Dr. Stacey Loeb of NYU Langone Health breaks down the real-world barriers preventing prostate cancer patients from accessing genetic testing and precision therapies. She explains how provider knowledge gaps, limited genetic counseling resources, insurance coverage issues, and lack of family history awareness contribute to inequities in care. Dr. Loeb also highlights actionable solutions, like the Helix app, that help clinicians identify eligible patients and expand equitable access to biomarker testing and precision oncology.
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Transcript
Dr. Nicole Rochester:
Let’s move to discussing access barriers to precision medicine. We now have combination therapies like PARP inhibitors and androgen receptor inhibitors that work specifically for patients with HRR gene mutations. But if patients aren’t even getting tested, they can’t access these therapies.
Dr. Loeb, your work examines who receives biomarker testing in practice. What are the barriers that you’ve seen to widespread genetic testing adoption? Especially in community oncology and underrepresented populations?
Dr. Stacey Loeb:
Yes, thank you. So, definitely a lot of barriers to genetic testing at every level. There’s definitely a lot of knowledge gaps among providers. There’s also difficulties with referrals, with, for example, a shortage of genetic counselors, but many non-genetic providers, such as urologists and oncologists, not feeling sufficiently well-versed to perform genetic testing on their own and to be able to provide the full counseling to their patients.
At the patient level, you know, there can be barriers in terms of the cost of testing and coverage. It does have some insurance implications which is concerning for some people. Also, varying levels of knowledge and interest in genetics. For example, there’s really a lack of awareness in the population about transmission between different family members, and specifically the links between prostate cancer with cancers in female family members is something that people really are not aware of.
And so it may not seem like it would be relevant to, for example, the daughter of a patient with prostate cancer, when in fact, this could very much be linked with the patient’s daughter’s risk of breast or ovarian cancer, as an example.
So, lots of different issues coming into play that we have to tackle in order to try to get this more widespread. So, this is something we’ve been working on. We’ve looked at different, you know, points in the pathway where there are barriers, for example, knowledge gaps for clinicians, and we created a podcast series, and challenges applying the guidelines to figure out who’s even eligible for testing, so we made the Helix app for providers to answer some questions about the patient and find out if they would qualify in the guidelines.
But, you know, not everybody knows their full family history. Some people are adopted, and there may be cultural taboos around sharing of disease information. And so, if you don’t qualify based on family history criteria, but you don’t know your full family history, that alone might prevent insurance coverage of testing for some patients. So, definitely a lot of challenges that we have to, you know, overcome in order to provide more equitable access to, you know, genetically-based clinical trials and precision therapeutics.
Dr. Nicole Rochester:
Thank you for sharing that, and for sharing the resources. You know, it’s one thing for us to talk about the challenges, and there are many, but to understand what you all are doing about it, and some of the resources that you provide is extremely helpful.