Precision medicine navigators increase genomic testing rates for Black patients with prostate cancer

The presence of a medical navigator to behave as a liaison between individuals with prostate most cancers and the well being care system vastly will increase the probability that sufferers, particularly Black sufferers, will obtain superior testing that may assist predict the severity of their illness and information therapy, a brand new examine suggests.

The examine confirmed patients seen by a precision medication navigator had been considerably extra more likely to obtain genomic testing than these not seen by the navigator. Black sufferers, whose genomic testing charges historically are a lot decrease than white sufferers, skilled a six-fold enhance in the event that they had been seen by a navigator.

Findings had been offered on the American Society for Radiation Oncology (ASTRO) Annual Meeting.

“Black sufferers with prostate most cancers within the U.S. have disparately worse medical outcomes in comparison with different racial groups,” mentioned lead examine writer Alexander J. Allen, MD, a radiation oncology resident doctor on the College of Maryland Medical Middle in Baltimore. “Our findings counsel hiring a precision medication navigator who focuses on genetic testing can enhance the charges of Black sufferers receiving these checks, which might doubtlessly scale back health disparities and enhance outcomes.”

Analysis shows Black sufferers are 76% extra more likely to be identified with prostate most cancers than white patients and 120% extra more likely to die from it. This disparity stems from many elements, together with lower rates of early prostate most cancers screening that lead to extra aggressive cancers by the point Black sufferers are identified.

Genomic testing is used to gauge the probability {that a} most cancers will metastasize, or unfold past the prostate, inside the subsequent 5 to 10 years; the commonest type of this take a look at is named Decipher, which analyzes RNA markers in tumor tissue samples.

Research offered at ASTRO’s 2021 Annual Assembly prompt genomic testing could also be higher at predicting the danger for metastases than standard prostate most cancers checks, such because the Gleason rating and prostate-specific antigen (PSA) ranges. Dr. Allen mentioned oncologists use the outcomes of all three checks to information therapy selections.

“Genomic testing supplies extra data that may alter a affected person’s therapy plan,” he mentioned. “For instance, if Gleason scores and PSA ranges counsel a affected person has an intermediate danger for metastases, however the genetic analysis categorizes them at excessive danger due to the organic make-up of the tumor, you then may intensify therapy.”

Precision medication navigators are individuals whose job is concentrated fully on figuring out sufferers eligible for genomic testing after which ensuring the checks are accomplished—a job Dr. Allen mentioned is way more sophisticated than it sounds.

“Acquiring genetic checks in a medical setting is complicated and requires data of the submission necessities,” he mentioned. After working with health care providers to determine which sufferers are eligible, the navigator helps the affected person fill out requisition types and coordinates the submission of biopsy tissue samples to the suitable genomic testing firm.

On this examine, researchers in contrast how ceaselessly sufferers with prostate most cancers in a big health care system obtained genetic testing from the seven months previous to the arrival of a precision medication navigator (PMN) to the seven months following the creation of that place.

Of the 693 sufferers studied, 44.9% (n=311) had been handled previous to the arrival of the PMN and 55.1% (n=382) had been handled after the PMN started work. The median age in each teams was 68 years, and racial distributions had been comparable (60% white, 35.1% and 34% Black, 3.2% and three.7% Asian/Pacific Islander and 1.3% and a pair of.1% Latino). There have been no important variations between the 2 teams in illness severity, kind of insurance coverage protection or kind of facility during which they had been handled.

Black sufferers seen by the PMN had been six instances extra more likely to obtain testing than these not seen by a PMN. Following the arrival of the PMN, the proportion of Black sufferers referred for genomic testing rose from 19% to 58%. Genomic testing charges additionally rose for lower-income sufferers (from 20% to 64%), these on Medicare and Medicaid (from 20% to 68.5%) and individuals who had been being handled at neighborhood hospitals (from 6% to 77%), after the introduction of the PMN.

“We thought there can be some enhance however didn’t count on the testing charges to develop so considerably,” Dr. Allen mentioned. He additionally mentioned that genomic testing outcomes altered therapy plans for a lot of sufferers who obtained them. “The commonest manner remedies had been altered based mostly on genomic testing outcomes was in whether or not or not sufferers with intermediate danger illness got hormone blocking remedy,” during which hormones are suppressed to cease them from fueling cancer cell development.

Dr. Allen mentioned the following step for his staff is to design a examine that investigates whether or not the elevated charges of genomic testing finally result in higher affected person outcomes. “We theorize that if sufferers are handled in another way based mostly on this new genome-based danger stratification, outcomes will enhance.”

However ensuring genomic testing is offered to all sufferers who may profit will likely be key to serving to reduce racial disparities in prostate cancer going ahead, he mentioned.

“As precision medication turns into extra mainstream, it has the potential to alleviate disparities,” mentioned Dr. Allen. “But when there are not any measures taken to make sure entry to those instruments, we might simply be sustaining and even worsening the well being inequities that we’ve got immediately.”