Highlights
- •Reported rates of genetic testing for people with ovarian cancer remain well below the goal of universal testing.
- •Race and insurance status influence utilization of genetic services by women with ovarian cancer.
- •Promising interventions include mainstreaming genetic care, telemedicine, and embedding genetic counselors in the clinic.
- •The increased demand for testing coupled with the decreased supply of genetic counselors calls for novel approaches.
Abstract
Purpose
Several professional organizations recommend universal genetic assessment for people
with ovarian cancer as identifying pathogenic variants can affect treatment, prognosis,
and all-cause mortality for patients and relatives. We sought to evaluate the literature
on genetic assessment for women with ovarian cancer and determine if any interventions
or patient characteristics drive utilization of services.
Methods
We searched key electronic databases to identify trials that evaluated genetic assessment
for people with ovarian cancer. Trials with the primary aim to evaluate utilization
of genetic assessment with or without interventions were included. Eligible trials
were subjected to meta-analysis and the moderating influence of health interventions
on rates of genetic assessment were examined.
Results
A total of 35 studies were included (19 report on utilization of genetic services
without an intervention, 7 with an intervention, and 9 with both scenarios). Without
an intervention, pooled estimates for referral to genetic counseling and completion
of genetic testing were 39% [CI 27–53%] and 30% [CI 19–44%]. Clinician-facilitated
interventions included: mainstreaming of genetic services (99% [CI 86–100%]), telemedicine
(75% [CI 43–93%]), clinic-embedded genetic counselor (76% [CI 32–95%]), reflex tumor
somatic genetic assessment (64% [CI 17–94%]), universal testing (57% [28–82%]), and
referral forms (26% [CI 10–53%]). Random-effects pooled proportions demonstrated that
Black vs. White race was associated with a lower rate of genetic testing (26%[CI 17–38%]
vs. 40% [CI 25–57%]) as was being un-insured vs. insured (23% [CI 18–28%] vs. 38%
[CI 26–53%]).
Conclusions
Reported rates of genetic testing for people with ovarian cancer remain well below
the goal of universal testing. Interventions such as mainstreaming can improve testing
uptake. Strategies aimed at improving utilization of genetic services should consider
existing disparities in race and insurance status.
Keywords
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Article info
Publication history
Published online: May 19, 2021
Accepted:
May 8,
2021
Received:
March 10,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
