Catherine Neumann, BA, LGC, CGA-IGC Research Committee
Germline genetic testing for colorectal cancers (CRC) has historically only been recommended in patients under the age of 50 or those with a family history suspicious for a hereditary cancer syndrome. The National Comprehensive Cancer Network (NCCN) updated their guidelines in 2022 to consider germline testing all patients diagnosed with CRC.
Given the potential changes to workflow with an influx of a new patient population to consider germline testing, the CGA-IGC Research Committee sought to define the support for and the challenges to universal germline testing (UGT) for CRC through a clinical practice survey sent to CGA-IGC members. Members include genetic counselors, medical oncologists, gastroenterologists, surgeons, advanced practice providers, trainees, and researchers. Sanjee Arora, PhD, Assistant Professor in the Cancer Prevention and Control Program at Fox Chase Cancer Center and Chair of the CGA-IGC Research Committee presented these findings at the CGA-IGC annual conference in Las Vegas, NV on October 29th, 2023.
Eighty CGA-IGC members participated in the survey with 42 (53%) genetic counselors making up more than half of the respondents. Majority (57/78, 73%) of the respondents were supportive of UGT for patients newly diagnosed with CRC but only 18% (10/57) of those respondents felt ready to implement UGT. 79% (59/75) of respondents supported genetics providers ordering and consenting patients for UGT, but there was additional support of medical oncologists (64% 48/75), gastroenterologists (53% 40/75), and surgeons (49% 37/75) ordering this testing as well. Barriers to UGT identified on the survey included lack of knowledge in non-genetics providers, lack of insurance coverage for patients, lack of administrative support, and lack of clinician time to disclose results.
Sanjee Arora explained her takeaways from this study and directions for future research:
“Overall this study underscores the broad support among hereditary gastrointestinal cancer experts for UGT in colorectal cancer patients. However, it suggests the need to explore alternative service delivery models and investigate ways to ensure equitable access, as these are essential to overcoming the barriers associated with UGT. Future steps include expanding the study to encompass the perspectives of non-hereditary gastrointestinal cancer experts and the target patient population.”
This study was concurrently published online in JCO Precision Oncology on October 28th, 2023.