Peer MD Coaching Partnership Outcomes Between an NCI-designated Cancer Center Genetics Service and a Community Cancer Network Hospital

Abstract

Purpose Patients with cancer seen in rural and underserved areas disproportionately face barriers to access genetic services. Genetic testing is critical to inform treatment decisions, early detection of another cancer, and to identify at-risk family members who would benefit from screening and prevention. Methods We conducted a prospective cohort study to examine medical oncologist’s genetic testing ordering trends at Olympic Medical Cancer Center (OMCC), a community network hospital. Phase I focused on observation of clinic processes. Phase II incorporated peer coaching from cancer genetics experts from Fred Hutchinson Cancer Center (FHCC) for OMCC medical oncologists. Number of genetic testing tests ordered was compared between phases. Results Of the total patients with cancer, 29 out of 415 (7.0%) received genetic testing in phase I and 25 out of 219 (11.4%) in phase II. Although it did not reach statistical significance (p=0.057), uptake of genetic testing increased by 22% between phases. 4 out of 19 (21.1%) patients with pancreatic cancer and 6 out of 35 (17.1%) patients with ovarian cancer received testing when NCCN recommends offering genetic testing to 100% of these patients. Conclusion Peer coaching intervention from cancer genetics experts led to increased ordering of genetic testing by medical oncologists. Efforts made to 1) standardize gathering of personal and family history of cancer, 2) review biomarker data suggestive of a hereditary cancer syndrome, 3) facilitate ordering tumor and/or germline genetic testing every time NCCN criteria are met, 4) encourage data sharing between institutions, and 5) advocate for universal coverage for genetic testing will help realize the benefits of precision oncology for patients and their families seeking care at community cancer centers.