Understanding the Uptake and Challenges of Genetic Testing Guidelines for Prostate Cancer Patients

Suri, Yash; Yasmeh, Jonathan Parham; Basu, Arnab K.

doi:10.1016/j.ctarc.2022.100588

Cited by 8 publications

(7 citation statements)

References 37 publications

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“…For example, a small study at the University of Alabama at Birmingham (UAB) found that 39% of the 38 eligible patients with prostate cancer in 2019 were referred to genetics services. 18,19 The UAB cohort reported that 11% of referred patients received testing, similar to our cohort's 12% rate of genetic testing after counseling. 18 Other studies, such as a University of California, San Francisco (UCSF)-based study, found the proportion of those tested after counseling was much higher, at 60%.…”

Section: Discussionsupporting

confidence: 80%

Characterizing Referrals for Prostate Cancer Genetic Services in a Safety-Net Hospital

Gunn

Gignac

Hardy

et al. 2023

JCO Oncology Practice

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PURPOSE Little is known about the uptake of germline genetic testing for patients with prostate cancer after 2018 guideline changes. This study characterizes genetic service referral patterns and predictors of referrals among patients with prostate cancer. METHODS A retrospective cohort study using electronic health record data was conducted at an urban safety-net hospital. Individuals diagnosed with prostate cancer between January 2011 and March 2020 were eligible. The primary outcome was referral to genetic services after diagnosis. Using multivariable logistic regression, we identified patient characteristics associated with referrals. Interrupted time series analysis using a segmented Poisson regression examined whether guideline changes resulted in higher rates of referral after implementation. RESULTS The cohort included 1,877 patients. Mean age was 65 years; 44% identified as Black, 32% White; and 17% Hispanic or Latino. The predominant insurance type was Medicaid (34%) followed by Medicare or private insurance (25% each). Most were diagnosed with local disease (65%), while 3% had regional and 9% had metastatic disease. Of the 1,877 patients, 163 (9%) had at least one referral to genetics. In multivariable models, higher age was negatively associated with referral (odds ratio [OR], 0.96; 95% CI, 0.94 to 0.98), while having regional (OR, 4.51; 95% CI, 2.44 to 8.34) or metastatic disease (OR, 4.64; 95% CI, 2.98 to 7.24) versus local only disease at diagnosis was significantly associated with referral. The time series analysis demonstrated a 138% rise in referrals 1 year after guideline implementation (relative risk, 3.992; 97.5% CI, 2.20 to 7.24; P < .001). CONCLUSION Referrals to genetic services increased after guideline implementation. The strongest predictor of referral was clinical stage, suggesting opportunities to raise awareness about guideline eligibility for patients with advanced local or regional disease who may benefit from genetic services.

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Section: Discussionsupporting

confidence: 80%

Characterizing Referrals for Prostate Cancer Genetic Services in a Safety-Net Hospital

Gunn

Gignac

Hardy

et al. 2023

JCO Oncology Practice

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“…Suri et al identified barriers to genetic testing at a single center [ 18 •]. A ten-item survey was administered to a multidisciplinary team consisting of three medical oncologist, three urologic oncologists, two radiation oncologists, a pathologist, and a nurse practitioner.…”

Section: Challenges In Genetic Counseling and Germline Genetic Testin...mentioning

confidence: 99%

Germline Mutations and Ancestry in Prostate Cancer

Bataba,

Babcock,

Isensee

et al. 2024

Curr Oncol Rep

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Purpose of Review Prostate cancer is the most frequently diagnosed non-cutaneous malignancy of men in the USA; notably, the incidence is higher among men of African, followed by European and Asian ancestry. Germline mutations and, in particular, mutations in DNA damage repair genes (DDRGs) have been implicated in the pathogenesis of prostate cancer. This review intends to discuss the implication of ancestry on prostate cancer, specifically in regard to lack of diversity in genomic and genetic databases and the ability of providers to properly counsel patients on the significance of cancer genetic results. Recent Findings Ancestral differences in prostate cancer-associated DDRG germline mutations are increasingly recognized. Guidelines for treatment by the National Comprehensive Cancer Network® (NCCN®) support germline testing in certain patients, and a myriad of genetic testing panels for DDRG mutations are now available in clinical practice. However, the consensus among providers on what genes and mutations to include in the genetic tests has evolved from experience from men of European ancestry (EA). Gaps in ancestry-informed clinical practice exist in genetic risk assessment, implementation of screening, counseling, guiding recommendations, treatment, and clinical trial enrollment. Summary The lack of diversity in tumor genomic and genetic databases may hinder ancestry-specific disease-predisposing alterations from being discovered and targeted in prostate cancer and, therefore, impede the ability of providers to accurately counsel patients on the significance of cancer genetic test results.

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“… 1 Patients with prostate cancer have a low rate of germline genetic testing uptake with one study finding that only 11% of the eligible patients completed testing. 2 Fewer than 20% of breast and ovarian cancer patients who qualify for testing based on NCCN guidelines receive testing. 3 , 4 Another study found that among women with breast cancer who qualify for genetic testing per NCCN guidelines, only about 60% were referred and about 46% completed testing indicating that despite a referral, there is still a reduction of uptake in germline testing.…”

Section: Introductionmentioning

confidence: 99%

“…Guidelines suggest testing is indicated for all patients with pancreatic adenocarcinoma, however, only around 20% of patients get tested 1 . Patients with prostate cancer have a low rate of germline genetic testing uptake with one study finding that only 11% of the eligible patients completed testing 2 . Fewer than 20% of breast and ovarian cancer patients who qualify for testing based on NCCN guidelines receive testing 3,4 .…”

Section: Introductionmentioning

confidence: 99%

Psychosocial factors impacting barriers and motivators to cancer genetic testing

et al. 2023

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Background Only a small proportion of patients who qualify for clinical genetic testing for cancer susceptibility get testing. Many patient‐level barriers contribute to low uptake. In this study, we examined self‐reported patient barriers and motivators for cancer genetic testing. Methods A survey comprised of both new and existing measures related to barriers and motivators to genetic testing was emailed to patients with a diagnosis of cancer at a large academic medical center. Patients who self‐reported receiving a genetic test were included in these analyses ( n = 376). Responses about emotions following testing as well as barriers and motivators prior to getting testing were examined. Group differences in barriers and motivators by patient demographic characteristics were examined. Results Being assigned female at birth was associated with increased emotional, insurance, and family concerns as well as increased health benefits compared to patients assigned male at birth. Younger respondents had significantly higher emotional and family concerns compared to older respondents. Recently diagnosed respondents expressed fewer concerns about insurance implications and emotional concerns. Those with a BRCA‐related cancer had higher scores on social and interpersonal concerns scale than those with other cancers. Participants with higher depression scores indicated increased emotional, social and interpersonal, and family concerns. Conclusions Self‐reported depression emerged as the most consistent factor influencing report of barriers to genetic testing. By incorporating mental health resources into clinical practice, oncologists may better identify those patients who might need more assistance following through with a referral for genetic testing and the response afterwards.

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Understanding the Uptake and Challenges of Genetic Testing Guidelines for Prostate Cancer Patients

Cited by 8 publications

References 37 publications

Characterizing Referrals for Prostate Cancer Genetic Services in a Safety-Net Hospital

Characterizing Referrals for Prostate Cancer Genetic Services in a Safety-Net Hospital

Germline Mutations and Ancestry in Prostate Cancer

Psychosocial factors impacting barriers and motivators to cancer genetic testing

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