Assessment of a Peer Physician Coaching Partnership Between a Designated Cancer Center Genetics Service and a Community Cancer Network Hospital

Abstract

BackgroundPatients with cancer seen in rural and underserved areas disproportionately face barriers to access genetic services. Genetic testing is critical to inform treatment decisions, for early detection of another cancer, and to identify at-risk family members who may benefit from screening and prevention.ObjectiveTo examine medical oncologists’ genetic testing ordering trends for patients with cancer.Design, Setting, and ParticipantsThis prospective quality improvement study was performed in 2 phases over 6 months between August 1, 2020, and January 31, 2021, at a community network hospital. Phase 1 focused on observation of clinic processes. Phase 2 incorporated peer coaching from cancer genetics experts for medical oncologists at the community network hospital. The follow-up period lasted 9 months.Main Outcomes and MeasuresThe number of genetic tests ordered was compared between phases.ResultsThe study included 634 patients (mean [SD] age, 71.0 [10.8] years [range, 39-90 years]; 409 women [64.5%]; 585 White [92.3%]); 353 (55.7%) had breast cancer, 184 (29.0%) had prostate cancer, and 218 (34.4%) had a family history of cancer. Of the 634 patients with cancer, 29 of 415 (7.0%) received genetic testing in phase 1, and 25 of 219 (11.4%) received genetic testing in phase 2. Of the 29 patients who received testing in phase 1, 20 (69.0%) had germline genetic testing; 23 of 25 patients (92.0%) had germline genetic testing in phase 2. Uptake of germline genetic testing increased by 23.0% between phases, but the difference was not statistically significant (P = .06). Uptake of germline genetic testing was highest among patients with pancreatic cancer (4 of 19 [21.1%]) and ovarian cancer (6 of 35 [17.1%]); the National Comprehensive Cancer Network (NCCN) recommends offering genetic testing to all patients with pancreatic cancer and ovarian cancer.Conclusions and RelevanceThis study suggests that peer coaching from cancer genetics experts was associated with an increase in ordering of genetic testing by medical oncologists. Efforts made to (1) standardize gathering of personal and family history of cancer, (2) review biomarker data suggestive of a hereditary cancer syndrome, (3) facilitate ordering tumor and/or germline genetic testing every time NCCN criteria are met, (4) encourage data sharing between institutions, and (5) advocate for universal coverage for genetic testing may help realize the benefits associated with precision oncology for patients and their families seeking care at community cancer centers.

Socioeconomic and Demographic Barriers Associated with Delays in Pancreatic Cancer Germline Genetic Testing

“…To address these potential barriers in obtaining germline testing for pancreatic cancer patients and to alleviate health care disparities, our institution has started to expedite germline genetic testing for patients in our multi-disciplinary pancreatic cancer clinic by identifying a navigator who serves as a liaison between patients and medical oncologists/geneticists, facilitates patients consents, and notifies patients for follow-up appointments once germline genetic results are available. As was recently described (27), we have proposed an initiative to collaborate with cancer geneticists in order to mitigate health care literacy, especially in underserved minority group, and to ensure that germline genetic testing can be performed at the first visit after the diagnosis of PDAC. We hope that this institutional-level care plan will be an initiation of mitigating disparities in one aspect of pancreatic-cancer, and will lead to a more global awareness of medical disparities in underserved population, eventually streamlining testing for genetic mutations and optimizing patient-directed treatments.…”

Pancreatic Cancer Health Disparity: Pharmacologic Anthropology

“…Engaging local communities, community leaders, and traditional healers fosters trust and facilitates collaboration in addressing PCa. Working together with community stakeholders helps identify community-specific needs, build awareness, and develop culturally appropriate interventions that are embedded within the community's social fabric [43,147,150,151].…”

“…Collabo-rating with traditional healers and integrating their knowledge and practices within the healthcare system can improve patient care. This collaboration allows for the exchange of information, mutual referrals, and coordinated care, ensuring a holistic approach to PCa management [147,150,151]. Developing culturally sensitive educational materials [154], awareness campaigns [69], and public health initiatives raises awareness about PCa within specific communities [136].…”