Abstract A066: Assessment of disparities in completion of genetic testing in patients with advanced prostate cancer

Abstract

Introduction: Somatic and germline testing are now recommended for patients with advanced prostate cancer. Though referrals for genetic testing have increased since 2017 along with developments in National Comprehensive Cancer Network guidelines, genomic profiling in select cancers remains low, with a reported 50% to 80% of eligible patients not completing testing. This study aims to quantify race-associated disparities in both referrals to genetic counseling and completion of genetic testing in patients with advanced prostate cancer. Methods: Henry Ford Health’s electronic medical record (Epic) was queried to identify patients diagnosed with stage III or stage IV prostate cancer between Q1 2017 and Q2 2022. Demographics, site of referral, completion of counseling referrals, and completion of somatic and/or germline testing were identified. Incidence and completion of referral were calculated. Population comparisons were performed with Chi-squared testing. Results: Out of 4,505 unique patients diagnosed with prostate cancer, 919 patients were diagnosed with stage III prostate cancer and 468 patients were diagnosed with stage IV prostate cancer. Black patients had a higher incidence of stage IV versus stage III cancer compared to non-Hispanic whites (NHWs) (31.84% versus 24.92%, P-Value = 0.0042). In stage IV prostate cancer, Black patients were more likely to receive referrals to genetic counseling compared to NHWs (32.2% versus 21.1%, P-Value = 0.011). Black patients were more likely to have a referral placed from the main campus (downtown cancer institute) versus community clinics (suburban) compared to white patients (80.0% versus 50.8%, P-Value = 0.0018). There were no statistically significant differences in completion of testing between the downtown and suburban campuses (67.1% and 61.9%), completion of referral between Black and White patients (48.8% and 43.3%), completion of any genetic testing (66.7% and 64.2%), or completion of germline testing (51.1% and 58.2%). Patients with stage IV prostate cancer who completed their genetic counseling referral were more likely to complete a form of genetic testing (P-Value <0.00001) compared to those who did not present to a genetic counselor. Conclusion and Discussion: Black patients were more likely to present with stage IV disease and more likely to receive a referral to genetic counseling. Though testing completion rates were not significantly different between Black and White patients, overall referral, completion of referral, and testing completion rates remain low in the entire population. Increased indications for testing provide an opportunity for improved referral rates. The statistically significant increase in completed testing by patients who completed their genetic counseling referral reflects both the importance of counseling for optimizing care and stresses the implication that there are significant barriers to patient access that are worth studying further. Additional assessment is underway to better understand both provider- and patient-based barriers to genetic testing.

Citation Format: Kyle McElyea, James Purtell, Mohammed Baseer, Avery Ralston, Maria Jamil, Brigid Jacob, Clara Hwang. Assessment of disparities in completion of genetic testing in patients with advanced prostate cancer [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A066.