Ten-fold increase in genetic testing in pancreatic and metastatic prostate cancer with implementation of point of care (POC) testing.

Abstract

1506 Background: Germline genetic testing (GT) for cancer susceptibility is recommended for pancreatic and advanced prostate cancer patients, due to potential implications for targeted therapies and risk assessment of family members. Traditional cancer GT programs may create barriers for certain patient populations. To more effectively integrate testing into standard oncology care POC GT was introduced in early 2018 in a joint protocol with Memorial Sloan Kettering Cancer Center. Here we report pre and post POC referral and testing numbers at the University of Pennsylvania. Methods: Patients with metastatic prostate or pancreatic cancer were ascertained through their GU/GI oncologist onto an IRB approved protocol and shown an educational video about GT by research staff who obtained informed consent and facilitated biospecimen collection. Genetic counselors returned results and provided post-test counseling by phone. To evaluate the impact of this model on the uptake of GT services, the number of patients who were referred to and proceeded with GT was compared before and after study initiation. Results: In 2017, 77 patients were referred to genetics of which 45 underwent genetic counseling and testing. Twenty-nine (38%) did not complete genetic counseling or testing, and 3 later underwent testing through the POC study. Since the study launched in 2018, 407 patients were referred and underwent testing through the study. This represents a ten-fold increase in patients who underwent GT. Conclusions: Comparing uptake of GT services before and after study initiation suggests that a POC model with abbreviated pre-test education and post-test genetic counseling by phone is a possible solution to barriers of traditional genetic counseling, increasing physician referrals and uptake of testing by patients. This approach allows for more timely access to genetic information that may impact treatment strategies and medical management of family members. Clinical trial information: pending. [Table: see text]

Implementation of an Embedded In-Clinic Genetic Testing Station to Optimize Germline Testing for Patients with Pancreatic Adenocarcinoma

“…Furthermore, a genetic counseling appointment was scheduled prior to germline testing, necessitating the capacity for increased GC availability which may not be replicable at other institutions. This latter hurdle has been previously addressed by Symecko and colleagues, who created a system of video-based pretest counseling and point-of-care PDAC genetic testing at the University of Pennsylvania in 2018 [22]. Although this system relied on provider referrals, streamlining of pretest procedures nevertheless increased the volume of germline testing by greater than sixfold.…”

Burden of hereditary cancer susceptibility in unselected patients with pancreatic ductal adenocarcinoma referred for germline screening

“…In our study, the difference in test uptake did not appear to be explained by a difference in performance status or disease stage in the telehealth group and it is possible that logistics for international courier delivery was a barrier to testing for some patients. Point of care testing has demonstrated that the convenience of testing is a strong determinant of testing uptake in this population …”

Report from the 21st Annual Western Canadian Gastrointestinal Cancer Consensus Conference; Calgary, Alberta; 20–21 September 2019

“…There is recognition of 5-10% hereditary cancer risk associated with mPDAC diagnosis, which may be higher in certain subpopulations [ 83 , 84 , 85 ]. ASCO and NCCN guidelines recommend that germline testing be considered for all patients with mPDAC in recognition that up to half of the patients may not have a classical family history and germline BRCA mutations may carry treatment implications [ 86 , 87 , 88 , 89 ]. However, the implementation of testing across the population remains a significant barrier and is subject to ongoing research [ 89 ].…”

“…ASCO and NCCN guidelines recommend that germline testing be considered for all patients with mPDAC in recognition that up to half of the patients may not have a classical family history and germline BRCA mutations may carry treatment implications [ 86 , 87 , 88 , 89 ]. However, the implementation of testing across the population remains a significant barrier and is subject to ongoing research [ 89 ]. After an initial response to platinum-based chemotherapy, the use of maintenance olaparib compared to placebo demonstrated improved PFS, suggesting activity with the parp inhibitor, but the lack of OS improvement and use of placebo as a control (as opposed to ongoing chemotherapy) casts doubt over its utility despite FDA approval [ 85 ].…”