Germline screening rates and patterns for patients with pancreatic cancer at an academic medical center.

10590 Background: Current National Comprehensive Cancer Network guidelines recommend germline genetic testing for all pancreatic cancer patients irrespective of family history. Germline testing provides insight on inherited pathogenic variants that may influence care. Approximately 10% of pancreatic adenocarcinoma (PDAC) patients have pathogenic mutations which may have treatment implications and warrant the introduction of targeted therapy approaches. Patients with germline BRCA1/2 or PALB2 mutations have increased sensitivity to platinum chemotherapy and PARP-inhibitor therapies. Germline testing results may have important implications for patients’ family members for earlier targeted screening. A better understanding of the current state of testing is needed to develop systems to improve screening rates. We conducted a retrospective review of clinical practice patterns at an academic cancer center to assess the current uptake. Methods: Patients with pancreatic adenocarcinoma seen at the University of Virginia Health System within the 2021 calendar year were identified. Retrospective review of genetic counseling referral and germline genomic screening for individual patients was performed. Results: 210 patients with pancreatic adenocarcinoma were identified. 39 (19%) PDAC patients had a referral to genetic counseling placed in the electronic medical record and 44 (21%) completed germline screening. Of the patients referred to genetics, 17/39 patients (44%) met with a genetic counselor which led to germline screening, 3/39 (8%) patients were referred and saw genetics after receiving germline testing results. Among patients who completed germline screening, 27/44 (61%) had testing initially ordered by their oncologist with referral to genetic counseling based on testing results 3/27 (11%). Conclusions: Despite guideline recommendations, germline testing rates are low among this PDAC population. Genetic counselors are essential members of a multidisciplinary team and guide patient discussions and decision making with regards to germline testing. Typical practice has involved referral to meet with a genetics counselor prior to testing; however many patients elect not to schedule a visit and consequently do not obtain germline screening. Barriers may include costs associated with genetic counseling/testing, time constraints, and patient understanding of the relevance of testing for their cancer care. We observed that offering germline testing to PDAC patients with referral to genetic counseling based on results and patient preference is a viable practice pattern. Upfront clinician driven germline testing may offer an opportunity to improve access to germline screening. Prospective clinical trials are needed to increase rates of germline testing and genetic counseling for PDAC patients.