SEATTLE — About 10% of men with metastatic prostate cancer show germline pathogenic alterations which can inform precision therapy, surveillance, and cancer prevention for family members, according to a recent study.
The presentation at the recent American Society of Clinical Oncology meeting pointed out that national guidelines recommend germline genetic testing be offered to all men with mPC, but uptake of testing in the community has been documented to be 10-12% with numerous barriers.1
Researchers from the VA Puget Sound Healthcare System in Seattle and colleagues conducted a study to determine uptake of testing using remote consenting and testing for veterans with mPC who had participated in the VA’s Million Veteran Program (MVP). “We wanted to know if remote testing could augment point-of-care counseling and ordering to increase uptake of germline testing,” they explained.
Also participating were researchers from VAMCs in Philadelphia, Boston, as well as Bedford and Roxbury Crossing, MA.
Researchers contacted veterans by mail with an option to opt out of future contact. Those who did not opt out were sent information about the study and received a follow-up call to establish interest in germline testing with a CLIA-level germline test.
Veterans expressing interest provided verbal informed consent and were mailed a saliva collection kit for a multigene cancer predisposition gene panel test. The study team disclosed results by phone and mailed them to the patient with genetic counseling support. Information was also sent to the oncology healthcare provider. Two research coordinators and two part-time genetic counselors provided consenting, counseling and return of results.
The researchers noted that a study evaluating facilitated communication of results to first degree relatives (FDR) and germline testing of FDR was a component of the study.
As of early February, 1,952 veterans who were alive with an incident diagnosis of mPC were identified through MVP and did not opt out and received informational letters. About 35% completed informed consent and 23% of the total original cohort completed testing.
Of the participants, 70% were white, 21% were Black, 0.5% Asian and 8% unknown. Results indicated that 13% had a germline pathogenic variant, with documentation of positive germline results from study in the chart reports at 58%.
Of 30 results relevant for targeted therapy, 16 have received that therapy, 11 were not yet appropriate, and 3 patients did not receive targeted therapy. In addition, 29 family members were contacted and tested through the pilot study of facilitated contact and testing.
“We evaluated uptake of germline testing using a remote, VA system-wide approach to identify and offer genetic testing for veterans with mPC with access and cost issues removed,” the researchers concluded. “We completed germline testing at rates higher than those reported in the community with modest personnel requirements, in a diverse population of patients. Documentation of results in the electronic medical record can be improved. Remote genetic testing can augment uptake of testing in large integrated health care systems.”
- Montgomery RB, Lynch JA, Brown J, Maxwell KN, et. Al. Remote delivery of cancer genetic testing in veterans with metastatic prostate cancer: A Million Veteran Program study. J Clin Oncol 42, 2024 (suppl 16; abstr 1541). Presented at: 2024 American Society for Clinical Oncology Annual Meeting. May 31-June 4, Chicago, Illinois.
