Germline Genetic Testing in Advanced Prostate Cancer; Practices and Barriers

Survey Results from the Germline Genetics Working Group of the Prostate Cancer Clinical Trials Consortium

PCCTC Germline Genetics Working Group

Research output: Contribution to journalArticle

Abstract

Background: Germline genetic testing increasingly identifies advanced prostate cancer (PCa) patients who are candidates for precision therapies. The Prostate Cancer Clinical Trials Consortium (PCCTC) established the Germline Genetics Working Group to provide guidance and resources to expand effective use of germline genetic testing. Materials and Methods: A 14-item questionnaire was e-mailed to academic oncologists at 43 PCCTC sites to collect information on germline genetic testing patterns, including patients considered, choice of assays, barriers slowing adoption, and actions to overcome barriers. Results: Twenty-six genitourinary oncologists from 19 institutions responded. Less than 40% (10 of 26) reported referring patients to a genetics department, whereas the remainder take personal responsibility for genetic testing and counseling; 16 (62%) consider testing all metastatic PCa patients, whereas 3 (12%) consider testing all patients with high-risk local disease; and 7 (27%) use multigene comprehensive pan-cancer panels, and 14 (54%) use smaller or targeted cancer gene panels. Barriers to widespread use are: (1) delayed or limited access to genetic counseling; (2) no insurance coverage; (3) lack of effective workflows; (4) insufficient educational materials; and (5) time and space constraints in busy clinics. The primary limitation was the <50% (19 of 43) response from PCCTC sites and no coverage of nonacademic cancer treatment facilities. Conclusion: Joint efforts by urologists, oncologists, genetics counselors, insurers, and cancer centers can accelerate implementation of integrated germline genetic services for personalized treatment and clinical trial eligibility for PCa patients. More than 10% of patients with advanced prostate cancer carry inherited genetic mutations that might amplify their response to targeted therapies, but barriers, including a shortage of genetic counselors, limit patient access to testing that would enable targeted therapy. This study of practices in nineteen US comprehensive cancer centers showed that a shortage of genetic counselors and 4 other barriers limit adoption of this important advance. Herein we also catalogue germline genetic testing practices and illuminate initiatives that might expand testing availability.

Original languageEnglish (US)
JournalClinical Genitourinary Cancer
DOIs
StatePublished - Jan 1 2019

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Genetic Testing
Prostatic Neoplasms
Clinical Trials
Genetic Counseling
Neoplasms
Genetic Services
Therapeutics
Insurance Carriers
Insurance Coverage
Workflow
Surveys and Questionnaires
Neoplasm Genes
Mutation
Oncologists
Counselors

Keywords

  • BRCA
  • DNA repair
  • Lynch
  • PARP inhibitors
  • Pembrolizumab

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

@article{6e43c883566d4c8299df19a3e80477fc,
title = "Germline Genetic Testing in Advanced Prostate Cancer; Practices and Barriers: Survey Results from the Germline Genetics Working Group of the Prostate Cancer Clinical Trials Consortium",
abstract = "Background: Germline genetic testing increasingly identifies advanced prostate cancer (PCa) patients who are candidates for precision therapies. The Prostate Cancer Clinical Trials Consortium (PCCTC) established the Germline Genetics Working Group to provide guidance and resources to expand effective use of germline genetic testing. Materials and Methods: A 14-item questionnaire was e-mailed to academic oncologists at 43 PCCTC sites to collect information on germline genetic testing patterns, including patients considered, choice of assays, barriers slowing adoption, and actions to overcome barriers. Results: Twenty-six genitourinary oncologists from 19 institutions responded. Less than 40{\%} (10 of 26) reported referring patients to a genetics department, whereas the remainder take personal responsibility for genetic testing and counseling; 16 (62{\%}) consider testing all metastatic PCa patients, whereas 3 (12{\%}) consider testing all patients with high-risk local disease; and 7 (27{\%}) use multigene comprehensive pan-cancer panels, and 14 (54{\%}) use smaller or targeted cancer gene panels. Barriers to widespread use are: (1) delayed or limited access to genetic counseling; (2) no insurance coverage; (3) lack of effective workflows; (4) insufficient educational materials; and (5) time and space constraints in busy clinics. The primary limitation was the <50{\%} (19 of 43) response from PCCTC sites and no coverage of nonacademic cancer treatment facilities. Conclusion: Joint efforts by urologists, oncologists, genetics counselors, insurers, and cancer centers can accelerate implementation of integrated germline genetic services for personalized treatment and clinical trial eligibility for PCa patients. More than 10{\%} of patients with advanced prostate cancer carry inherited genetic mutations that might amplify their response to targeted therapies, but barriers, including a shortage of genetic counselors, limit patient access to testing that would enable targeted therapy. This study of practices in nineteen US comprehensive cancer centers showed that a shortage of genetic counselors and 4 other barriers limit adoption of this important advance. Herein we also catalogue germline genetic testing practices and illuminate initiatives that might expand testing availability.",
keywords = "BRCA, DNA repair, Lynch, PARP inhibitors, Pembrolizumab",
author = "{PCCTC Germline Genetics Working Group} and Channing Paller and Emmanuel Antonarakis and Beer, {Tomasz M.} and Borno, {Hala T.} and Carlo, {Maria I.} and George, {Daniel J.} and Graff, {Julie N.} and Shilpa Gupta and Heath, {Elisabeth I.} and Higano, {Celestia S.} and McKay, {Rana R.} and Morgans, {Alicia K.} and Akash Patnaik and Petrylak, {Daniel P.} and Rettig, {Matthew B.} and Ryan, {Charles J.} and Taplin, {Mary Ellen} and Whang, {Young E.} and Jacob Vinson and Cheng, {Heather H.} and Giri, {Veda N.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.clgc.2019.04.013",
language = "English (US)",
journal = "Clinical Genitourinary Cancer",
issn = "1558-7673",
publisher = "Elsevier",

}

TY - JOUR

T1 - Germline Genetic Testing in Advanced Prostate Cancer; Practices and Barriers

T2 - Survey Results from the Germline Genetics Working Group of the Prostate Cancer Clinical Trials Consortium

AU - PCCTC Germline Genetics Working Group

AU - Paller, Channing

AU - Antonarakis, Emmanuel

AU - Beer, Tomasz M.

