e22634 Background: Prostate, pancreatic, and ovarian cancer are malignancies with known high prevalences of pathogenic germline variants strongly associated with development of these malignancies. The implications for germline genetic testing (GGT) are significant and can have a substantial impact on patient care, treatment decisions, and prognostication. Furthermore, GGT can identify unaffected family members who may benefit from cancer screening and/or interventions to reduce their risk of various cancers. As of 2019, National Comprehensive Cancer Network (NCCN) guidelines recommend universal GGT for high/very-high risk localized or metastatic prostate cancer, exocrine pancreatic cancer, and epithelial ovarian cancer. Despite this recommendation, low rates of genetic counseling (GC) referrals and GGT are well-recognized concerns within the field. Therefore, we sought to determine the rates of GC referrals and GGT at our rural-based institution for the aforementioned cancers. Methods: Following IRB approval, we identified all adult patients diagnosed in our health system between January 2020 and January 2024 with high/very-high risk localized prostate cancer, node-positive/metastatic prostate cancer, epithelial ovarian cancer, and exocrine pancreatic cancer. Those who previously had undergone GGT for hereditary cancer evaluation were excluded. Via retrospective review of patient electronic health records, we captured demographics, disease-specific variables, and data regarding GC appointments, patient access, and GGT by cancer type. Results: Six hundred twenty-one patients met study inclusion criteria: (55% prostate, 31% pancreatic, 13% ovarian). Our sample was 98% White, 74% male, 53% current/former smoker, had a median age of 71 years, and 63% lived in a non-metropolitan area. Most patients had stage III or IV disease (72%). In total, 168 (27%) had a GC order (16% prostate, 26% pancreatic, 75% ovarian; p < 0.01), 106 (17%) completed a GC appointment (9.6% prostate, 13% pancreatic, 58% ovarian; p < 0.01), and 106 (17%) underwent GGT (9.6% prostate, 14% pancreatic, 55% ovarian; p< 0.01). Median time from diagnosis to GC appointment was 129 days (148 prostate, 115 pancreatic, 129 ovarian; p = 0.3). Most GC orders were placed by medical oncology (72%), followed by radiation oncology (17%). Conclusions: Despite clear NCCN recommendations for universal testing for high/very-high risk localized or metastatic prostate cancer, pancreatic cancer, and ovarian cancer, our institution has very low rates of GC referrals and GGT. Ovarian cancer had the highest rates of GC and GGT (58% and 55%, respectively), rates still far from optimal. Despite low rates of GGT in these cancers, our data appear consistent with national trends for GGT (10% prostate, 22% pancreatic, 55% ovarian). A future study will identify barriers to GC and GGT and propose strategies to increase GGT rates at our institution.
O'Neil et al. (Thu,) studied this question.