On-site genetic testing consults lead to higher testing completion rate, finds PCF-backed study

Patients who received genetic counseling in-person are more likely to complete full germline genetic testing compared with those who received a consult via telehealth, according to findings from a new study published in JCO Oncology Practice.^1,2

Among all patients who received genetic counseling, 117 underwent genetic testing.

The study assessed US veterans receiving care at the Veterans Health Administration for all cancer types, including prostate cancer.

"Without a doubt, telemedicine has many benefits, but this research shows that when it comes to genetic counseling and testing, in-person consults are most impactful. [Prostate Cancer Foundation] commends Dr. Maxwell and her colleagues and proudly supports their efforts to extend leading-edge precision oncology care to our nation's Veterans." said Howard R. Soule, PhD, in a news release on the findings.2 Soule is the executive vice president and chief science officer of Prostate Cancer Foundation, which funded the study.

In total, 238 veterans were retrospectively analyzed for the study, of whom 108 (45%) were seen via the on-site, nurse-led genetics program and 130 (55%) were seen via the telegenetics service.

Those seen on-site were older, more likely to be male, have a personal history of cancer as the indication for consult, and be referred by the oncology service. Patients with a personal history of cancer who were seen on-site were more likely to have prostate cancer (55%) compared with those seen via a telehealth consult (33%). More than half (54%) of the patients included in the study self-identified as Black.

Patients were followed until the completion of testing, death before testing, or data cutoff. Among all patients who received genetic counseling, 117 underwent genetic testing.

Findings showed that patients who were seen in-person were 3.2 times more likely to complete genetic testing and less likely to be lost to follow-up compared with patients seen via the telegenetics service. Upon multivariate analysis with adjustments made for covariates, the association between on-site visits and complete testing remained (P = .006), though the association only remained statistically significant among Black veterans (P < .001).

Non-Hispanic White veterans were 1.46 times more likely to complete testing when seen on-site (P = .276), and non-Hispanic Black veterans were 4.78 times more likely to complete testing compared with those seen via the telegenetics service (P = .007). The interaction between SIRE-race and completion of genetic testing was found to be significant (P = .016).

The authors stated, “Genetics consults for patients with cancer or for patients at risk for hereditary cancer syndromes can be complex encounters, and for patients with active cancer, they occur during a stressful period of their care… Although telegenetics has greatly expanded access to genetics evaluations, it is possible that a face-to-face interaction with a provider on site may be a better method for delivery of genetics consultations, given the inherent complexity in these encounters, particularly in the Veteran population.”

References

1. Shevach JW, Aiello LB, Lynch JA, et al. One-site nurse-led cancer genetics program increases cancer genetic testing completion in Black veterans. JCO Oncol Pract. [published online ahead of print May 23, 2023]. Accessed May 25, 2023. doi: 10.1200/OP.22.00738.

2. Prostate Cancer Foundation-funded study sheds light on improving access to precision oncology care for U.S. veterans with prostate cancer. News release. Prostate Cancer Foundation. May 24, 2023. Accessed May 25, 2023. https://www.prnewswire.com/news-releases/prostate-cancer-foundation-funded-study-sheds-light-on-improving-access-to-precision-oncology-care-for-us-veterans-with-prostate-cancer-301833621.html