Uptake in genetic testing in patients with pancreatic cancer with oncologist-driven testing protocol.

Abstract

33 Background: The objective was to compare the uptake of genetic testing in patients with pancreatic adenocarcinoma (PDAC) seen at a single center (1) before the 2019 NCCN recommendation of universal screening for genetic mutations in all new PDAC diagnoses, (2) after this change in guideline, and (3) after transitioning to an oncologist-driven genetic testing protocol. Methods: A retrospective review of patient records seen for a new PDAC diagnosis at BIDMC between May 2018-May 2022 was performed. Patients were categorized into three groups by date of visit: pre-guideline change (5/2018-4/2019), post-guideline change (5/2019-12/ 2020), and after implementation of an oncologist-driven testing protocol (12/ 2020-5/2022). The primary outcome was the differences in rates of testing between each time period. Results: An increase in rates of genetic testing occurred between each successive time period. Pre-guideline change, 22% of patients had testing sent, and this increased to 32% post-guideline. With the oncologist-driven testing, this increased to 73%. There was an increase in referrals for genetic testing from the pre- to post-guideline change time periods (42% to 61%). However, in both groups, the number of patients who completed testing was approximately half of those who were referred (23% and 34%, respectively). Conclusions: Our cancer center moved to oncologist-driven testing to increase uptake in the wake of a guideline change recommending universal testing of all PDAC patients. By this protocol, germ-line testing is sent by the medical oncologist at the initial multidisciplinary clinic visit, rather than following a consultation with our genetic counseling team. With this change, there was a dramatic increase in genetic testing (32% to 73%), thereby capturing approximately 10 additional patients with actionable pathogenic variants. However, this change necessitated additional resources in the multidisciplinary clinic and time from the oncologist to consent for testing. In addition, the expertise of cancer genetics counselors was not provided to all patients. We attempted to address the latter via selective referral after positive results. Despite these trade-offs, oncologist-driven testing successfully met the goal of increasing our adherence with guideline-based genetic testing of all PDAC patients.[Table: see text]