Abstract PR001: Socioeconomic analysis and disparities in germline genetic testing for pancreatic cancer
Authors: Zou Xianghui , Sidiqi Baho , Patruni Sunita , Hollweg Christopher , Kauff Noah , King Daniel 
Published: November 2022

Abstract
Introduction: Germline genetic testing is now recommended for patients with pancreatic ductal adenocarcinoma (PDAC). We explored whether attributes of testing, such as uptake fraction and rate, were associated with various clinical features. Here we identified barriers to germline testing and explored a relationship between lag of germline diagnosis and patient social profiles, including median income, race, and ethnicity from New York’s largest healthcare system. Methods: Patients with PDAC were identified using billing records across our institution with an IRB-approved protocol. Germline mutation data were assessed through chart review. Median income was annotated using zip codes and www.census.gov. Date of diagnosis (DOD) was recorded as the date of biopsy or, if no biopsy was performed, the date of earliest lesion-found CT scan. Lag of testing was calculated as the difference between DOD and the date of germline sample collection. Results: Between Mar 2016 and Feb 2022, 305 patients with PDAC were identified, with 103 (36.3%) having reports found (F), and 202 (63.7%) not having reports found (NF). Availability of germline testing did not vary by median income (F: 95954 dollars vs NF: 94368 dollars, t=0.414, p=0.68). There was no significant difference in the geographic distribution (gender, race, and ethnicity) of patients between F and NF: gender (F: Male 41%, Female 59%; NF: Male 43%, Female 57%; p=0.92), race (F: Asian 8%, African American 13%, White 55%, Others 5%, Not Reported 19%; NF: Asian 9%, African American 16%, White 54%, Others 6%, Not Reported 15%; p=0.92), ethnicity (F: Non-Hispanic 81%, Hispanic 11%, Others 5%; NF: Non-Hispanic 83%, Hispanic 4%, Others 12%; p=0.16). Pearson analysis between median income (x) and lag of testing (y) showed a negative correlation (y=-0.0027x+315.6, R=-0.241, p=0.014). Level of income (cutoff: 100k) also affected the mean days in lag of testing (below 100k: 111.8d, above 100k: -44.0d, t=2.190, p=0.031). African American (AA) patients` had a significant lag of testing compared to White (W) patients (AA: 194.4d, W: -20.9d, t=2.123, p=0.037) and insignificant lag compared to Asian (A) patients (AA: 194.4d, A: -7.33d, t=1.924, p=0.068). In addition, no African American patients had germline genetic testing performed before the diagnosis of pancreatic cancer, whereas 1 Asian patient (11.1%) and 11 White patients (18.6%) had testing performed before the diagnosis. Finally, Hispanic (H) patients had a statistically insignificant lag of testing compared to non-Hispanic (NH) patients (H: 193.9d, NH: 27.76d, t=1.419, p=0.160). Conclusion: Analysis of germline and clinical data from our 305-patient cohort identified a striking and concerning negative correlation between patient median income and lag between DOD and germline testing. In addition, patient race and ethnicity also significantly contributed to delays in germline testing. These results compel further investigation into the operational processes and socioeconomic barriers that will prompt germline testing at our institution.
Citation Format: Xianghui Zou, Baho Sidiqi, Sunita Patruni, Christopher Hollweg, Noah Kauff, Daniel King. Socioeconomic analysis and disparities in germline genetic testing for pancreatic cancer [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr PR001.