Mainstreaming improved adoption of germline testing for Veterans Affairs patients with metastatic prostate cancer without exacerbating disparities.

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusions: Mainstreaming germline testing for mPrCA patients improved adoption without introducing disparities between non-Hispanic Black and White patients.