Abstract B074: Primary non-inferiority and secondary moderator analyses from the eREACH study - a randomized study of digital delivery alternative for cancer genetic testing in patients with metastatic cancer

Abstract Background: With FDA approval of targeted therapies in patients with germline BRCA1/2-related advanced cancers there is a need to evaluate efficient and effective delivery models for germline cancer genetic testing. Digital alternatives for delivery of genetic services could address barriers to, and efficiency of services, but understanding outcomes in diverse clinical populations is needed to inform clinical use. Methods: eREACH is a 4 arm non-inferiority study where traditional pre-test (visit 1) and post-test (visit 2) counseling delivered by a genetic counselor (GC) are replaced with a patient-centered digital intervention in patients with metastatic cancer. GC visits were offered by telehealth in the home. Arms include: A (GC/GC), B (GC/digital), C (digital/GC) and D (digital/digital). Surveys were completed at baseline (T0), after visit 1 (T1), visit 2 (T2) and 6 months (T3). Primary analyses evaluated non-inferiority (T0-T1, T0-T2). Secondary analyses evaluated moderators of patient-reported outcomes (PROs). We used ANOVAs and chi-squared tests for non-inferiority testing, and regressions with interactions for moderator testing. Results: 229 patients were recruited from 14 states through Penn Medicine, community sites and social media (56-60/arm). Participants were 35-91 YO (mean 67 YO), and 37% were male, 17% were non-white and 43% had less than a college education. 70% were from academic sites, 21% from community sites and 9% from social media. We met the non-inferiority threshold for all PROs for the two one-visit arms (Arms B and C). We met non-inferiority for all PROs in the fully digital arm (Arm D) except knowledge which was inconclusive. Increases in knowledge (T0-T2) were greater in Arms A-C as compared to Arm D, although differences were small (averages +2.03-2.54 v +1.23). For pre-test counseling (T0-T1), patients living in poorer areas had greater reductions in anxiety in the GC arms. Rural patients had greater increase in knowledge with digital arms, while suburban/urban patients had greater increases in the GC arms. For disclosure visits (T1-T2), men had greater decreases in anxiety with digital disclosure, while women had greater reductions with GC disclosure. Patients with a higher social vulnerability index (SVI) minority status had greater reduction in distress and more positive response with GC disclosure, while those from lower SVI had greater benefits with digital disclosure. Those with positive results had higher satisfaction with GC disclosure, while those with negative or VUS results and higher satisfaction with digital disclosure. Conclusion: Offering patient-centered digital delivery models with one digital visit and one visit with a genetic counselor is non-inferior to two visits with a genetic counselor for patients with metastatic cancer. The fully digital model may be associated with small differences in knowledge gain, although the clinical significance may be small. Women and patients with higher social vulnerability and positive results may experience greater short-term benefits from GC visits. Citation Format: Angela R. Bradbury, Kimberley Lee, Brian Egleston, Sarah Brown, Briana McLeod, Dominique Fetzer, Cara Cacioppo, Janice Christiansen, Dana Clark, Susan Domchek, Jessica Ebrahimzadeh, Linda Fleisher, Sarah Howe, Kelsey Karpink, Enida Selmani, Lynne Wagner, Michelle Weinberg, Kuang Yi Wen, Elisabeth Wood. Primary non-inferiority and secondary moderator analyses from the eREACH study - a randomized study of digital delivery alternative for cancer genetic testing in patients with metastatic cancer [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr B074.