Remote delivery of cancer genetic testing in veterans with metastatic prostate cancer: A Million Veteran Program study.

Abstract

60 Background: Germline pathogenic alterations are found in approximately 10% of men with metastatic prostate cancer (mPC) and can inform precision therapy, surveillance, and cancer prevention for family. National guidelines recommend germline genetic testing be offered to all men with mPC, yet uptake of testing in the community has been documented to be 6-12% with many barriers to testing. We conducted a study to determine uptake of testing using remote consenting and testing for veterans with mPC who had participated in the Veteran’s Administration Million Veteran Program (MVP). We wanted to know if remote testing could overcome limited point-of-care counseling and ordering to increase uptake of germline testing. Methods: This prospective study enrolled veterans who participated in MVP study with a diagnosis of mPC. Veterans were contacted by mail with an option to opt-out of further contact. Those who did not opt-out were mailed information regarding the study and received a follow-up phone call to establish interest in germline testing with a CLIA-level germline test (BROCA). Those expressing interest provided verbal informed consent and were mailed a saliva collection kit for a multigene cancer predisposition gene panel test (University of Washington). Results were disclosed by phone and mailed to the patient with genetic counseling support and was also sent to the oncology provider by email, phone or both. Two research coordinators and two part-time genetic counselors provided review of consenting, counseling and return of results. Results: As of September 17, 2023, 1952 veterans who were alive with an incident diagnosis of mPC were identified through MVP and did not opt out of further contact. Informational letters were sent to the home address of all eligible participants. 681 (22%) of veterans were reached and completed informed consent. All participants were then sent a saliva kit and 432 (63%) completed testing, with 23 tests currently pending. Among the participants, 70% were White, 21% were Black, 0.5% Asian and 8% unknown. Thirteen percent (53/409) were found to have a germline pathogenic variant. Conclusions: We evaluated uptake of germline testing using a remote, VA system-wide approach to identify and offer genetic testing for veterans with mPC with access and cost issues removed. We completed germline testing at rates significantly higher than those reported in the community with modest personnel requirements, while also reaching a more diverse population of patients. Remote genetic testing can improve uptake of testing in large integrated health care systems.