Highlights
- •Implementation of bundled interventions improved genetics referral in EOC patients.
- •Genetics referrals from oncology providers yield a high rate of consult completion.
- •There is a high rate of completing genetic testing after genetic counseling.
Abstract
Objective
To increase genetic counseling referrals for patients with newly diagnosed epithelial
ovarian cancer (EOC).
Methods
A practice-gap analysis was performed after measuring baseline genetic counseling
referral rates to identify barriers to referral from the multidisciplinary single
institution EOC care group. A Genetics Referral Toolkit consisting of a referral template,
a genetic risk checklist, family history worksheet and provider and patient awareness
was developed to address identified gaps with the goal of increasing referral rates.
Clinical characteristics, referral placement, completion of genetic counseling/testing
were abstracted for a historic cohort and intervention cohort. Data for the two cohorts
were compared using chi-square, Fisher's exact test, or t-test. Association with referral was determined by univariate logistic regression.
Results
Eighty one patients from July through December 2013 (historic cohort) and 62 patients
from July through December 2015 (intervention cohort) were identified as having a
new diagnosis of EOC. Among these women, genetic counseling referral rates increased
from 48.1% (39/81) in 2013 to 74.2% (46/62) in 2015 (p = 0.002) after implementation of the toolkit. In a subset of patients without a previous
genetic counseling referral, 87.9% (29/33) completed counseling and 79.3% (23/29)
pursued testing from the historic cohort. In the intervention cohort, 60% (24/40)
were seen for counseling and 100% (24/24) had testing.
Conclusion
Application of a quality improvement process to create a Genetics Referral Toolkit
increased the genetic counseling referral rate in patients with a new diagnosis of
EOC. The majority of patients who were referred completed genetics consultation and
elected genetic testing.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gynecologic OncologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cancer statistics, 2017.CA Cancer J. Clin. 2017; 67: 7-30
- Inherited mutations in women with ovarian carcinoma.JAMA Oncol. 2016; 2: 482-490
- Poly (ADP-ribose) polymerase inhibitors: recent advances and future development.J. Clin. Oncol. 2015; 33: 1397-1406
- Breast and/or ovarian cancer genetic assessment. National Comprehensive Care Network (NCCN) 2017.(Available from:)https://www.nccn.org/professionals/physician_gls/pdf/genetics_screening.pdfDate: 2017Date accessed: February 2, 2017
- Society of Gynecologic Oncology statement on risk assessment for inherited gynecologic cancer predispositions.Gynecol. Oncol. 2015; 136: 3-7
- Adherence patterns to National Comprehensive Cancer Network (NCCN) guidelines for referral to cancer genetic professionals.Gynecol. Oncol. 2015; 138: 109-114
- Does the diagnosis of breast or ovarian cancer trigger referral to genetic counseling?.Int. J. Gynecol. Cancer. 2013; 23: 431-436
- Genetic risk assessment for women with epithelial ovarian cancer: referral patterns and outcomes in a university gynecologic oncology clinic.J. Genet. Couns. 2013; 22: 662-673
- Keeping it simple: genetics referrals for all invasive serous ovarian cancers.Gynecol. Oncol. 2013; 130: 329-333
- The sooner the better: genetic testing following ovarian cancer diagnosis.Gynecol. Oncol. 2015; 137: 423-429
- Timing of BRCA1/BRCA2 genetic testing in women with ovarian cancer.Genet. Med. 2009; 11: 624-628
- There is no decision to make: experiences and attitudes toward treatment-focused genetic testing among women diagnosed with ovarian cancer.Gynecol. Oncol. 2012; 124: 153-157
- What women with ovarian cancer think and know about genetic testing.Gynecol. Oncol. 2008; 111: 132-136
- Testing for hereditary predisposition in patients with gynecologic cancers, quo vadis?.Surg. Pathol. Clin. 2016; 9: 301-306
- A systematic review of factors that act as barriers to patient referral to genetic services.Eur. J. Hum. Genet. 2015; 23: 739-745
- Improving referral for genetic risk assessment in ovarian cancer using an electronic medical record system.Int. J. Gynecol. Cancer. 2014; 24: 1003-1009
- You've got the power. The power to protect your family from cancer with genetic counseling.(Available from:)http://mncanceralliance.org/wp-content/uploads/2013/08/SuperYou_Checklist.pdfDate: 2013Date accessed: February 3, 2017
- Germline BRCA1 and BRCA2 mutations in ovarian cancer: utility of a histology-based referral strategy.Obstet. Gynecol. 2012; 120: 235-240
- Genetic consultation embedded in a gynecologic oncology clinic improves compliance with guideline-based care.Gynecol. Oncol. 2017; 147: 110-114
Article info
Publication history
Published online: February 04, 2018
Accepted:
January 29,
2018
Received in revised form:
January 21,
2018
Received:
December 5,
2017
Footnotes
☆Research supported by the Stand Up To Cancer – Ovarian Cancer Research Fund Alliance – National Ovarian Cancer Coalition Dream Team Translational Research Grant (Grant Number: SU2C-AACR-DT16-15). Stand Up to Cancer is a program of the Entertainment Industry Foundation; research grants are administered by the American Association for Cancer Research, a scientific partner of SU2C.
☆☆Presented at the Society of Gynecologic Oncology Annual Meeting on Women's Cancer, March 19–22, 2016, in San Diego, California.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
