QIM20-134: Genetic Testing for At-Risk Patients With Colorectal and/or Pancreatic Cancer at Our Institution, a Quality Improvement Project

Background: Colorectal cancer (CRC) is the third leading cause of cancer-related deaths in men and women in the USA. It's expected to cause about 51,020 deaths during 2019. There is evidence that screening all CRC patients (pts) with microsatellite instability (MSI) or immunohistochemistry (IHC) testing has shown to be a cost-effective approach for identifying those who should be offered germline molecular genetic testing for Lynch syndrome. Identifying Lynch syndrome in CRC pts was linked to improved health outcomes in their relatives. Hence, the National Comprehensive Cancer Network (NCCN) recommends universal screening for all CRC pts for Lynch syndrome using MSI or IHC testing. Pancreatic cancer (PC) is one of the deadliest malignancies known. It is expected to cause about 45,750 deaths during 2019. The current NCCN Guidelines recommend genetic counseling and germline testing in all PC pts. This recommendation was based on evidence that germline genetic mutations were identified in 5.5% of all PC pts, including 5.2% of pts without a family history of PC. Relatives of pts with Lynch syndrome or genetically mutated PC could then be offered genetic testing/ counseling, and where indicated, additional surveillance for various cancers based upon their risk. This study aimed to assess the level of adherence to the NCCN recommendations for genetic testing in pts with CRC and PC. Methods: This is a single-institution, retrospective study. The project was approved by Marshall University Institutional Review Board and the data were collected from the Cancer Registry at Edwards Comprehensive Cancer Center (ECCC) in Huntington, WV, USA. Results: Among 159 pts diagnosed with CRC between January 2017 and June 2019 at ECCC, 31 pts (19.5%) had MSI or IHC testing. 4 pts had positive MSI high, all of which were referred for further genetic testing/ counseling. 24 pts were diagnosed with CRC below the age of 50 years old with only 12 pts (50%) had genetic testing/ counseling. Out of 20 pts diagnosed with PC between June 2018 and June 2019 at ECCC, only 5 pts (25%) had genetic testing/ counseling. Conclusions: Genetic testing for at-risk pts with CRC or PC at our institution is still not optimum. We believe this may be due to numerous issues, including staff education regarding current recommendations. We propose an automatic referral system for genetic testing to be performed by our Pathologists and nurse navigator upon initial diagnosis for all at-risk pts.