This study introduces an integrated approach using structured and unstructured data from an electronic health record to identify and characterize patient utilization of hereditary cancer genetic testing among patients with metastatic castration-resistant prostate cancer (mCRPC). Secondary objectives were to describe factors associated with the receipt of testing.
This retrospective cohort study included a cohort of Veterans diagnosed with mCRPC from January 2016 to December 2021. Receipt of genetic testing was identified using structured and unstructured data. Time to testing, age at testing, and testing rate were analyzed. Sociodemographic and clinical factors associated with receipt of hereditary cancer genetic testing were identified including race, marital status, rurality, Charlson comorbidity index (CCI), and genetic counseling.
Among 9,703 Veterans with mCRPC who did not decline testing, 16% received genetic testing, with nearly half of the tests occurring in 2020-2021. Factors positively associated with genetic testing included receipt of genetic counseling (adjusted odds ratio [aOR], 11.07 [95% CI, 3.66 to 33.51]), enrollment in clinical trial (aOR, 7.42 [95% CI, 5.59 to 9.84]), and treatment at a Prostate Cancer Foundation-Veterans Affairs Center of Excellence (aOR, 1.43 [95% CI, 1.04 to 1.95]). Negative associations included older age (aOR, 0.95 [95% CI, 0.93 to 0.97]) and severe CCI score (aOR, 0.82 [95% CI, 0.71 to 0.94]). Trends revealed that time to testing decreased per diagnosis year while median age at testing increased per year.
Although testing rates are still suboptimal, they have increased steadily since 2016. Educating Veterans about the benefits of genetic testing may further improve testing rates.
JCO clinical cancer informatics. 2025 Feb 10 [Epub]
Danielle Candelieri-Surette, Anna Hung, Fatai Y Agiri, Mengke Hu, Elizabeth E Hanchrow, Kyung Min Lee, Nai-Chung N Chang, Ming Yin, Jeffrey W Shevach, Weiyan Li, Tyler J Nelson, Anthony Gao, Kathryn M Pridgen, Martin W Schoen, Scott L DuVall, Yu-Ning Wong, Julie A Lynch, Patrick R Alba
VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT., Durham VA Medical Center, Durham, NC., Department of Population Health Sciences, Duke University School of Medicine, Durham, NC., Division of Medical Oncology, The Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC., AstraZeneca Pharmaceuticals, LP, Gaithersburg, MD., Medicine Service, St Louis Veterans Affairs Health Care System, Saint Louis, MO., Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA.