Barry Tong, CGC, MS, MPH, UCSF Medical Center, San Francisco, CA, discusses a study evaluating the effectiveness of a prostate Genetic Testing Station at UCSF and compared these outcomes to those of a previously implemented take-home method.
This study was presented at the 2021 ASCO Genitourinary Cancer Symposium.
Transcript
Hello, I'm Barry Tong. I'm a genetic counselor at UCSF in the Cancer Genetics and Prevention Program, and we presented an abstract, "Streamlining the Genetics Pipeline to Increase Testing for Patients at Risk for Hereditary Prostate Cancer," the UCSF Genetic Testing Station, or GTS, at ASCO GU Symposium 2021.
The purpose of this study was to identify if our recent process improvements for offering germline genetic testing for individuals with metastatic prostate cancer could add additional access variables to their care. Prior to the genetics department being directly involved with genitourinary medical oncology at UCSF, approximately 850 men with metastatic prostate cancer were seen annually in their departments.
They have been offering germline genetic testing for inherited cancer on a take-home, self-pay basis. The intent was that any suspicious or positive results would then be referred for genetic counseling on the back end.
Over a few years of experience with this model in GU Medical Oncology, we had then approached that department to offer a more hands-on approach from genetics called the Genetic Testing Station.
Through this Genetic Testing Station, which we had already piloted in other oncology areas, like pancreas and breast, we used one of our staff roles, genetic counselor assistants, to help facilitate a same-day referral, testing, and education process for patients with advanced prostate cancers.
If patients were identified at their oncology visit, a same-day referral was made. Our genetic counselor assistant would immediately meet with that patient same day, provide video education that our genetics department had developed around germline genetic testing, enroll in our research consent, as well as collect a saliva sample for germline genetic testing.
These orders were managed by our genetics department, and results were triaged by genetic counselors, into the electronic medical record. Then post-test results disclosure was given by patient option, either a letter for normal results, or genetic counseling visit at patient request, or for suspicious or positive germline-positive results.
Our primary outcomes in thinking about the number of results that were returned, 98% of our patients who went through the Genetic Testing Station workflow received a result from germline genetic testing, versus 78% from the prior workflow.
We saw an 11% mutation-positive rate on an 87-gene panel, versus a 9% positive rate prior to GTS on a 30-gene panel. Our main takeaways from resulting was that we saw a significant increase in the number of results returned through the Genetic Testing Station, but the positivity rate was only slightly increased, even with the larger panel.
In thinking about the volume of patients that were able to achieve germline genetic testing, we looked at six-month period from October through March of two subsequent years, the first year being the before-GTS model, and the second year being our GTS model.
We saw a 218% increase in the number of results reported in those two different timeframes in comparing those two models, and a significantly decreased median turnaround time from test ordered to resulting from 15 to 9 days. Patients were getting results almost a week earlier.
Then in terms of referral to genetic counseling, prior to GTS, only 36% of the 22 positives that were identified met with the UCSF genetic counselor to review their genetic test results. Of the 40 variants of uncertain significance, none had a resulting genetic counseling encounter on retrospective chart review.
With our Genetic Testing Station model, of course, all results are reviewed by a genetic counselor in our department, and so all 15 positive results in the Genetic Testing Station process saw a genetic counselor for results disclosure and could discuss implications.
Of the 77 variant of uncertain significance results -- which was 55% of the total, and a large proportion because we did a larger panel -- 72 out of the 77 variants were interpreted as clinically not suspicious by our genetic counselors, and only 5 of the variants of uncertain significance were suspicious that required subsequent disclosure by a genetic counselor discussion.
Those were the results of our study looking at the Genetic Testing Station model in GU Medical Oncology. Thank you.
Tong B, Borno H, Small EJ, et al. Streamlining the Genetics Pipeline to Increase Testing for Patients at Risk for Hereditary Prostate Cancer. Presented at the 2021 ASCO Genitourinary Cancer Symposium; February 11-13, 2021.
