The positive impact of implementing an onsite guideline-based genetic testing procedure for prostate cancer in a multidisciplinary uro-oncology clinic.

Abstract

234 Background: Prior to the guidelines set forth by the 2017 Philadelphia consensus conference, genetic testing for prostate cancer was conducted based on personal and family history of malignancies pursuant to NCCN recommendations. The 2017 guidelines expanded testing criteria to included age at diagnosis, metastatic disease, and tumor sequencing. In spite of these advancements, limited literature is available regarding successful implementation of a streamlined system for genetic testing in prostate cancer. This paper explores the benefits of implementing an on-site guideline-based genetic testing process for prostate cancer patients treated at a multi-disciplinary uro-oncology practice. Methods: Data was retrospectively reviewed for 561 prostate cancer patients seen in a multi-disciplinary uro-oncology clinic since January 2017. Prior to January, 1, 2019 genetic testing was recommended to patients based on NCCN guidelines, and swabs for testing were procured off-site less than 1 mile from the clinic (n=107). After January, 1, 2019 genetic testing was recommended based on the guidelines set forth by the Philadelphia consensus conference, and swabs for testing were procured at the clinic itself (n=454). Results: A statistically significant increase in compliance with genetic testing was observed after the implementation of an on-site, guideline-based testing process. Patient compliance with genetic testing increased from 33.6% to 96.5%. The time to receive the genetic test results (calculated as the time between referral for genetic testing and obtaining the test results) was also significantly improved from 38 days to 21 days. Conclusions: The implementation of an on-site, guideline-based genetic testing model for prostate cancer patients significantly improved compliance with genetic testing to 96.5% and decreased the time to receive genetic test results by 17 days. Overall, adopting a guide-line based model with on-site genetic testing has the potential to significantly improve the detection rate for pathogenic and actionable mutations, increase the utilization of targeted therapies, and increase cascade testing to include at-risk family members.

Hereditary cancer risk assessment and genetic testing in the community urology practice setting

“…A recent study in a multidisciplinary uro-oncology clinic described how implementing a hereditary cancer risk assessment (HCRA) protocol for patients with PCa increased compliance with genetic testing. 13 Process interventions aimed at improving HCRA and genetic testing may increase the feasibility of appropriate screening and testing. In other community medical practices, this approach has resulted in significant improvements in the number of patients undergoing HCRA, as well as patient and provider satisfaction with the screening and testing processes.…”

“…11 Paller et al 12 highlighted the following barriers encountered by oncologists when considering germline testing in patients with PCa: (1) access to genetic counselors, (2) insurance coverage and cost, (3) clinic workflow, (4) time and space availability, and (5) access to provider and patient educational resources. These barriers, which have also been reported in oncology, broader urology, and community urology settings, [13][14][15] can be surmounted by integrating education and workflow initiatives for genetic testing.…”

“…A recent study in a multidisciplinary uro‐oncology clinic described how implementing a hereditary cancer risk assessment (HCRA) protocol for patients with PCa increased compliance with genetic testing 13 . Process interventions aimed at improving HCRA and genetic testing may increase the feasibility of appropriate screening and testing.…”