Precision navigators reduce racial disparities in genomic testing for prostate cancer
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Key takeaways:
- Black patients experienced a significant increase in genomic testing with a precision medicine navigator.
- Precision medicine navigators reduced racial amd socioeconomic disparities in genomic testing.
The presence of a precision medicine navigator significantly improved genomic testing rates among Black men with prostate cancer, according to study results.
The findings — presented during American Society for Radiation Oncology Annual Meeting — suggest the presence of precision medicine navigators may alleviate genomic testing inequities among other patient demographics as well, researchers concluded.
Rationale and methods
“In the United States, Black men with prostate cancer experience worse clinical outcomes compared with white men, such as higher stage of presentation, as well as higher prostate cancer-specific mortality,” Alexander J. Allen, MD, radiation oncology resident at University of Maryland Medical Center, said during a press conference.
“Genomic testing for prostate cancer has shown promising results in terms of the ability to accurately prognosticate disease risk, as well as guide physicians in appropriate clinical management,” he added. “There is hope that wider implementation of this testing will potentially mitigate some of the existing inequities. However, there’s also concern that persistent systemic failure will lead to lower rates of utilization of these genomic tests among black men with prostate cancer and amplify current inequities.”
Researchers sought to investigate whether the presence of a precision medicine navigator could potentially mitigate some of the existing inequities in genomic testing use among Black men with prostate cancer.
“We believe it is important to investigate the utility of a precision medicine navigator as this is a resource that is not available at the majority of cancer care providing centers,” Allen said.
Researchers retrospectively reviewed prostate cancer consults within University of Maryland network hospitals for 693 men (median age, 68 years; 60% white; 35% Black) and compared the frequency of patients who received standard-of-care genomic testing within the 7 months before the arrival of a precision medicine navigator (n = 311) vs. the 7 months after the creation of the position (n = 382).
Investigators used chi-square analysis to compare subgroups and binary logistic regression to calculate the odds of receiving genomic testing.
Findings
Results showed that Black patients experienced a sixfold increase (P < .001) in the likelihood of receiving standard-of-care genomic testing after the arrival of a precision medicine navigator vs. those not seen by a navigator.
The proportion of Black patients referred for genomic testing increased from 19% before the arrival of a precision medicine navigator to 58% after the introduction of a navigator.
Results also showed an increase in genomic testing rates after the introduction of a precision medicine navigator for patients with lower income (20% to 64%), those on Medicare and Medicaid (20% to 68%) and those treated at community hospitals (6% to 77%).
“We thought there would be some increase but did not expect the testing rates to grow so substantially,” Allen said in a press release.
“Genomic testing results altered treatment plans for many patients who received them,” he added. “The most common way treatments were altered based on genomic testing results was in whether or not patients with intermediate risk disease were given hormone-blocking therapy.”
Researchers reported no significant differences between the groups in disease severity, type of insurance coverage or type of treatment facility.
Next steps
The findings indicate that the presence of a precision medicine navigator may improve rates of standard care genomic testing among Black men with prostate cancer, in addition to other demographic groups, Allen said during the press conference.
“Future directions of our research include evaluating the effect of a precision medicine navigator on clinical trial enrollment for marginalized groups, as well as assessing the effect of the precision medicine navigator after adjusting for other social determinants of health,” he said. “Based on our results, we believe it is important to advocate for governmental funding of precision medicine navigator positions at more cancer care providing centers.”
References:
- Allen AJ, et al. Abstract 122. Presented at: ASTRO Annual Meeting; Oct. 1-4, 2023; San Diego.
- Precision medicine navigators increase genomic testing rates for Black patients with prostate cancer (press release). Available at: https://www.astro.org/News-and-Publications/News-and-Media-Center/News-Releases/2023/Precision-medicine-navigators-increase-genomic-tes. Published Oct. 1, 2023. Accessed Oct. 3, 2023.
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Allen AJ, et al. Abstract 122. Presented at: ASTRO Annual Meeting; Oct. 1-4, 2023; San Diego.
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