Clinical navigators may improve genomic testing rates among Black patients with prostate cancer

Black patients with prostate cancer who were seen by a precision medicine navigator (PMN) were 6 times more likely to undergo genomic testing to determine the extent of their disease and help guide treatment decisions compared with those who did not see the navigator.

"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,” says Alexander J. Allen, MD.

The findings were presented at the 2023 American Society for Radiation Oncology (ASTRO) meeting in San Diego, California.^1,2

“Black patients with prostate cancer in the US have disparately worse clinical outcomes compared [with] other racial groups. 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,” said lead author Alexander J. Allen, MD, in a news release on the findings.² Allen is a radiation oncology resident physician at the University of Maryland Medical Center in Baltimore, Maryland.

In total, the study enrolled 693 patients who were being treated for prostate cancer at a large health care system. Of those, 44.9% (n = 311) of patients were treated in the 7 months prior to the addition of a PMN, and 55.1% (n = 382) were treated in the 7 months following the start of the PMN position. Both patient cohorts were similar in age, racial distributions, disease severity, type of insurance coverage, and type of facility where they were treated.

After implementation of the role, the PMN worked to assist patients who were deemed eligible for genomic testing in completing requisition forms and submitting biopsy tissue samples.

Data showed that the proportion of Black patients referred for genomic testing increased significantly after the implementation of the PMN, rising from 19% to 58%. Further, the proportion of patients who were lower income referred for genomic testing rose from 20% to 64% following the addition of the PMN.

Those on Medicare and Medicaid also experienced a rise in referrals, increasing from 20% to 68.5% after the PMN joined the team. Patients who were being treated in community hospitals were also more likely to be referred following implementation of the PMN, with an increase from 6% to 77% in this population.

“We thought there would be some increase but did not expect the testing rates to grow so substantially. 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,” commented Allen in the news release.²

The team next plans to explore whether the increase in referrals and altered treatment plans ultimately leads to improved patient outcomes. Allen noted, however, that funding for PMN’s and access to genomic testing is crucial.

Allen concluded in the news release,² “As precision medicine becomes more mainstream, it has the potential to alleviate disparities. 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.”

References

1. A precision medicine navigator can mitigate inequities associated with utilization of genomic tests in Black men with prostate cancer. Presented at the American Society for Radiation Oncology (ASTRO) Annual Meeting. October 1-4, 2023. San Diego, California. Abstract 122

2. Precision medicine navigators increase genomic testing rates for Black patients with prostate cancer. News release. American Society for Radiation Oncology (ASTRO). September 28, 2023. Accessed October 3, 2023. https://www.newswise.com/articles/precision-medicine-navigators-increase-genomic-testing-rates-for-black-patients-with-prostate-cancer