Research Article| Volume 160, ISSUE 2, P457-463, February 2021

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Embedding a genetic counselor into oncology clinics improves testing rates and timeliness for women with ovarian cancer

Published:November 21, 2020DOI:


      • Embedding a GC resulted in greater completion and timeliness of genetic counseling.
      • An embedded GC promoted genetic testing for ovarian cancer patients irrespective of age at diagnosis or family history.
      • Improvements in GC access through this model were sustained over time.



      Germline genetic testing is crucial to the care of ovarian cancer patients, and as part of the guideline-based care for ovarian cancer patient's adherence to this recommendation has been low. We sought to determine whether embedding a genetic counselor (GC) within a medical and gynecologic oncology clinic would increase testing rates and improve the timeliness of testing.


      Prospective cohort study of 358 ovarian cancer patients seen by medical and gynecologic oncologists between 2013 and 2015. Rates of referrals, completion of counseling, and genetic testing and timeliness of counseling were abstracted before and after a GC was embedded in the clinic in 2014. An additional year of data (2015) was collected to evaluate sustainability of the intervention.


      Between 2013 and 2015, 88–92% of women were referred for genetic testing, but in 2013 only 66% completed counseling and 61% were tested. After a GC was embedded in the clinic in 2014, more than 80% of referred women completed counseling and germline genetic testing. Time to genetic counseling also decreased from a median of 107 to 40 days, irrespective of age and cancer family history (p < 0.01).


      Embedding a GC into the workflow for ovarian cancer patients is an effective way of improving access to genetic counseling, testing rates, and the timeliness of testing.


