Empowering young-onset colorectal cancer patients with an accessible, self-navigable online platform for universal germline testing.

Abstract

11004 Background: Since 2022, the National Comprehensive Cancer Network (NCCN) has recommended universal germline testing (UGT) for all individuals diagnosed with colorectal cancer (CRC) under age 50. Up to 20% harbor a germline cancer predisposition, and identifying this high-risk cohort is critical for personalized care. Realizing UGT has been hampered by access to and delivery of cancer genetics care, highlighting the need for novel strategies. We report the impact of an accessible, self-navigable online platform for UGT. Methods: Consecutive YOCRC patients were offered a standardized care pathway including UGT. A prospective quality improvement trial aimed at UGT launched an interactive online platform designed to enable self-eligibility screening, self-navigation to video-based pretest education and counseling, consent submission, and blood or saliva collection arrangements. Patients could self-opt for genetic counseling (GC, in-person or virtual) at any time, and those who did not engage with the online platform after 3 invitations were reflexively referred to GC. The trial was designed with a 3-month run-in pilot followed by a 12-month study period. The primary outcome was UGT completion rate; secondary outcomes were process feasibility and GC resource preserved. Results: Among 377 YOCRC patients, 158 had GT prior to referral, 7 were international, 3 declined all contact, and 209 patients were invited to the online UGT platform. Another 49 reported prior GT, leaving 160 patients of interest. Active platform engagement was observed in the majority (100 of 160 patients, 63%), where 89 (89%) completed UGT, including 79 (96%) of the 82 who self-navigated the entire online platform and 10 (71%) of the 14 who had opted for GC. Lack of platform engagement led to reflex GC referral for 60 patients, and 19 (32%) have completed GT to date. Taken together, among 160 patients of interest, pre-test GC workforce involvement was spared in 79 (49%) patients through the online platform. Conclusions: The rising incidence of YOCRC, increasing patient demand and limited GC resources are barriers to executing UGT. We successfully implemented an online platform achieving 96% GT completion rate among those who self-navigated the entire process, and eliminating the need for pre-test GC resource utilization in nearly half of the cases. Our experience supports online care delivery platforms that highlight accessibility and autonomy.