The presence of a clinical navigator to act as a liaison between individuals with prostate cancer and the health care system greatly increases the likelihood that patients, especially Black patients, will receive advanced testing that might help predict the severity of their disease and guide treatment, a brand new study suggests.
The study showed patients seen by a precision medicine navigator were substantially more prone to receive genomic testing than those not seen by the navigator. Black patients, whose genomic testing rates traditionally are much lower than white patients, experienced a six-fold increase in the event that they were seen by a navigator. Findings can be presented today on the American Society for Radiation Oncology (ASTRO) Annual Meeting.
Black patients with prostate cancer within the U.S. have disparately worse clinical outcomes in comparison with other racial groups. Our findings suggest hiring a precision medicine navigator who makes a speciality of genetic testing can improve the rates of Black patients receiving these tests, which could potentially reduce health disparities and improve outcomes.”
Alexander J. Allen, MD, lead study writer, radiation oncology resident physician on the University of Maryland Medical Center in Baltimore
Research shows Black patients are 76% more prone to be diagnosed with prostate cancer than white patients and 120% more prone to die from it. This disparity stems from many aspects, including lower rates of early prostate cancer screening that lead to more aggressive cancers by the point Black patients are diagnosed.
Genomic testing is used to gauge the likelihood that a cancer will metastasize, or spread beyond the prostate, inside the following five to 10 years; essentially the most common type of this test is known as Decipher, which analyzes RNA markers in tumor tissue samples. Research presented at ASTRO’s 2021 Annual Meeting suggested genomic testing could also be higher at predicting the chance for metastases than conventional prostate cancer tests, corresponding to the Gleason rating and prostate-specific antigen (PSA) levels. Dr. Allen said oncologists use the outcomes of all three tests to guide treatment decisions.
“Genomic testing provides additional information that may alter a patient’s treatment plan,” he said. “For instance, if Gleason scores and PSA levels suggest a patient has an intermediate risk for metastases, however the genetic evaluation categorizes them at high risk due to biological makeup of the tumor, then you definitely might intensify treatment.”
Precision medicine navigators are people whose job is concentrated entirely on identifying patients eligible for genomic testing after which ensuring the tests are accomplished – a task Dr. Allen said is rather more complicated than it sounds.
“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 discover which patients are eligible, the navigator helps the patient fill out requisition forms and coordinates the submission of biopsy tissue samples to the suitable genomic testing company.
On this study, researchers compared how regularly patients with prostate cancer in a big health care system received genetic testing from the seven months prior to the arrival of a precision medicine navigator (PMN) to the seven months following the creation of that position. Of the 693 patients studied, 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 each groups was 68 years, and racial distributions were similar (60% white, 35.1% and 34% Black, 3.2% and three.7% Asian/Pacific Islander and 1.3% and a couple of.1% Latino). There have been no significant differences between the 2 groups in disease severity, form of insurance coverage or form of facility through which they were treated.
Black patients seen by the PMN were six times more prone 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 rose from 19% to 58%. Genomic testing rates also rose for lower-income patients (from 20% to 64%), those on Medicare and Medicaid (from 20% to 68.5%) and other people who were being treated at community hospitals (from 6% to 77%), after the introduction of the PMN.
“We thought there can be some increase but didn’t expect the testing rates to grow so substantially,” Dr. Allen said. He also said that genomic testing results altered treatment plans for a lot of patients who received them. “Probably the most common way treatments were altered based on genomic testing results was in whether or not patients with intermediate risk disease got hormone blocking therapy,” through which hormones are suppressed to stop them from fueling cancer cell growth.
Dr. Allen said the following step for his team is to design a study that investigates whether the increased rates of genomic testing ultimately lead to higher patient outcomes. “We theorize that if patients are treated in another way based on this recent genome-based risk stratification, outcomes will improve.”
But ensuring genomic testing is obtainable to all patients who might profit can be key to helping lessen racial disparities in prostate cancer going forward, he said. Precision medicine navigators are usually not funded through traditional business models, suggesting that novel funding mechanisms may should be initiated to diminish disparities.
“As precision medicine becomes more mainstream, it has the potential to alleviate disparities,” said Dr. Allen. “But when there aren’t any measures taken to make sure access to those tools, we could just be maintaining and even worsening the health inequities that we have now today.”