses, case studies, webinars, podcasts, websites, and more.

Featured Resources

ONS Call to Action: Using the Appropriate Genomic Terminology for Safety and Quality

Newly released call to action urges all oncology nurses to become fluent in the terms represented within the ONS Genomics Taxonomy and to use these terms in practice. The use of consistent and correct genomic terminology minimizes confusion and misconceptions and contributes to the high-quality and safe delivery of cancer care.

Read the Oncology Nursing Society Call to Action: Using the Appropriate Genomic Terminology for Safety and Quality to learn more about actions you can take to integrate the genomics taxonomy into your nursing practice.

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.

Learn More About the ONS Genomics Advisory Board

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.

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 Mahon, RN, DNSc, AOCN®, AGN-BC
Mary L. Schmitt, MS, APRN, FNP-BC, AOCNP®
Kerensa Marty, RN, MSN/Ed, OCN®

Clinical Practice Resources- New!

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

Biomarker Testing Nursing Process New!
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 New!
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 New!
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 New!
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.

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.

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.

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.

 

Learning Activities - New!

Experts Introduce Biomarker Testing: Biomarker Basics New!
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 New!
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 New!
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 New!
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 New!
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.

Genomics Case Study: Constructing a Pedigree New!
In this interactive case study, you will be constructing a pedigree and learning about red flags that would necessitate referral to a genetics professional. 
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.

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. CHEK2 and Lynch Syndrome are currently available and more to be released every other month.

ONS Genomic Testing in Cancer Care Webinar
Genomic technologies are rapidly being integrated into cancer care. Genetic/genomic tests are applied across the cancer care continuum for risk identification, risk reduction and cancer prevention, diagnosis and treatment. Oncology nurses must be knowledgeable about the different types of technologies/tests including when and how they are used so they can navigate patients and families through the maze of precision oncology.
Earn 1 NCPD ILNA categories: Scientific Basis, Professional, Disease-Related Biology, and Basic Concepts and Indications for Transplantation

Genomic "Glad You Asked" Video Series

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.

ONS Articles

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:

Voice Article

Key Content

What Is the Different Between Genetics and Genomics?

 

“Genetics versus genomics: Is there a difference? Does it even matter? There is, and it does. In our era of precision medicine, also referred to as individualized or genomic medicine, being able to differentiate the terms is a first step in establishing a foundational understanding of what they mean for cancer care from prevention to treatment.
According to the National Human Genome Research Institute (NHGRI), genetics is the study of individual genes, whereas genomics is the study of the entire genome, or all of an organism’s genes, interactions among genes, and the environment’s role in affecting them.”

Germline and Somatic Mutations: What Is the Difference?

 

“Somatic Variants”
Somatic or acquired genomic variants are the most common cause of cancer, occurring from damage to genes in an individual cell during a person’s life. They are classified in terms of the actionability of an available effective therapy. Cancers that occur because of somatic variants are referred to as sporadic cancers. Somatic variants are not found in every cell in the body, and they are not passed from parent to child. Some common carcinogens that cause pathogenic variants include tobacco use, ultraviolet light or radiation, viruses, chemical exposures, and aging. 

"Germline Variants”
Germline variants are far less common, accounting for only about 5%–10% of all cancers. A germline variant occurs in a sperm cell or an egg cell and is passed directly from a parent to a child at the time of conception. As the embryo grows into a baby, the pathogenic variant from the initial sperm or egg cell is copied into every cell in the body. Because the pathogenic variant affects reproductive cells, it can pass from generation to generation. 

How DNA Sequencing Technologies Are Used in Cancer Care, Now and in the Future

 

“What Is the Difference Between the Techniques?”
Think of DNA as letters of the alphabet. Letters are arranged to make words, sentences, chapters, and entire books. Genes are defined as DNA that is functionally active or that codes for a protein, but most elements of human DNA are considered non-coding. Non-coding DNA (not a gene) still has important regulatory functions and may affect the expression and regulation of nearby genes (coding DNA). The techniques differ based on how much DNA is sequenced.
 - The entire book: Sequences each of the approximately 3 billion base pairs, including all non-coding regions. This is known as whole genome sequencing (WGS).
 - A few sentences in each chapter: Only sequences the coding regions of a person’s genome (the exons). This is known as whole-exome sequencing (WES) and represents about 2% of a person’s total DNA.
 - A paragraph or even a single line of text: This is known as targeted DNA sequencing and is used for known pathogenic variants. Targeted sequencing can look for those variants in a single gene (e.g., BRCA) or multiple genes (analyzed simultaneously with NGS), such as with multi-gene panels.

World Gets Closer to Identifying Cancer’s Genomic Drivers

 

Some highlights from the genome report include:

The average cancer genome is driven by four or five cancer-causing mute.
 - Approximately 13% of cancer-related mutations were found in non-coding DNA, or portions of the genome that don’t code proteins.
 - Many cancer-causing mutations occur years prior to a cancer diagnosis, indicating the need to increase early detection and screening efforts.
 - The mutations were seen in nearly 100 different molecular processes, all with unique mutational signatures.
 - Some signatures were associated with known cancer causes, including aberrant DNA repair and exposure to carcinogens like tobacco smoke or UV light. Other signatures were unexplained, suggesting that far more research needs to be done.

Testing in the Era of Precision Oncology

This ONS Voice article describes how every cancer diagnosis is as individualized and unique as the person receiving it.

Topics include:
 - understanding testing in practice
 - common misconceptions
 - types of targeted therapies
 - resources including online courses, guides, and published articles on personalized medicine

ONS Genomics Taxonomy

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

 

The ONS Advisory Board has selected additional genomics information and resources from respected authorities across the web, review that collection in the drop-down below. 

Genomics External Resources

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

    Essential Genetic and Genomic Competencies for Nurses with Graduate Degrees
    This document identifies essential genetic and genomic competencies for individuals prepared at the graduate level in nursing. These competencies apply to anyone functioning at the graduate level in nursing, including but not limited to advanced practice registered nurses (APRNs), clinical nurse leaders, nurse educators, nurse administrators, and nurse scientists.

    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.

    Method for Introducing a New Competency: Genomics (MINC)
    A resource for nurse educators and administrators interested in integrating genomic competency into nursing practice. Content provided includes:

    •  Action plan and steps in the process
    •  Strategies
    •  Genomic education resources
    •  Evaluation and sustainability
    •  Challenges and potential solutions

    Learning Tools

    Jackson Laboratory
    Jackson Labs offer ‘free’ and ‘for pay’ CNE and CME educational modules and mini courses for all healthcare providers related to genomics and applications in practice. 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

    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.