Retrospective review of clinical factors influencing germline testing in patients with pancreatic cancer across a hospital system between 2021–2023.

44 Background: The National Comprehensive Cancer Network (NCCN) recommends germline testing for all patients with pancreatic cancer, as the presence of hereditary mutations can guide treatment decisions and can be central to screening recommendations for patients’ families. This study assessed clinical processes associated with completion of germline testing. Methods: At a 2021 year-end meeting as a part of the Integrated Network Cancer Program, it was decided to start tracking rates of genetic testing. We conducted a retrospective analysis of patients diagnosed with and treated for pancreatic cancer within the Allegheny Health Network (AHN) for the year prior to data tracking, 2021, and the two years post (2022 and 2023). Demographic variables including age, sex, race, marital status, and median household income based on residential ZIP code were collected. Interventions of interest included: (1) number of tumor board presentations, (2) placement of referral orders to oncology genetics, and (3) appointment with genetic counseling. One model of logistic regression was conducted to examine the effect of the year and interventions on germline testing after controlling the covariates. Analyses were performed in SAS 9.4 with α = 0.05. Results: Among 549 patients treated for pancreatic cancer between 2021 and 2023 within AHN, 219 (40%) underwent germline testing, and 39 had actionable mutations including ATM , BRCA1 , BRCA2 , and CHEK2 . Tumor board presentation was not significantly associated with testing while controlling for demographics (OR = 1.12; 95% CI: 0.61–2.07; p = .7140). Genetic testing completion increased significantly by year: compared to 2021, odds were 3.45 times higher in 2022 (95% CI: 1.60–7.42; p = .0015) and 5.95 times higher in 2023 (95% CI: 2.64–13.42; p < .0001). Referral to oncology genetics was associated with increased testing (OR = 3.52; 95% CI: 1.84–6.73; p = .0001), and genetic counseling attendance was the strongest predictor (OR = 46.54; 95% CI: 21.96–98.63; p < .0001). Conclusions: Active tracking, referral to oncology genetics, and completion of genetic counseling appointments are strongly associated with increased rates of germline testing among patients with pancreatic cancer. Quality improvement projects to further streamline referral processes may aid in the completion of necessary testing. These findings highlight the critical role of care coordination and referral pathways in ensuring adherence to NCCN guidelines.