Impact of a Precision Medicine Navigator on Genomic Test Utilization in Black Patients With Prostate Cancer

As oncologic precision medicine develops, there is concern that tumor genomic profiling among Black patients and other underrepresented demographics will lag and amplify health disparities. We evaluate whether a precision medicine navigator (PMN), a clinical navigator specialized in obtaining tumor genomic testing for patients, is associated with increased genomic testing rates and whether this is the case among Black patients and other disadvantaged groups.

We retrospectively reviewed prostate cancer consults within one health care system from November 2, 2021, to January 2, 2023. We compared the proportion of patients who received genomic testing in the 7 months before the PMN start (pre-PMN) to the 7 months afterward (post-PMN). Binary logistic regression was used to calculate the odds of receiving testing.

The sample included 693 patients, 311 pre-PMN and 382 post-PMN. Racial distribution and clinical stage were well-balanced between the pre- and post-PMN groups. From pre- to post-PMN, the proportion of patients receiving testing increased from 18% to 70% (P = .0002). Significant increases in testing post-PMN occurred among Black patients, lower median income patients, patients with Medicare/Medicaid, and community hospital patients. However, utilization post-PMN was significantly higher in non-Black compared with Black patients, 75.4% and 58.5%, respectively (P = .0006).

For patients with prostate cancer, the presence of a PMN is associated with increased rates of genomic testing overall, including among Black patients and other groups that experience health inequities. Utilization post-PMN was significantly lower in Black patients compared with non-Black patients. More research is needed into why Black patients show lower rates of genomic testing.