AU - Borno, Hala T.

AU - Carlo, Maria I.

AU - George, Daniel J.

AU - Graff, Julie N.

AU - Gupta, Shilpa

AU - Heath, Elisabeth I.

AU - Higano, Celestia S.

AU - McKay, Rana R.

AU - Morgans, Alicia K.

AU - Patnaik, Akash

AU - Petrylak, Daniel P.

AU - Rettig, Matthew B.

AU - Ryan, Charles J.

AU - Taplin, Mary Ellen

AU - Whang, Young E.

AU - Vinson, Jacob

AU - Cheng, Heather H.

AU - Giri, Veda N.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Germline genetic testing increasingly identifies advanced prostate cancer (PCa) patients who are candidates for precision therapies. The Prostate Cancer Clinical Trials Consortium (PCCTC) established the Germline Genetics Working Group to provide guidance and resources to expand effective use of germline genetic testing. Materials and Methods: A 14-item questionnaire was e-mailed to academic oncologists at 43 PCCTC sites to collect information on germline genetic testing patterns, including patients considered, choice of assays, barriers slowing adoption, and actions to overcome barriers. Results: Twenty-six genitourinary oncologists from 19 institutions responded. Less than 40% (10 of 26) reported referring patients to a genetics department, whereas the remainder take personal responsibility for genetic testing and counseling; 16 (62%) consider testing all metastatic PCa patients, whereas 3 (12%) consider testing all patients with high-risk local disease; and 7 (27%) use multigene comprehensive pan-cancer panels, and 14 (54%) use smaller or targeted cancer gene panels. Barriers to widespread use are: (1) delayed or limited access to genetic counseling; (2) no insurance coverage; (3) lack of effective workflows; (4) insufficient educational materials; and (5) time and space constraints in busy clinics. The primary limitation was the <50% (19 of 43) response from PCCTC sites and no coverage of nonacademic cancer treatment facilities. Conclusion: Joint efforts by urologists, oncologists, genetics counselors, insurers, and cancer centers can accelerate implementation of integrated germline genetic services for personalized treatment and clinical trial eligibility for PCa patients. More than 10% of patients with advanced prostate cancer carry inherited genetic mutations that might amplify their response to targeted therapies, but barriers, including a shortage of genetic counselors, limit patient access to testing that would enable targeted therapy. This study of practices in nineteen US comprehensive cancer centers showed that a shortage of genetic counselors and 4 other barriers limit adoption of this important advance. Herein we also catalogue germline genetic testing practices and illuminate initiatives that might expand testing availability.

AB - Background: Germline genetic testing increasingly identifies advanced prostate cancer (PCa) patients who are candidates for precision therapies. The Prostate Cancer Clinical Trials Consortium (PCCTC) established the Germline Genetics Working Group to provide guidance and resources to expand effective use of germline genetic testing. Materials and Methods: A 14-item questionnaire was e-mailed to academic oncologists at 43 PCCTC sites to collect information on germline genetic testing patterns, including patients considered, choice of assays, barriers slowing adoption, and actions to overcome barriers. Results: Twenty-six genitourinary oncologists from 19 institutions responded. Less than 40% (10 of 26) reported referring patients to a genetics department, whereas the remainder take personal responsibility for genetic testing and counseling; 16 (62%) consider testing all metastatic PCa patients, whereas 3 (12%) consider testing all patients with high-risk local disease; and 7 (27%) use multigene comprehensive pan-cancer panels, and 14 (54%) use smaller or targeted cancer gene panels. Barriers to widespread use are: (1) delayed or limited access to genetic counseling; (2) no insurance coverage; (3) lack of effective workflows; (4) insufficient educational materials; and (5) time and space constraints in busy clinics. The primary limitation was the <50% (19 of 43) response from PCCTC sites and no coverage of nonacademic cancer treatment facilities. Conclusion: Joint efforts by urologists, oncologists, genetics counselors, insurers, and cancer centers can accelerate implementation of integrated germline genetic services for personalized treatment and clinical trial eligibility for PCa patients. More than 10% of patients with advanced prostate cancer carry inherited genetic mutations that might amplify their response to targeted therapies, but barriers, including a shortage of genetic counselors, limit patient access to testing that would enable targeted therapy. This study of practices in nineteen US comprehensive cancer centers showed that a shortage of genetic counselors and 4 other barriers limit adoption of this important advance. Herein we also catalogue germline genetic testing practices and illuminate initiatives that might expand testing availability.

KW - BRCA

KW - DNA repair

KW - Lynch

KW - PARP inhibitors

KW - Pembrolizumab

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U2 - 10.1016/j.clgc.2019.04.013

DO - 10.1016/j.clgc.2019.04.013

M3 - Article

JO - Clinical Genitourinary Cancer

JF - Clinical Genitourinary Cancer

SN - 1558-7673

ER -