Black men in the United States are more likely to be diagnosed with prostate cancer and to experience worse outcomes than men from other racial groups. According to data presented at the American Society for Radiation Oncology (ASTRO) Annual Meeting (Abstract 122), an innovative new role in cancer care might be able to help.
“If an institution wants to attempt to alleviate disparities in this era of genomic medicine and prevent the amplification of disparities, then investing in a precision medicine navigator is a good idea,” lead study author Alexander Allen, MD, a radiation oncology resident physician at the University of Maryland Medical Center in Baltimore, told Patient Power.
Dr. Allen and his colleagues found that support from a precision medicine navigator (PMN) can improve the rate at which Black men with prostate cancer receive genomic testing, a procedure that can inform treatment decisions and potentially improve outcomes.
What Is a PMN?
“A precision medicine navigator is someone that is a precision medicine champion at their institution,” explained Elana Plotkin, CMP-HC, director of Provider Education Programs for the Association of Community Cancer Centers (ACCC) in Rockville, Maryland. “They are the bridge between the clinical team and the patient undergoing biomarker testing.”
Plotkin explained that PMNs work to streamline the process for the institution by following the test from start to finish. They ensure the specimen is collected and arrives at the laboratory, the team distributes the results as needed, and any follow-up communication happens through a central contact.
For a person with cancer, PMNs can provide critical education about what to expect from the test and why the results are worth waiting for before starting treatment. They can also explain what the patient’s financial responsibility is, if any, and which other clinicians they should be working with.
Plotkin emphasized that the PMN role is a new and innovative solution to biomarker testing challenges experienced by cancer programs nationwide. A standard definition has yet to be established, so the title and responsibilities may vary by institution. Other names for this role include precision patient navigator and precision medical steward.
Do PMNs Improve Outcomes?
After receiving an anonymous philanthropic grant to fund a precision radiation oncology initiative, the University of Maryland hired a PMN. With genomic testing representing a new frontier in cancer care, Dr. Allen and his colleagues wanted to see if having this liaison between the patients and the medical team would impact testing rates for Black men.
“There is a lot of data to suggest that communities with traditionally lower healthcare access are at risk of being left behind and disparities being even more amplified, especially in the earlier stages [of disease],” Dr. Allen said.
“When cutting-edge therapies are introduced, people of more advantaged demographic groups are generally the ones who have greater access and get greater utilization of those therapies, based on existing systemic factors,” he continued. “We wanted to see if having a navigator specializing in helping patients obtain these genomic markers could improve access to tests.”
The research Dr. Allen presented at ASTRO included 693 patients with prostate cancer. Of those, 44.9% received treatment before the PMN was hired and 55.1% received treatment after. Black patients who met with the PMN were six times more likely to receive genomic testing. In addition, the percentage of Black patients referred for genomic testing rose from 19% to 58% after the PMN came on board.
“Our findings suggest hiring a precision medicine navigator who specializes in genetic testing can improve the rates of Black patients receiving these tests, which can potentially reduce health disparities and improve outcomes,” Dr. Allen said in a press release. During his conversation with Patient Power, he explained the benefits of having a PMN fill this role versus another staff member.
“Most places have clinical navigators of some kind and social workers and nurses who can fill that role and fill that role just fine,” Dr. Allen said. “The advantage of having a precision medicine navigator is that getting these tests done can be an arduous task with many steps and can potentially be more complicated than routine diagnostic tests. So, having someone who only focuses on these tests and can develop a deep knowledge of the companies, what they require, and how to complete the tests as expeditiously as possible is an advantage. It also frees up other people in other positions.” Dr. Allen acknowledged that despite the benefits, some institutions may not have the budget to fill this role.
“Having a precision medicine navigator does require more resources,” Dr. Allen continued. “We were lucky in that we had a philanthropic donation to allow us to do this – we understand that not everyone has that.”
How to Find a PMN and Get Tested
Ask your cancer center or oncologist if they have a PMN on staff. They may not, as this is an emerging role. A general patient navigator can also help. Plotkin recommends downloading the free Biomarker Testing Conversation Guide from ACCC. You can use it to prepare for and guide conversations with your healthcare team.
“I would also strongly encourage anyone diagnosed with cancer to reach out to national patient advocacy organizations related to their cancer type,” Plotkin said. “They have so many resources to support patients and help them understand what tests they need.”
For prostate cancer, Plotkin recommends ZERO Prostate Cancer, an organization offering support groups, podcasts, and other resources through their Black Men’s Prostate Cancer Initiative. She also suggests Cancer Support Community, an organization providing cancer education and navigation services for people with all cancer types.
“I think the benefits of any kind of navigation or peer support are exponential, even if they are not explicitly built for precision medicine navigation,” Plotkin said. Some organizations may also be able to suggest resources to help you pay for testing, a barrier Plotkin believes PMNs will help mitigate in the future.
“The ability to pay for tests should never be a reason for a patient not to get tested – but if patients are not directed to these resources by their care team, it may be a limiting factor to agreeing to be tested,” Plotkin said. “Having a trusted team member provide the education to the patient and direct them to important education and resources helps to equalize the playing field for patients that wouldn’t go and do their own research.”
To address healthcare disparities, ACCC has collaborated with the American Society of Clinical Oncology (ASCO) to create implicit bias training resources to help cancer research sites address barriers to participation in cancer clinical trials among historically underrepresented racial and ethnic populations.
“Biomarker testing is a critical piece of screening for trials, so training staff to recognize implicit and explicit bias assists with disparities across the board,” Plotkin said.
Dr. Allen and his colleagues are discussing future research, including multivariable analyses to see what other social determinants of health might influence how likely a patient from a disadvantaged demographic group is to get a genomic test before and after the presence of the navigator or if any other variables influence that. Now that they know a PMN can increase genomic testing rates, they plan to look at whether those increased rates lead to better outcomes.
“I’m excited to see where this goes,” Dr. Allen said. “I truly think that the benefit is there in terms of having a precision medicine navigator. Of course, not every institution can afford to have one. Still, I think once more data comes out, we’ll have much more of a case to advocate for novel mechanisms of funding for positions like this.”
Plotkin is also committed to advocating for PMNs in cancer care.
“In order to get the right patient to the right treatment at the right time, the biomarker testing process must happen efficiently and effectively,” Plotkin said. “Biomarker testing is so complex. There are lots of vendors and labs that perform testing differently, depending on where you get treatment and what the clinicians order. New targeted mutations are being connected to helpful cancer medications every day. Having a champion within a cancer program that can perform critical services helps cancer teams and patients.” Plotkin also shared good news and hope on the horizon for people with cancer.
“ACCC is working on a program to help cancer centers across the country make the business case to hire precision medicine stewards,” she continued. “Stay tuned!”