Impact of Clinical Genetics Attendance at a Gynecologic Oncology Tumor Board on Referrals for Genetic Counseling and BRCA Mutation Testing

Abstract

Patients with ovarian cancer had a high rate of BRCA mutations. Attendance of a genetics service at a tumor board was associated with an improved rate of referral of patients for genetic counseling and BRCA mutation testing.

Uptake of testing for germline BRCA mutations in patients with non-mucinous epithelial ovarian cancers in Western Australia: a comparison of different genetic counseling methods

“…Compared with our previous report for the period 2013–2015,10 the proportion of patients referred for genetic testing in the current study has almost doubled from 40.6% to 78.6%. Factors that likely contributed to this change were increased awareness among clinicians treating women with non-mucinous epithelial tubo-ovarian cancers following the introduction in 2016 of the poly-(ADP-ribose) polymerase inhibitor Olaparib; the introduction of additional pathways for genetic counseling and testing such as mainstreaming and tele-counseling; and the attendance of genetic counselors from the Familial Cancer Clinic at the weekly tumor board who recorded eligible patients and followed up referrals from the treating clinicians if a referral had not been received after 6 weeks.…”

“…Of note, despite the significant increase in the proportion of patients referred for genetic testing, the proportion of patients who subsequently declined testing remains similar at 16.4% compared with 19.4% in our previous study 10. During the study period the poly-(ADP-ribose) polymerase inhibitor Olaparib was only licensed in Australia for women with platinum-sensitive disease at relapse, and hence there may have been less incentive for patients who were reluctant to consider genetic testing after completion of first-line therapy.…”

“…We have previously reported referral rates for genetic testing of patients with non-mucinous epithelial tubo-ovarian cancers during 2013–2015 of 40.6% 10. During this period genetic counseling was available via the Familial Cancer Clinic at Genetic Services of Western Australia and at a private Familial Cancer Clinic at WOMEN Center in Perth.…”

“…Our primary aim was to identify the proportion of eligible women diagnosed with high-grade non-mucinous epithelial tubo-ovarian cancers referred for genetic counseling and testing between July 2015, when our previous study ceased,10 to December 2017, and to compare this with the findings of our previous study 10. Secondary outcomes included the rates of genetic testing by genetic counseling modality, the proportion of women who underwent germline mutation testing, and the proportion of women who tested positive for a germline BRCA mutation.…”

Genetics in palliative oncology: a missing agenda? A review of the literature and future directions

“…Despite care of the family being central to the values and ethos underpinning palliative care [34], genetics appeared to be missing from the palliative agenda due to assumptions amongst providers that genetic issues will have already been addressed earlier in the disease trajectory. This assumption is flawed, given that numerous studies have identified suboptimal genetic referral rates within the oncology setting, with genetic issues often being overlooked at the time of initial diagnosis [6,8]. Furthermore, patients with particularly aggressive cancers may not present until the advanced stages of their disease [8], and concerns about the family history may only surface as the affected individual becomes increasingly unwell [21].…”