To improve germline testing adoption for Veterans Affairs (VA) patients with metastatic prostate cancer (mPrCA), new delivery models were introduced to complement genetic consultation (traditional model); mainstreaming where oncologists perform pre/post-test activities and a hybrid model where oncologists perform informed consent and then refer to genetics. We assessed germline testing adoption by delivery model.
We conducted a nationwide cohort study of mPrCA patients ascertained 5/3/2021 to 11/2/2022 with follow-up through 5/3/2023. We assessed associations between patient and facility characteristics and having or completing germline test orders using Cox proportional hazards models.
We identified 18,623 mPrCA patients. Average age was 73.9 years (SD, 8.3, range 35-102) with 59.6% non-Hispanic White and 28.9% non-Hispanic Black patients. The cumulative incidence of germline test orders was 13.7% over two years. Non-Hispanic Black patients were more likely than non-Hispanic White patients to have germline test orders (HR, 1.28; 95%CI, 1.15-1.41) but less likely to complete their orders (HR, 0.81; 95%CI 0.72-0.91). Compared with non-Hispanic White patients, non-Hispanic Black patients were more likely to complete orders under the traditional model (HR, 1.40; 95%CI, 111-1.76), less likely under the hybrid model (OR, 0.62; 95%CI, 0.50-0.77) with no difference under the mainstream model.
Mainstreaming germline testing for mPrCA patients improved adoption without introducing disparities between non-Hispanic Black and White patients.
Genetics in medicine : official journal of the American College of Medical Genetics. 2025 Feb 13 [Epub ahead of print]
Maren T Scheuner, Katherine J Hoggatt, Paloma Sales, Barbara Lerner, Eva Ferino, Morgan Danowski, Ning Zhang, Colin Purmal, Samuel L Washington, Michael M Goodman, Emily E Ziegler, Andrea J Stoddard, Carolyn Menendez, Tori Foote, Kerry Rowe, Gina McWhirter, Michael J Kelley
San Francisco VA Health Care System; University of California, San Francisco, School of Medicine. Electronic address: ., San Francisco VA Health Care System; University of California, San Francisco, School of Medicine., San Francisco VA Health Care System., Northern California Institute for Research and Education., Boston VA Health Care System., Atrium Health Wake Forest Baptist; Salisbury VA Health Care System., Salt Lake City VA Health Care System., VA National Oncology Program Office., VA National Oncology Program Office; Durham VA Health Care System; Duke University School of Medicine.