Abstract 7333: From provider discussion to test completion: Evaluating cancer genetic services in a diverse academic comprehensive cancer care population
Authors: Naaseh Ariana , Rice Hannah , Temosihue Isabel , Zimmermann Natasha , Linnenbringer Erin 
Published: March 2024

Objective: Genetic testing (GT) and counseling (GC) are important aspects of comprehensive cancer care, yet persistent equity challenges exist. We aim to characterize the evolving utilization of GT and GC services for potential hereditary breast, ovarian, pancreatic, and prostate cancers (HBOPP).

Methods: We performed a retrospective single-institution chart review of a balanced racial subset of HBOPP patients who met National Comprehensive Cancer Network (NCCN) criteria diagnosed from 2019-2013. Data were analyzed using chi-squared test and multivariable logistic regression.

Results: 503 HBOPP patients were studied. GT was discussed with 50.5% (n=254) of patients, 42.3% (n=213) completed GT, but only 8.7% had GC (n=44) (Table 1). Patients who were younger, had managed care, or had a family history of cancer were significantly more likely to have a GT discussion and complete GT (all p&lt;0.01). Pancreatic cancer (RR 0.11; 95% CI 0.05-0.21) and prostate cancer patients (RR 0.05; 95% CI 0.02-0.10) were less likely to have a GT discussion with their provider than breast cancer patients. HBOPP patients had a lower likelihood of having a GT discussion with each additional year of age at diagnosis (RR 0.95; 95% CI 0.93-0.98). Among patients who had a GT discussion, prostate cancer patients (RR 0.14; 95% CI 0.04-0.47) and Black patients (RR 0.25; 95% CI 0.09-0.71) were less likely to complete GT. Ovarian cancer patients (RR 12.1; 95% CI 5.19-28.5) and patients with a family history of cancer (RR 2.26; 95% CI 1.05-4.86) were more likely to have GC.

Conclusions: Inequities persist in GT and GC. NCCN-eligible patients who were older or had prostate or pancreatic cancer were less likely to have GT discussion. We found that Black patients were less likely than White patients to complete GT. GC rates were low across all groups except patients with ovarian cancer. Multilevel and systemic interventions are needed to improve equity in cancer genetic services.

Access to, completion, and outcomes of genetic testing and counseling, by cancer type. Breast (n=212) Ovarian (n=48) Pancreatic (n=105) Prostate (n=138) Total (n=503) Test (p) Was there evidence a provider discussed and/or offered genetic testing? Yes 172 (81.1%) 36 (75.0%) 26 (24.8%) 20 (14.5%) 254 (50.5%) &lt;0.001 No 40 (18.9%) 12 (25.0%) 79 (75.2%) 118 (85.5%) 249 (49.5%) Is there any evidence that the patient received genetic testing? Yes 155 (90.1%) 32 (88.9%) 18 (69.2%) 8 (42.1%) 213 (84.2%) &lt;0.001 No 17 (9.9%) 4 (11.1%) 8 (30.8%) 11 (57.9%) 40 (15.8%) What were the patients results? Mutation positive 25 (16.3%) 5 (15.6%) 2 (11.1%) 0 (0.0%) 32 (15.2%) 0.095 Mutation negative 83 (54.2) 12 (37.5%) 13 (72.2%) 3 (37.5%) 111 (52.6%) Variant of unknown significance 43 (28.1%) 13 (40.6%) 3 (16.7%) 4 (50.0%) 63 (29.9%) No info available/cannot find 2 (1.3%) 2 (6.2%) 0 (0.0%) 1 (12.5%) 5 (2.4%) Was there evidence of any genetic counseling encounter? No 195 (92.4%) 27 (57.4%) 102 (97.1%) 133 (96.4%) 457 (91.2%) &lt;0.001 Yes 16 (7.6%) 20 (42.6%) 3 (2.9%) 5 (3.6%) 44 (8.8%)

Citation Format: Ariana Naaseh, Hannah Rice, Isabel Temosihue, Natasha Zimmermann, Erin Linnenbringer. From provider discussion to test completion: Evaluating cancer genetic services in a diverse academic comprehensive cancer care population [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7333.