Hereditary Cancer Clinics Improve Adherence to NCCN Germline Testing Guidelines for Pancreatic Cancer

Area of Science:

• Oncology
• Genetics
• Medical Guidelines

Background:

• Pancreatic ductal adenocarcinoma (PDAC) has a dismal prognosis, with a 5-year survival rate of only 10%.
• In November 2018, NCCN guidelines were updated to recommend genetic counseling (GC) and germline testing for all PDAC patients, irrespective of family history.
• The study hypothesized that these guideline changes would increase testing referrals and that a hereditary cancer clinic (HCC) would further enhance compliance.

Purpose of the Study:

• To evaluate the impact of NCCN guideline updates on GC referral rates for PDAC patients.
• To assess the effect of implementing an HCC on the compliance with genetic counseling and testing recommendations.
• To analyze referral patterns before and after guideline changes and HCC implementation.

Main Methods:

• A retrospective analysis of 335 PDAC patients diagnosed between June 2017 and December 2021 at a single institution.
• Comparison of GC referral rates across three eras: pre-NCCN guideline change, post-NCCN guideline change, and post-HCC implementation.
• Statistical analyses including chi-square, Fisher exact, and multivariate analyses were used to compare referral patterns.

Main Results:

• GC referral rates increased from 30% pre-guideline change to 54.7% post-guideline change.
• Following HCC implementation, referral rates surged to 77.4% (P<.0001).
• The odds ratio for referral among patients with a positive family history decreased over time, indicating broader application of testing recommendations.

Conclusions:

• NCCN guideline updates significantly boosted GC referral rates for PDAC patients.
• The establishment of an HCC further improved adherence to genetic counseling and testing guidelines.
• These findings underscore the importance of guideline dissemination and dedicated clinics in enhancing patient care for PDAC.