IMPROVING GERMLINE TESTING IN AT-RISK PATIENTS WITH PROSTATE CANCER

Introduction

Germline testing is recommended for patients with high risk localized, locally advanced, and metastatic prostate cancer. Despite this recommendation, implementation of germline testing in prostate cancer has been suboptimal. There is a need for novel strategies to engage oncology clinicians and patients in germline testing and integrate germline testing into the clinic.

Methods

We designed a single-arm investigator-initiated study utilizing video education as a means of delivering pre-test counseling to patients who meet the National Cancer Comprehensive Network testing criteria for germline testing. Inclusion criteria includes men greater than or equal to 18 years of age, diagnosis of prostate cancer of any histology, and NCCN indication for germline testing. Patients who consented to the study underwent a one-on-one in-person education session with an educational video about germline testing. Patients completed pre and post-intervention questionnaires to assess their knowledge and satisfaction with the intervention. The primary endpoint was the proportion of patients who underwent germline testing among those enrolled to the study. Key secondary endpoints include the impact of education intervention on change in knowledge of germline testing and patient perceptions of germline testing.

Results

The study enrolled a total of 58 patients, 50 patients completed the study protocol. The majority of patients were White 78.0% (39/50), Non-Hispanic 92.0% (46/50), spoke English 98.0% (49/50), and were college educated 70% (35/50). The majority of patients had high risk localized disease 46.0% (23/50) or metastatic castrate sensitive prostate cancer 26.0% (13/5). Overall, 82.0% (41/50) of patients choose to participate in germline testing following the intervention. Of the tests ordered, 26.0% (13/50) were by urologists and 74.0% (37/50) were by medical oncologists. In this cohort 12.0% (6/50) of patients had a P/LP mutation, 14.0% (7/50) had a VUS. The most important factor influencing patients to pursue genetic testing would be if the results guide treatment selection. The most important factor influencing patients to not pursue genetic testing would be if the results had no clinical value. Most patients had a high level of understanding of genetics knowledge prior to the intervention with a mean score of 9.1 out of 11 in the genetics knowledge test. There was no significant increase or decrease genetics knowledge after the intervention (p = 0.88). A majority of patients were satisfied with the intervention and found it useful 94% (47/50).

Conclusions

The uptake of germline testing after the video intervention was high, most patients already had an understanding of genetics, but were more likely to pursue testing after the intervention and if it would influence their treatment. Furthermore, utilization of virtual educational aids should be integrated into clinical practice to increase germline testing rates.