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        • Buys S.S.
        • Partridge E.
        • Black A.
        • et al.
        Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial.
        JAMA. 2011; 305: 2295-2303
        • Siegel R.L.
        • Miller K.D.
        • Jemal A.
        Cancer statistics, 2015.
        CA Cancer J. Clin. 2015; 65: 5-29
        • Toss A.
        • Tomasello C.
        • Razzaboni E.
        • et al.
        Hereditary ovarian cancer: not only BRCA 1 and 2 genes.
        Biomed. Res. Int. 2015; 2015: 341723
        • Walsh T.
        • Casadei S.
        • Lee M.K.
        • et al.
        Mutations in 12 genes for inherited ovarian, fallopian tube, and peritoneal carcinoma identified by massively parallel sequencing.
        PNAS. 2011; 108: 18032-18037
        • Kurian A.W.
        • Ward K.C.
        • Hamilton A.S.
        • et al.
        Uptake, results, and outcomes of germline multiple-gene sequencing after diagnosis of breast cancer.
        JAMA Oncol. 2018; 4: 1066-1072
        • Norquist B.M.
        • Harrell M.I.
        • Brady M.F.
        • et al.
        Inherited mutations in women with ovarian carcinoma.
        JAMA Oncol. 2016; 2: 482-490
        • Yang D.
        • Khan S.
        • Sun Y.
        • et al.
        Association of BRCA1 and BRCA2 mutations with survival, chemotherapy sensitivity, and gene mutator phenotype in patients with ovarian cancer.
        Jama. 2011; 306: 1557-1565
        • Liang M.I.
        • Wong D.H.
        • Walsh C.S.
        • Farias-Eisner R.
        • Cohen J.G.
        Cancer genetic counseling and testing: perspectives of epithelial ovarian cancer patients and gynecologic oncology healthcare providers.
        J. Genet. Couns. 2018; 27: 177-186
        • Audeh M.W.
        • Carmichael J.
        • Penson R.T.
        • et al.
        Oral poly(ADP-ribose) polymerase inhibitor olaparib in patients with BRCA1 or BRCA2 mutations and recurrent ovarian cancer: a proof-of-concept trial.
        Lancet. 2010; 376: 245-251
        • Bolton K.L.
        • Chenevix-Trench G.
        • Goh C.
        • et al.
        Association between BRCA1 and BRCA2 mutations and survival in women with invasive epithelial ovarian cancer.
        JAMA. 2012; 307: 382-390
        • Pennington K.P.
        • Walsh T.
        • Harrell M.I.
        • et al.
        Germline and somatic mutations in homologous recombination genes predict platinum response and survival in ovarian, fallopian tube, and peritoneal carcinomas.
        Clin. Cancer Res. 2014; 20: 764-775
        • Rubin S.C.
        • Benjamin I.
        • Behbakht K.
        • et al.
        Clinical and pathological features of ovarian cancer in women with germ-line mutations of BRCA1.
        N. Engl. J. Med. 1996; 335: 1413-1416
        • Rebbeck T.R.
        • Kauff N.D.
        • Domchek S.M.
        Meta-analysis of risk reduction estimates associated with risk-reducing salpingo-oophorectomy in BRCA1 or BRCA2 mutation carriers.
        J. Natl. Cancer Inst. 2009; 101: 80-87
        • Domchek S.M.
        • Friebel T.M.
        • Singer C.F.
        • et al.
        Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality.
        JAMA. 2010; 304: 967-975
        • Warner E.
        • Hill K.
        • Causer P.
        • et al.
        Prospective study of breast cancer incidence in women with a BRCA1 or BRCA2 mutation under surveillance with and without magnetic resonance imaging.
        J. Clin. Oncol. 2011; 29: 1664-1669
        • Passaperuma K.
        • Warner E.
        • Causer P.A.
        • et al.
        Long-term results of screening with magnetic resonance imaging in women with BRCA mutations.
        Br. J. Cancer. 2012; 107: 24-30
        • Meyer L.A.
        • Anderson M.E.
        • Lacour R.A.
        • et al.
        Evaluating women with ovarian cancer for BRCA1 and BRCA2 mutations: missed opportunities.
        Obstet. Gynecol. 2010; 115: 945-952
        • Bellcross C.A.
        • Peipins L.A.
        • McCarty F.A.
        • et al.
        Characteristics associated with genetic counseling referral and BRCA1/2 testing among women in a large integrated health system.
        Genet. Med. 2015; 17: 43-50
        • Demsky R.
        • McCuaig J.
        • Maganti M.
        • Murphy K.J.
        • Rosen B.
        • Armel S.R.
        Keeping it simple: genetics referrals for all invasive serous ovarian cancers.
        Gynecol. Oncol. 2013; 130: 329-333
        • Wright J.D.
        • Chen L.
        • Tergas A.I.
        • et al.
        Underuse of BRCA testing in patients with breast and ovarian cancer.
        Am. J. Obstet. Gynecol. 2016; 214: 761-763
        • Randall T.C.
        • Armstrong K.
        Health care disparities in hereditary ovarian cancer: are we reaching the underserved population?.
        Curr. Treat. Options in Oncol. 2016; 17: 39
        • Armstrong K.
        • Micco E.
        • Carney A.
        • Stopfer J.
        • Putt M.
        Racial differences in the use of BRCA1/2 testing among women with a family history of breast or ovarian cancer.
        JAMA. 2005; 293: 1729-1736
        • Kurian A.W.
        • Ward K.C.
        • Howlader N.
        • et al.
        Genetic testing and results in a population-based cohort of breast cancer patients and ovarian cancer patients.
        J. Clin. Oncol. 2019; 37: 1305-1315
        • Childers C.P.
        • Childers K.K.
        • Maggard-Gibbons M.
        • Macinko J.
        National estimates of genetic testing in women with a history of breast or ovarian cancer.
        J. Clin. Oncol. 2017; 35: 3800-3806
        • Katz S.J.
        • Ward K.C.
        • Hamilton A.S.
        • et al.
        Gaps in receipt of clinically indicated genetic counseling after diagnosis of breast cancer.
        J. Clin. Oncol. 2018; 36: 1218-1224
        • Bednar E.M.
        • Oakley H.D.
        • Sun C.C.
        • et al.
        A universal genetic testing initiative for patients with high-grade, non-mucinous epithelial ovarian cancer and the implications for cancer treatment.
        Gynecol. Oncol. 2017; 146: 399-404
        • Pederson H.J.
        • Hussain N.
        • Noss R.
        • et al.
        Impact of an embedded genetic counselor on breast cancer treatment.
        Breast Cancer Res. Treat. 2018; 169: 43-46
        • Petzel S.V.
        • Vogel R.I.
        • Bensend T.
        • Leininger A.
        • Argenta P.A.
        • Geller M.A.
        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
        • Lilyquist J.
        • LaDuca H.
        • Polley E.
        • et al.
        Frequency of mutations in a large series of clinically ascertained ovarian cancer cases tested on multi-gene panels compared to reference controls.
        Gynecol. Oncol. 2017; 147: 375-380
        • Hinchcliff E.M.
        • Bednar E.M.
        • Lu K.H.
        • Rauh-Hain J.A.
        Disparities in gynecologic cancer genetics evaluation.
        Gynecol. Oncol. 2019; 153: 184-191
        • Gray S.W.
        • Park E.R.
        • Najita J.
        • et al.
        Oncologists’ and cancer patients’ views on whole-exome sequencing and incidental findings: results from the CanSeq study.
        Genet. Med. 2016; 18: 1011-1019
        • Offit K.
        • Tkachuk K.A.
        • Stadler Z.K.
        • et al.
        Cascading after peridiagnostic cancer genetic testing: an alternative to population-based screening.
        J. Clin. Oncol. 2020; 38: 1398-1408
        • Hallquist M.L.G.
        • Tricou E.P.
        • Hallquist M.N.
        • et al.
        Positive impact of genetic counseling assistants on genetic counseling efficiency, patient volume, and cost in a cancer genetics clinic.
        Genet. Med. 2020; 22: 1348-1354
        • Hnatiuk M.J.
        • Noss R.
        • Mitchell A.L.
        • Matthews A.L.
        The current state of genetic counseling assistants in the United States.
        J. Genet. Couns. 2019; 28: 962-973
        • Pirzadeh-Miller S.
        • Robinson L.S.
        • Read P.
        • Ross T.S.
        Genetic counseling assistants: an integral piece of the evolving genetic counseling service delivery model.
        J. Genet. Couns. 2017; 26: 716-727
        • Swisher E.M.
        • Rayes N.
        • Bowen D.
        • et al.
        Results from MAGENTA: A national randomized four-arm noninferiority trial evaluating pre- and post-test genetic counseling during online testing for breast and ovarian cancer genetic risk.
        J. Clin. Oncol. 2020; 38 (1506–1506)
        • Watson C.H.
        • Ulm M.
        • Blackburn P.
        • et al.
        Video-assisted genetic counseling in patients with ovarian, fallopian and peritoneal carcinoma.
        Gynecol. Oncol. 2016; 143: 109-112
        • Schmidlen T.
        • Schwartz M.
        • DiLoreto K.
        • Kirchner H.L.
        • Sturm A.C.
        Patient assessment of chatbots for the scalable delivery of genetic counseling.
        J. Genet. Couns. 2019; 28: 1166-1177