Model increases odds of timely prostate cancer germline testing, but disparities persist
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Germline genetic testing has become an increasingly valuable tool for patients with various malignancies, including prostate cancer.
In anticipation of expanded National Comprehensive Cancer Network guidelines on germline testing for men with prostate cancer, researchers at University of California, San Francisco, developed and introduced a telehealth model called the genetic testing station (GTS). They designed the model to make genetic testing more accessible to men with prostate cancer and to streamline the testing process.
“We knew there would be a national guideline change coming up, in which the recommendations for germline prostate cancer testing would be significantly expanded to cover not just people with family history risk, but also people who have metastatic prostate cancer and locally advanced prostate cancer,” Daniel Kwon, MD, assistant clinical professor of hospital-based oncology and genitourinary medical oncology at University of California, San Francisco, told Healio. “Some of the researchers here thought it would be a good idea to implement a genetic testing station to streamline and increase access to germline testing at UCSF.”
Kwon spoke with Healio about the implementation of the GTS and the concerning racial disparity in testing that his team identified.
Healio: What inspired you and your colleagues to develop the GTS?
Kwon: We knew the NCCN guideline was about to change and we wanted to offer greater access to germline testing. Our researchers also thought it would be good to conduct a research study to track outcomes and review the implementation process so that the broader research community could learn from our findings.
Our study assessed men with prostate cancer referred to the GTS between October of 2019 and October of 2021. We evaluated the association between GTS and rates of germline testing completion. The main question we looked at was whether GTS led to timely completion rates among eligible men with prostate cancer.
Healio: What did you find?
Kwon: We evaluated the timely completion of germline testing pre- vs. post-GTS — what was the rate of completion within 60 days?
In a multivariable analysis, we found that GTS was associated with increased odds of timely germline testing in eligible men (OR = 8.97; 95% CI, 2.71-29.75).
In terms of implementation, it seemed to be successful overall. The fidelity of our staff to the workflow was high with minimal errors. We reached hundreds of people, resulting in nearly 600 completing germline testing across dozens of clinics, which is great.
Maintenance of this program was an issue. This sort of program is pretty costly — about $100,000 a year. That’s a significant amount of money. So, that finding is a bit of a concern.
Healio: Your study also identified a racial disparity in germline testing completion. Can you explain this?
Kwon: There is a reason we included that in the conclusion, even though it wasn’t a primary question. We found that in the primary outcome of getting timely testing done, patients who identified as Black were less likely to get timely genetic testing done than white patients. We found an independent association between Black race and lower odds of testing completion compared with white patients (OR = 0.35; 95% CI, 0.13-0.96).
This is not surprising or completely new — we know historically that there is less participation in genetic testing studies and also standard-of-care testing among African American men. There are a number of reasons for this. Historically, there has been racial discrimination from the scientific community, which persists to this day. Anecdotally, I can tell you I still hear about [racism] from my patients who are Black. This is a concerning finding, because if we’re not giving access to germline testing to all people regardless of race, ethnicity or location, we are worsening these disparities. Germline testing is important because for about 10% of people, it can identify eligibility for targeted treatments that they otherwise would not know about if they didn’t get this testing. These patients could potentially be living shorter lives and could be suffering more — they could have a worse quality of life. So, it was important that we identified this and brought it to the forefront.
Healio: What is next in your research on this topic?
Kwon: It’s twofold. For the racial disparity question, I’m doing research regarding African American men with metastatic prostate cancer who receive somatic genetic testing. This study will evaluate how we can increase education and augment recruitment using decision tools. The second area of focus is how we can make GTS more sustainable. There is this ongoing transition of trying to offload some of the work onto more of a digital online system, so that patients can watch videos or read, rather than getting more time-consuming counseling from genetic staff.
For more information:
Daniel Kwon, MD, can be reached at University of California, San Francisco, 505 Parnassus Ave. M1286C, San Francisco, CA 94143; email: daniel.kwon@ucsf.edu.
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