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A universal genetic testing initiative for patients with high-grade, non-mucinous epithelial ovarian cancer and the implications for cancer treatment

  • Erica M. Bednar
    Affiliations
    The Department of Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, 1155 Herman P. Pressler Dr. Houston, TX 77030, United States
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  • Holly D. Oakley
    Affiliations
    The Department of Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, 1155 Herman P. Pressler Dr. Houston, TX 77030, United States
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  • Charlotte C. Sun
    Affiliations
    The Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1155 Herman P. Pressler Dr. Houston, TX 77030, United States
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  • Catherine C. Burke
    Affiliations
    The Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1155 Herman P. Pressler Dr. Houston, TX 77030, United States
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  • Mark F. Munsell
    Affiliations
    The Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1155 Herman P. Pressler Dr. Houston, TX 77030, United States
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  • Shannon N. Westin
    Affiliations
    The Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1155 Herman P. Pressler Dr. Houston, TX 77030, United States
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  • Karen H. Lu
    Correspondence
    Corresponding author at: P.O. Box 301439, Houston, TX 77230-1439, United States.
    Affiliations
    The Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1155 Herman P. Pressler Dr. Houston, TX 77030, United States
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      Highlights

      • <25% of ovarian cancer patients in the U.S. receive recommended genetics services.
      • We increased the rates of genetic counseling and testing to over 85% in our clinic.
      • Various interventions were used to increase rates of genetic counseling and testing.
      • Physician-coordinated genetic testing of ovarian cancer patients is an option.
      • Genetic testing results can impact ovarian cancer treatment options.

      Abstract

      Objective

      Genetic counseling (GC) and germline genetic testing (GT) for BRCA1 and BRCA2 are considered standard of care for patients with high-grade, non-mucinous epithelial ovarian, fallopian tube, and primary peritoneal cancers (HGOC). We describe a universal genetic testing initiative to increase the rates of recommendation and acceptance of GC and GT to >80% for patients with HGOC at our institution.

      Methods

      Data from a consecutive cohort of patients seen in our gynecologic oncology clinics between 9/1/2012 and 8/31/2015 for evaluation of HGOC were retrospectively analyzed. Data were abstracted from the tumor registry, medical records, and research databases. Descriptive statistics were used to evaluate patient characteristics and GC, GT, and PARP inhibitor use. Various clinic interventions were developed, influenced by the Plan-Do-Study-Act cycle method, which included physician-coordinated GT, integrated GC, and assisted GC referrals.

      Results

      A cohort of 1636 patients presented to the gynecologic oncology clinics for evaluation of HGOC during our study period, and 1423 (87.0%) were recommended to have GC and GT. Of these, 1214 (85.3%) completed GT and 217 (17.9%) were found to have a BRCA1 or BRCA2 mutation. Among BRCA-positive patients, 167 had recurrent or progressive disease, and 56 of those received PARP inhibitor therapy.

      Conclusions

      The rates of GC and GT recommendation and completion among patients with HGOC at our institution exceeded 80% following the implementation of a universal genetic testing initiative. Universal genetic testing of patients with HGOC is one strategy to identify those who may benefit from PARP inhibitor therapy.

      Keywords

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