Improving germline genetic testing in pancreatic cancer: A quality improvement project.

Abstract

e16414 Background: Germline testing (GT) can provide insights into risk stratification, clinical management and potential eligibility for targeted therapies, yet uptake of GT in clinical practice remains inconsistent. National Comprehensive Cancer Network (NCCN) 2019 recommends GT for all patients with exocrine pancreatic cancer [1] . This quality improvement study aimed at identifying hurdles in testing and enhancing the integration of GT in clinical practice. Methods: A multistep approach was implemented in our cancer center including oncologists, nurses, and genetic counsellors. A random sample of patients diagnosed with pancreatic adenocarcinoma between January 1 2022 to June 30 2023 with active follow-up were analysed for baseline data. Exclusion criteria included time to hospice of less than 1 month, pregnancy, and patient refusal. Interventions included implementation of clinic initiated GT as opposed to genetic counselling referrals, introduction of a smart phrase for consent documentation, simplified forms for GT to standardize gene panels, and an information booklet to improve patient understanding of the testing process. Post-intervention analysis included all patients between July 1 2023 and September 30, 2024. Data on testing rates, time to results, and ordered gene panel were collected. Results: Baseline results showed that 37.8% completed testing, 8% had incomplete testing and 54.05% did not get tested. Post-intervention data showed completed testing in 63.7% patients. 3.75% had incomplete testing and 32.5% did not get tested. The p-value was 0.015399, significant at p < 0.05. With the current interventions, there was an absolute increase in testing rates by 25.95%. Time to GT results from diagnosis was also compared with the mean improving from 168.94 days pre-intervention to 77.68 days post-intervention and the median from 80 to 55 days. Conclusions: Factors contributing to low testing were the existence of a multistep process for GT with ultimate loss of follow-up, complicated testing forms, patient and provider education. This improvement is primarily related to increased awareness by our providers and cancer-specific simplified testing forms and showed that oncology clinic-initiated testing is more effective and faster than direct hereditary cancer clinic referrals. Our study indicates the need for further improvements and paths ways for future prospective clinical trials. We acknowledge the gap in patients' understanding of the role of GT and plan to incorporate it in future studies. References Margaret AT. NCCN Guidelines updates: pancreatic cancer. J Natl Compr Canc Netw. 2019;17(5.5):603-605. Pre and post intervention data. Pre-intervention Post-intervention Number (Percentage %) Number (Percentage %) Total 50 99 Excluded 13 19 Included 37 80 Incomplete testing 3 (8%) 3 (3.75%) No testing 20 (54.05%) 26 (32.5%) Tested 14 (37.8%) 51 (63.7%) Mean time to results 168.94 days 77.68 days