Onsite, nurse-led cancer genetics program may reduce racial disparity in testing completion
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Key takeaways:
- Black veterans seen through the nurse-led program had a 4.7-fold higher likelihood of testing completion.
- The findings suggest an onsite service can potentially mitigate racial disparities in genetics care.
A nurse-led cancer genetics program embedded within an oncology clinic appeared associated with a significant increase in genetic testing rates vs. a telegenetics service among Black veterans, according to a study in JCO Oncology Practice.
“Prior evidence has demonstrated that racial disparities in genetics care persist in the telehealth setting within the VA,” Jeffrey W. Shevach, MD, an internist in the department of medicine-hematology-oncology at University of Pennsylvania Perelman School of Medicine, and researchers wrote. “Importantly, our findings suggest that the presence of an onsite genetics service can potentially mitigate these disparities, while effectively increasing the proportion of completed [germline testing] for patients regardless of racial or ethnic background.”
Background and methodology
Shevach and colleagues conducted an observational, retrospective cohort study of 238 patients at the Philadelphia Veterans Affairs Medical Center referred for cancer genetics services between Oct. 1, 2020, and Feb. 28, 2022. Among the patients, 108 (45%) received services onsite. Most had been referred for either a personal history of cancer (65%) or a family history of cancer (26%).
The researchers evaluated the potential association between an onsite vs. telegenetics cancer genetics service and likelihood of germline testing completion among a subcohort of new consults. They excluded patients with prior consults, as well as patients referred for known history of germline mutations.
The analysis of testing completion included 121 veterans in the subcohort, 54% of whom self-identified as Black and 50% of whom were seen on site.
Results, implications
Univariate analysis showed patients seen by the onsite genetics service had a 3.2-fold increased likelihood of completing germline testing when compared with those who used the telegenetics service (RR = 3.22; 95% CI, 1.89-5.48). Upon multivariable analysis, the association of onsite genetics service with higher likelihood of germline testing completion appeared statistically significant only among Black veterans, when compared with white veterans (adjusted RR = 4.78; 95% CI, 1.53-14.96).
Researchers noted that the findings are only hypothesis-generating and need confirmation in a cluster randomized trial.
“The indications for referral for cancer susceptibility genetic testing have increased exponentially in recent years because of advancement in understanding of the benefits cancer screening for at-risk individuals and the development of therapies for precision treatment of inherited cancers,” researchers wrote. “As such, health care systems must adapt to increased cancer genetic testing needs without widening existing racial disparities in genetic testing.”
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