Synapse - Mainstreaming in parallel with ovarian cancer tumor testing to improve genetic testing uptake

Mainstreaming in parallel with ovarian cancer tumor testing to improve genetic testing uptake Journal Article

Authors:	Byrne, M.; Sia, T. Y.; Fong, C.; Khurram, A.; Waters, M.; Kemel, Y. M.; Zhou, Q.; Ranganathan, M.; Long Roche, K.; Chi, D. S.; Saban, S.; Wu, M.; Varice, N.; Hamilton, J. G.; Carrot-Zhang, J.; Abu-Rustum, N. R.; Iasonos, A.; Ellenson, L. H.; Mandelker, D.; Weigelt, B.; Brown, C. L.; Aghajanian, C.; Stadler, Z.; Liu, Y. L.
Article Title:	Mainstreaming in parallel with ovarian cancer tumor testing to improve genetic testing uptake
Abstract:	Objectives: Although genetic testing (GT) is universally recommended for patients with epithelial ovarian cancer (EOC), rates are low (34%). In 1/2019, we implemented mainstreaming—GT in parallel with tumor testing via MSK-IMPACT within oncology clinics. We sought to determine GT rates pre/post-mainstreaming and patient characteristics associated with GT. Methods: Patients with newly diagnosed EOC seen at our institution from 7/1/2015–3/31/2022 were included. Clinical data were abstracted including social determinants of health (SDOH) variables, race/ethnicity, marital status, insurance, language, comorbidities, employment, and Yost index, a measure of socioeconomic status. GT rates were calculated overall and pre−/post-mainstreaming (1/2019). Logistic regression models were fit to identify variables associated with GT. Results: Of 1742 patients with EOC, 1591 (91%) underwent GT. Rates of GT increased from 87% to 95% after mainstreaming (p < 0.001). Among 151 patients not undergoing GT, major reasons were lack of provider recommendation (n = 76, 50%) and logistical issues (n = 38, 25%) with few declining (n = 14, 9%) or having medical complications preventing GT (n = 7, 4.6%). High-grade serous histology, advanced stage (III/IV), and having a spouse/partner were associated with increased GT uptake (p < 0.01). Among SDOH variables, there were no differences by insurance, Yost score, language, comorbidities, employment, or race/ethnicity. In multivariable models, likelihood of GT increased with mainstreaming, even after adjustment for histology, stage, and marital status (OR 3.77; 95% CI: 2.56–5.66). Conclusions: Mainstreaming increased the likelihood of GT in patients with EOC. We found lower testing rates in patients without partners/spouses, non–high-grade serous histology, and early-stage disease, representing potential areas for future interventions. © 2024 Elsevier Inc.
Keywords:	adult; controlled study; aged; middle aged; major clinical study; genetics; clinical feature; histopathology; cancer staging; ovarian cancer; ovarian neoplasms; cohort analysis; pathology; oncology; social status; health insurance; medicaid; medicare; clinical study; ovary tumor; diagnosis; clinical evaluation; comorbidity; ovary carcinoma; marriage; genetic screening; race difference; patient attitude; ethnic group; patient acceptance of health care; genetic testing; health disparity; genetic counseling; language ability; employment; procedures; medical genetics; health disparities; cancer test; humans; human; female; article; social determinants of health; carcinoma, ovarian epithelial; divorced person; widowed person; regression model; mainstreaming; yost index
Journal Title:	Gynecologic Oncology
Volume:	183
ISSN:	0090-8258
Publisher:	Elsevier Inc.
Date Published:	2024-04-01
Start Page:	126
End Page:	132
Language:	English
DOI:	10.1016/j.ygyno.2024.03.005
PUBMED:	38493020
PROVIDER:	scopus
PMCID:	PMC11153006
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85188018111&doi=10.1016%2fj.ygyno.2024.03.005&partnerID=40&md5=7be1241684c7af5374e672c5d76c90e1
Notes:	Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed and PDF -- MSK corresponding author is Ying Liu -- Source: Scopus