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On-site cancer genetics services significantly increased germline testing completion for Black Veterans compared to telegenetics. This highlights the importance of accessible, in-person genetic counseling for equitable cancer care.

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Area of Science:

  • Oncology
  • Genetics
  • Health Services Research

Background:

  • Telegenetics expands access to cancer genetic testing, but equitable distribution across racial and ethnic groups remains a challenge.
  • Disparities in healthcare access can limit guideline-recommended cancer genetic testing for diverse populations.

Purpose of the Study:

  • To evaluate the impact of an on-site nurse-led cancer genetics service within a Veterans Affairs Medical Center (VAMC) oncology clinic on germline testing completion rates.
  • To assess whether an on-site model improves equitable access to cancer genetic testing compared to telegenetics.

Main Methods:

  • Observational retrospective cohort study of Veterans referred for cancer genetics services at the Philadelphia VAMC (October 2020 - February 2022).
  • Analysis focused on a subcohort of new consults to determine the association between on-site versus telegenetics service and germline testing completion.
  • Multivariable regression analysis was used to adjust for potential confounders and examine race-specific effects.

Main Results:

  • The on-site genetics service was associated with a 3.2-fold higher likelihood of germline testing completion compared to telegenetics in univariate analysis.
  • In multivariable analysis, the on-site service showed a statistically significant association with higher germline testing completion specifically among self-identified Black Veterans compared to White Veterans (aRR, 4.78).
  • A significant interaction between race and genetics service type (P-interaction = .016) indicated that the on-site model disproportionately benefited Black Veterans.

Conclusions:

  • An on-site, nurse-led cancer genetics service integrated into a VAMC Oncology practice significantly improved germline genetic testing completion rates.
  • The on-site model demonstrated a more equitable impact, particularly enhancing testing completion among self-identified Black Veterans compared to telegenetics.
  • Implementing embedded, on-site genetics services may be a crucial strategy to address racial disparities in cancer genetic testing access and utilization.