LOS ANGELES, Calif., May 24, 2023 – A team of Prostate Cancer Foundation (PCF)-funded researchers found that U.S. Veterans with cancer who receive in-person genetics counseling versus a telehealth consult are significantly more likely to complete full germline genetic testing, findings which may help address disparities in patient access to precision oncology therapies and improve early detection and screening practices for families.
The research led by 2020 Gary & Allison Lieberman-PCF VAlor Young Investigator Award recipient Kara Maxwell, MD, PhD, and her team at the Corporal Michael J. Crescenz Veterans Affairs Medical Center (CMCVAMC) was recently published in the journal JCO Oncology Practice. Maxwell is also the Director of the newly established Men & BRCA Program within the Basser Center for BRCA at Penn Medicine.
“Without a doubt, telemedicine has many benefits, but this research shows that when it comes to genetic counseling and testing, in-person consults are most impactful,” said PCF Executive Vice President and Chief Science Officer Howard R. Soule, PhD. “PCF commends Dr. Maxwell and her colleagues and proudly supports their efforts to extend leading-edge precision oncology care to our nation’s Veterans.”
The Veterans Health Administration (VHA) is the largest integrated health care system in the United States, providing care to over 9 million Veterans. Among them, prostate cancer is the most frequently diagnosed cancer, accounting for about a third of all VA cancer cases.
Germline genetic testing, which evaluates inherited mutations in genes, plays a large role in secondary screening for (in at risk individuals) and treatment of prostate, and several other, cancers. However, barriers to genetic testing – such as lack of access to cancer genetic services and an overall shortage of genetics service providers, both within and outside of the VA – translate to missed opportunities to diagnose cancer earlier, identify at risk family members, and offer precision oncology treatment. Telehealth genetic consults, also known as telegenetics, help expand access to genetic services, but some studies suggest that they widen racial and ethnic disparities with regard to genetic testing. The VA provides genetics care to Veterans through telegenetics as well as through on-site programs such as the racially diverse oncology practice at CMCVAMC.
To determine whether an on-site, nurse-led genetics program could address these barriers and improve cancer genetic care, Maxwell – a CMCVAMC staff physician and an Assistant Professor of Medicine and Genetics in the Perelman School of Medicine at the University of Pennsylvania – and colleagues conducted a retrospective study of 238 Veterans referred to CMCVAMC for genetics services. Of this cohort, 130 received consults through the VA’s telegenetics service and 108 through on-site consultations. More than 50% of the patients were Black. A total of 117 underwent germline testing after the genetics consult.
Researchers found that those who were seen on-site had higher rates of genetic testing completion and lower rates of being lost to continuing follow-up care. Patients seen on-site had more than a three-fold higher likelihood of completed germline testing; and for Black Veterans, the likelihood was close to five-fold higher.
Explaining the results, the researchers point out that patients receiving on-site consults had better access to genetic testing. In the on-site program, led by advanced practice genetics nurse and study co-author Lisa Aiello, PhD, RN, AOCNS, genetic testing occurs at the time of the consult; with the telegenetics model, testing kits are mailed to the Veteran’s home to be completed later, which can be a significant barrier, particularly for Veterans with unstable housing. Researchers also explain that a face-to-face interaction with a trusted health care provider may be a better forum for having psychosocially complex genetic counseling discussions than telemedicine.
Taken together, the findings suggest that an on-site genetics service can potentially mitigate barriers and disparities and increase access to germline genetic testing for all patients regardless of racial or ethnic background.
The study builds on PCF’s collaboration with VA’s Office of Nursing Services and Office of Research and Development and two national program offices, the VA Informatics and Computing Infrastructure (Salt Lake City, UT) and the National Oncology Program (Durham, NC). Experts including Lori Hoffman Hogg, MS, RN, CNS, AOCN®, VHA’s Office of Nursing Services National Clinical Nurse Advisor and the VHA National Program Manager for Prevention Policy at the National Center for Health Promotion and Disease Prevention, and Julie A. Lynch, PhD, MBA, RN, a Clinical Research Scientist and Investigator at the Veterans Healthcare Administration (VA), identified the opportunity to enhance the delivery of precision oncology through nursing-led genetic service, research, and training programs.
In conducting this study, Maxwell was also supported by the Basser Center for BRCA at Penn Medicine, the National Cancer Institute, the Burroughs Wellcome Fund, and Independence Blue Cross through the PCF New Data Nurse of the Future pilot program award, which supported Aiello and established the nurse-led genetics service program at CMCVAMC serving a catchment area of VA medical centers in Philadelphia, PA, East Orange, NJ, and Wilmington, DE. This program works in conjunction with PCF’s Veterans Health Initiative, which has committed more than $50 million through a multi-year partnership with the VA to provide US Veterans with access to precision oncology care, genomics research and clinical trials. The Philadelphia CMCVAMC is the Precision Oncology Center of Excellence in honor of Jonathan and Plum Simons with funding support from Andy Astrachan of the AJA Foundation and Marc and Mindy Utay of the Utay Family Foundation in collaboration with the University of Pennsylvania, administrative support from the VA Non-Profit Philadelphia Research Education Foundation (PREF) and CMCVAMC. PCF’s nurse-led genetics service network is further supported by Arthur Rabin and Drew and Melissa Katz of the Katz Foundation.
About the Prostate Cancer Foundation
The Prostate Cancer Foundation (PCF) is the world’s leading philanthropic organization dedicated to funding life-saving prostate cancer research. Founded in 1993 by Mike Milken, PCF has been responsible for raising close to $1 billion in support of cutting-edge research by more than 2,200 research projects at 245 leading cancer centers in 28 countries around the world. Since PCF’s inception, and through its efforts, patients around the world are living longer, suffering fewer complications, and enjoying better quality of life. PCF is committed to creating a global public square for prostate cancer, in service to our mission of ending death and suffering from the disease. Learn more at pcf.org.
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Staci L. Vernick
Prostate Cancer Foundation