Socioeconomic and Demographic Barriers Associated with Delays in Pancreatic Cancer Germline Genetic Testing

BackgroundGermline genetic testing is recommended for patients with pancreatic ductal adenocarcinoma (PDAC) and pre-diagnostic testing is offered to patients with a significant family history. However, only 41% of patients in our institution obtained genetic testing. We identified associations between patient social profiles and delays in obtaining germline genetic testing from New Yorks largest healthcare system. MethodsPatients with PDAC were identified using our EMR between Mar 2016 and Feb 2022 with an IRB-approved protocol. Median income was extrapolated using zip code. Date of diagnosis (DOD) was recorded as the date of biopsy. Delays of testing was calculated as the difference between DOD and the date of germline test. Social work needs and insurance were captured by EMR review of social work notes. Results329 patients with PDAC were identified, with 135 (41%) having reports found. Availability of germline testing did not vary by median income. Pearson analysis between income and delays showed a negative correlation (r=-0.258, p=0.0025). Patients who received social security and were unemployed/disabled had significant delays (167d) in testing compared to patients receiving social security (13d) and retired or patients receiving salaries (30d). African Americans and Hispanics, classified as underserved minority, had significant delays in testing (66d) compared to not underserved patients (22.5d, p=0.021). In addition, African American patients had significant delays in testing (66d) compared to White patients (20d, p=0.0076). Patients with social work needs had significant delays in testing (104d) compared to patients without SW needs (20.5d, p=0.0002). Of the twelve patients who required SW, six required home care, three required transportation, and two required financial assistance. In addition, patients with Medicare and supplementary insurances had significant decreases in delays (10d) of germline testing compared with patients with Medicare alone (32d, p=0.0077), Medicaid (57d, p=0.020), or commercial insurances (21d, p=0.021). We identified 12 patients who had germline mutation reports before PDAC diagnosis. For patients with pre-diagnostic testing, 5 had Medicare with supplementary insurances. For the rest of patients with germline testing after the diagnosis of PDAC, 10 had supplementary insurances (p=0.0043). ConclusionThe analysis of our 329-patient cohort showed a striking and concerning negative correlation between patient income and delays in germline testing. Under-represented minority patients had significant delays in germline testing and did not obtain any pre-diagnostic testing. Social work needs and insurance may be barriers as well. Interprofessional collaborations may be required to prompt germline testing.