Poster Presentation 2025 Joint Meeting of the COSA ASM and IPOS Congress

Equitable Delivery of Comprehensive Genomic Profiling (CGP) across Australia: Evaluating Models to support Oncologist to delivery pan-cancer molecular testing (126066)

Kortnye Smith 1 , Lavinia Tan 1 , Kim An 2 , Sachin Joshi 3 , Gary Richardson 4 , Arvind Sahu 5 , Belinda Lee 6 , Daphne Day 7 , Sophia Frentzas 7 , Sharad Sharma 8 , Javier Torres 5 , Florencia Sjaaf 9 , Christopher Schilling 9 , Chelsee Hewitt 10 , Stephen Fox 10 , Laura Forrest 2 , Jayesh Desai 1
  1. Peter MacCallum Cancer Centre, Caulfield, VIC, Australia
  2. Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria
  3. Department of Medical Oncology, Latrobe Regional Hospital, Tarralgon, Victoria, Australia
  4. Cabrini Hospital, Melbourne, Victoria, Australia
  5. Medical Oncology, Goulburn Valley Hospital, Shepparton, Victoria, Australia
  6. Medical Oncology, Northern Health, Epping, Victoria, Australia
  7. Department of Medical Oncology, Monash Medical Centre, Clayton, Victoria, Australia
  8. Department of Medical Oncology, Ballarat Regional Integrated Cancer Centre, Ballarat, Victoria, Australia
  9. Centre for Health Policy, The University of Melbourne, Carlton, Victoria, Australia
  10. Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

Objective/Purpose:  

Use of CGP is rapidly becoming part of mainstream cancer management.  Strategies are required to overcome testing barriers and improve support for oncologists with varied genomic expertise, particularly in underserved and regional areas. Our multisite, hybrid-effectiveness implementation trial investigated models-of-care to increase utilisation and patient satisfaction with CGP outside of comprehensive cancer centres(CCC).  

 

Sample/Setting:

3 service models for testing of circulating tumour DNA(ctDNA) were piloted across 3 metropolitan and 3 regional centres with support from a CCC. Blood for ctDNA was drawn locally and transported for centralised testing and virtual molecular tumour board review, attended by all sites. Models of care included: Independent; without centralised support, Local Super User; designated site oncologist, upskilled and centrally supported, and Telehealth; referred locally, provided by CCC.  A mixed-method approach examined effectiveness, costing and patient/oncologist preferences.  

 

Results:

131 of 194(67%) pts had any variant detected of which 68% had an actionable variant determined by MTB, with no statistical difference between models. 176 pts(91%) and 38 oncs(100%) completed initial surveys and 112(55%) and 33(87%) subsequent surveys. 11 pts and 28 oncologists sat semi-structured interviews. Overall: Oncologists reported offering CGP increased workload;70% requested education, resources or training, 60% predicted increased appointment length. Between models; Patients noted lower result comprehension at independent sites, LSU sites experienced streamlined processes and lower cost but additional workload for designated oncologist. Telehealth was less resource intensive for referring oncologists but least preferred by patients. 

 

Conclusion/clinical implications: 

Each model provided CGP across geographical distance with similar clinical effectiveness, but different enablers and barriers are present for oncologist and patients in each.  Our study provides evidence to support tailored local strategies that reflect patients preferences and respects the key role of local oncologists. Providing central support to overcome barriers of education, workload and funding models remain critical to broader CGP implementation.