Outcomes of germline expedited point of care (POC) genetic testing through telehealth in the Veterans Health Administration (VA)

Background: Germline genetic testing is standard of care for treatment planning for several malignancies. To increase access to genetic testing for Veterans, VA developed and disseminated educational materials, laboratory portal access, and templates for ordering and documenting consent and testing in the electronic health record to facilitate POC testing by oncology providers. Here, we describe the outcomes of POC testing. Methods: POC tests ordered between 2/24/23-11/18/24 by oncology providers at VA sites or with National TeleOncology (NTO) were identified through the VHA’s Corporate Data Warehouse and the VINCI (VA Informatics and Computing Infrastructure) research environment. Pathogenicity of variants was determined by the classification provided by the laboratory. Providers are recommended to use the POC testing for patients actively being treated for the following cancers: metastatic/high risk prostate, breast, ovarian, exocrine pancreatic/ampullary, colon, 50 years of age, medullary thyroid, and pheochromocytoma/paraganglioma. Results: POC tests were ordered at 45 different VAs for 1293 patients. Total of 1364 tests were ordered, and 1195 (87.5%) tests were. The tests ordered included 854 (62.6%) curated multigene panel and 510 (37.4%) targeted cancer panels. Demographics are summarized in Table. Among 1382 diagnoses listed as the indication for testing (some patients had multiple), the most common cancer diagnoses were prostate (831, 60.1%), breast (206, 14.9%), and pancreatic (94, 6.8%). Most tests were ordered for patients who met POC indications, but 13.6% of orders were for other indications. A total of 77 (6.4%) patients were found to have pathogenic/likely pathogenic variants (PV) in dominantly inherited cancer predisposition genes. Seventy-one (5.9%) patients had PVs in high/moderate penetrance cancer predisposition genes. Conclusions: POC testing is feasible and being widely adopted across the VA. Further work is needed to determine if patients found to have actionable PVs through the POC mechanism have changes in treatment or are referred for follow-up genetic counseling. A significant, minority of tests were ordered for patients with diagnoses not eligible for POC testing. Continued education and support is planned to increase utilization of POC testing in oncology across the VA. Research Sponsor: None.

Duke Scholars

Author Michael John Kelley Medicine, Medical Oncology

Author Akiko Chiba Surgical Oncology