Patterns and predictors of genetic referral among ovarian cancer patients at a National Cancer Institute‐Comprehensive Cancer Center

Abstract

Germline mutations (eg, BRCA1/2) have prognostic and treatment implications for ovarian cancer (OVCA) patients. Thus, national guidelines recommend genetic testing for OVCA patients. The present study examines patterns and predictors of genetics referral in OVCA patients. Electronic medical record data were abstracted retrospectively from 557 OVCA patients treated from 1 January 2001 to 31 December 2015.Logistic regression models identified sociodemographic characteristics, disease/treatment characteristics, family history data, provider characteristics, and survival data that predicted genetics referral. Overall, 27.5% of patients received referral. Eleven variables predicting referral were selected during stepwise regression: younger age, White race, not having private insurance, professional school education, year of OVCA diagnosis, platinum sensitivity, female gynecologic oncologist, chemotherapy administered by a gynecologic oncologist, clinical trial enrollment, longer overall survival, and family history of OVCA. Genetics referral among OVCA patients was similar to rates reported nationwide. Unique predictive factors will contribute to quality improvement and should be validated at a multi-institutional level to ensure guideline concordant care is provided to all OVCA patients. Future research should identify both patient-level and provider-level factors associated with genetics referral. K E Y W O R D S

Temporal Patterns and Adoption of Germline and Somatic BRCA Testing in Ovarian Cancer

“…In contrast to other studies, 20–23 we did not find racial or ethnic differences between patients who did and did not receive genetic testing. Although we hope that care is provided regardless of race or ethnicity, it is also possible that this significance is explained by limitations of the Flatiron Health EHR, such as the relatively low diversity in the study cohort and the relatively high amount of missing demographic data.…”

“…Previous population-based studies, although representing large numbers of patients with ovarian cancer, have included only germline testing results or have been geographically limited. 21,31–33 At 72%, our study has a higher estimate of BRCA testing than other studies, 19,22–27,31,32 and this could represent a difference in testing between academic and community cancer centers or between Flatiron Health and non–Flatiron Health centers. However, an estimated 28% of patients with ovarian cancer in our study population did not receive any genetic testing and, thus, may have missed important opportunities for targeted therapy or cascade testing.…”

“…19 The rate of testing varies between 3% and 99% depending on the specific study, 19 and studies have found significant disparities in genetic testing based on race, ethnicity, and socioeconomic factors. 20–23…”

“…Most previous studies examining genetic testing have been conducted using institutional data from academic centers 19,22–27 and thus may not provide a comprehensive view of the adoption of BRCA testing in the United States. The goal of the present study was to use real-world data to describe the prevalence, patient characteristics, temporal trends, timing, and results of germline and somatic testing in patients with ovarian cancer.…”

“…19 The rate of testing varies between 3% and 99% depending on the specific study, 19 and studies have found significant disparities in genetic testing based on race, ethnicity, and socioeconomic factors. [20][21][22][23] Most previous studies examining genetic testing have been conducted using institutional data from academic centers 19,[22][23][24][25][26][27] and thus may not provide a comprehensive view of the adoption of BRCA testing in the United States. The goal of the present study was to use real-world data to describe the prevalence, patient characteristics, temporal trends, timing, and results of germline and somatic testing in patients with ovarian cancer.…”