Developing a multidisciplinary pediatric cancer predisposition service at a mid-sized children's hospital.

Roughly one in ten children and young adults diagnosed with cancer has an underlying genetic variant that may explain his/her malignancy. It is critical to identify patients with cancer predisposition syndromes (CPSs) to provide personalized cancer treatment, surveillance, counseling, psychosocial support, and in some cases, risk-reducing interventions to maximize long-term outcomes. Over the past five years, we developed a comprehensive pediatric CPS program at our institution. We engaged our institutional adult cancer center for clinical cancer genetic counseling services and needed research shared resource facilities. We also initiated a clinical study called "Project Inherited Cancer Risk" (PICR) to identify pediatric oncology patients affected by CPSs through universal germline NextGen sequencing of a known panel of CPS genes. Finally, we have engaged the CPS community to learn how we can better serve them. Here, we describe the rationale, process, challenges and opportunities of developing a multidisciplinary CPS clinical service in a medium-sized academic pediatric oncology center.