P135: Integrating germline analysis with tumor sequencing: Advancing cancer genomics

Introduction: Since the addition of metastatic prostate cancer to the NCCN guidelines as an indication for germline genetic testing, our institution has struggled to incorporate genetic testing into the care plan.Baseline data for calendar year 2021 found a genetic testing rate of 28% (20 of 71 total cases) within this population.Our prostate focused nurse navigator was engaged to increase the referral rate for this harder to reach population.The navigator worked with the genetics department to develop a strategy to identify patients that met NCCN criteria and created an education plan to increase the awareness of providers and patients within the population.Methods: Implementation steps included:1. Attended urology and medical oncology provider meeting to review NCCN guidelines and the importance of germline testing.Achieved buy in for the process and agreement to participate.2. Created an EPIC report to pull pathology to identify all newly diagnosed prostate patients.Patients sorted by stage to identify metastatic diagnose.3. Developed a patient tracking system shared between navigation and genetics.Team members were able to input referral status, appointment dates, and test results.4. Streamlined the scheduling process and held urgent appointments for metastatic prostate cases.5. Drafted smart phrases that were sent to providers via their EPIC inbasket to "nudge" a genetics referral three months after diagnosis if it has not occurred.6. Created a patient fact sheet that could be provided to patients at time of referral to genetics.7. Provided real time outcome data to the referring providers for the six months post implementation.8. Presented all data and outcomes at Cancer Committee and subcommittee meetings.Results: These strategies were rolled out starting in June 2023 for patients diagnosed starting January 2023 and data was tracked for six months post implementation.The total referral rate to genetics for patients diagnosed between January 2023 and November 2023 increased to 65.5% (19 of 29).For patients diagnosed after implementation the referral rate increased to 81.8% (9 of 11).This equates to a 292% increase in referrals for patients diagnosed after implementation compared to the previous calendar year.We also noted a significant increase in referral rates to genetics from urology after implementation regardless of patient indication.Referral data for urologists to the Wellstar Genetics Department was pulled from EPIC for the implementation period and compared to the CY2022 data.Over this same period the nonprostate related referrals increased by 357% from 28 to 100 total referrals.This included increased referrals for renal cancers, bladder cancers, and unaffected patients with family history of breast and ovarian cancer.Conclusion: This simple intervention increased overall awareness of the genetics department for urology which was reflected by referral patterns.We have seen this increase in referral patterns continue for over a year since the initial intervention.