Genetic Testing in the Safety Net: Improving Equity in Prostate Cancer Treatment
Abstract
Recent advances in prostate cancer treatment have not benefited all populations equally. Compared to white men, black and low-income men receive appropriate treatment less frequently and also are 2-3 times more likely to die of prostate cancer. In 2018, professional medical societies began recommending genetic testing following a diagnosis for prostate cancer to a broader patient population, including men with early-stage disease, in order to help guide doctors in making personalized decisions about the most effective type of treatment. However, white and insured patients are more likely to receive genetic testing services, potentially exacerbating gaps in prostate cancer outcomes. Most of what is known about implementing new cancer care procedures comes from large health care delivery settings, like comprehensive cancer centers and the Department of Veterans Affairs, but most men do not get their cancer care in these settings. Many factors may contribute to a failure to receive genetic testing, including cost, lack of available genetic counselors, mistrust of how results might be used, or lack of recommendation by a doctor. The goal of this proposal is to identify opportunities for health care delivery interventions that improve access to prostate cancer genetic testing to guide appropriate treatment and improve patient quality of life among a racially and socioeconomically diverse patient population treated at an urban safety-net hospital, Boston Medical Center (BMC). This proposal directly addresses the Prostate Cancer Research Program’s Overarching Challenges to reduce lethal prostate cancer in African Americans and other high-risk populations by identifying what leads to missed opportunities for timely use of genetic testing for different populations. The proposed project includes quantitative and qualitative methods. First, we will use electronic health record-based data from all prostate cancer patients treated at BMC during the past 10 years. More than 50% of prostate cancer patients treated at BMC are African American, and 30% do not speak English. We will identify who received a referral for genetic testing, who completed a test, and who received post-test counseling about their results. We expect that those who are non-English speaking have lower incomes, are non-white, and are older will be less likely to have a referral and receive testing. This will help identify where along the pathway to receiving personalized treatment there are gaps and for whom. We will also evaluate changes in referral rates before and after the 2018 guideline changes. Second, we will engage and train prostate cancer survivors to conduct individual interviews with three key informant groups: (1) men who did and did not get genetic testing, to better understand their experiences; (2) family members of patients, to understand how they experienced counseling about genetics, the process of testing, and how that affected treatment choices; and (3) staff and doctors who work in the prostate cancer clinic, to understand whether there are factors related to how the clinic works that help or hinder staff in ensuring testing is recommended and completed. To make sure that the supports we develop will benefit men from multiple backgrounds, interviews with patients and family members will be conducted in English, Spanish, and Haitian Creole, the three most common languages spoken at BMC. Findings from our study will provide the most comprehensive information to date on specific contributors to treatment-based disparities in a population that often experiences many barriers to receiving optimal cancer care. Exploring the response to genetic testing guideline changes in settings with fewer resources and more diverse patients is key to improving equity. At the conclusion of the study, results can be presented to cancer center leadership at our own institution and other safety-net settings and used to make immediate changes that c
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Mar 10, 2021
- Source ID
- W81XWH2010110
Entities
People
- Christine Gunn
Organizations
- Boston Medical Center
- United States Army