New data presented Sunday at the American Society for Radiation Oncology (ASTRO) Annual Meeting shows that precision medicine navigators (PMNs) increased the rate of genetic testing in Black prostate cancer patients six-fold. The findings have the potential to significantly reduce the health inequities and improve health outcomes for black patients.
“Black patients with prostate cancer in the U.S. have disparately worse clinical outcomes compared to other racial groups,” said lead study author Alexander J. Allen, MD, a radiation oncology resident physician at the University of Maryland Medical Center in Baltimore. “Our findings suggest hiring a precision medicine navigator who specializes in genetic testing can improve the rates of Black patients receiving these tests, which could potentially reduce health disparities and improve outcomes.”
Prior research has shown that Black patients have a 76% higher incidence rate of prostate cancer and are more than 120% more likely to die from the disease compared with their white peers. The discrepancy in diagnostic rates is likely due from a number of factors, one of which is the lower rate of prostate cancer screening in the Black population.
The use of genomic testing prostate cancer is used to predict whether the cancer will metastasize within the next 10 years. Research presented last year at ASTRO indicated that testing to analyze RNA markers from tissue samples was better at predicting metastasis rates than conventional testing such as Gleason score and PSA levels. Allen suggest that treating physicians employ all three methods with their patients.
“Genomic testing provides additional information that can alter a patient’s treatment plan,” Allen noted. “For example, if Gleason scores and PSA levels suggest a patient has an intermediate risk for metastases, but the genetic analysis categorizes them at high risk because of the biological makeup of the tumor, then you might intensify treatment.”
The use of patient navigators stretches back more than 30 years with the first program launched at Harlem Hospital Center in 1990 in an effort to reduce healthcare disparities in cancer care, according to the American Cancer Society. Since then—along with the advent of genomic cancer testing—the field of precision medicine navigators has sprung up with the sole job of these navigators being to identify patient eligible for genetic testing and then ensuring these tests are completed. It is a highly specialized skills that requires a detailed understanding of care pathways and how individual treatment centers operate.
“Obtaining genetic tests in a clinical setting is complex and requires knowledge of the submission requirements,” he said. After working with health care providers to identify which patients are eligible, the navigator helps the patient fill out requisition forms and coordinates the submission of biopsy tissue samples to the appropriate genomic testing company.
For the study presented Sunday, the investigators collected data on how frequently prostate cancer patients in a large medical system received genetic testing from the seven months prior to the arrival of a PMN to the seven months following the creation of that position.
The study comprised 693 patients. Of those 44.9% (n=311) were treated prior to the arrival of the PMN and 55.1% (n=382) were treated after the PMN began work. The median age in both groups was 68 years, and racial distributions among the two groups were similar (60% white, 35.1% and 34% Black, 3.2% and 3.7% Asian/Pacific Islander and 1.3% and 2.1% Latino). There were no significant differences between the two groups in disease severity, type of insurance coverage or type of facility in which they were treated.
The data showed that Black patients seen by the PMN were six times more likely to receive testing than those not seen by a PMN. Following the arrival of the PMN, the proportion of Black patients referred for genomic testing also rose from 19% to 58%. Similar increases in genomic testing rates were found for lower-income patients (from 20% to 64%), those on Medicare and Medicaid (from 20% to 68.5%) and people who were being treated at community hospitals (from 6% to 77%), after the introduction of the PMN.
“We thought there would be some increase but did not expect the testing rates to grow so substantially,” Allen added. He also said that genomic testing results altered treatment plans for many patients who received them. “The most common way treatments were altered based on genomic testing results was in whether or not patients with intermediate risk disease were given hormone blocking therapy,” in which hormones are suppressed to stop them from fueling cancer cell growth.
Next steps for this line of study, Allen noted, is to determine the effects these increased genomic testing rates have on health outcomes. A potential stumbling block for increased use of PMNs remains, however, as they are not typically funded in current models, which suggests the potential need for novel funding methods to ensure wider use of PMNs as an effective measure of decreasing health disparities.
“As precision medicine becomes more mainstream, it has the potential to alleviate disparities,” Allen concluded. “But if there are no measures taken to ensure access to these tools, we could just be maintaining or even worsening the health inequities that we have today.”
