Document Type
Podium Presentation
Publication Date
2022
Keywords
swedish learning 21; seattle; swedish; genomics
Abstract
Background: Epithelial ovarian cancer (EOC) accounts for the highest mortality of all gynecological cancers. NCCN guidelines recommend germline and somatic testing for all women with invasive EOC. Despite this recommendation, there is a large diversity in the types of testing patients receive even within a single healthcare system. Reported data of genetic testing for epithelial ovarian cancer (EOC) patients is largely based on patients treated at academic medical centers or patients who participate in clinical trials.
Purpose: This study sought to determine the rates of germline and somatic testing for epithelial ovarian cancer patients and identify factors that impact testing rates across a large community-based healthcare system over 5 states: WA, OR, CA, AK, and MT. The system is comprised of over 100,000 caregivers, 51 hospitals and 829 physician clinics. The aim was to identify barriers to testing such as region, hospital type, insurance status, racial/ethnic disparities, and stage of diagnosis.
Methods: Clinical, pathologic, demographic and genomic testing information was obtained from the diverse dataset within the Providence St. Joseph Health Electronic Medical Records and the system-wide cancer registry for all patients with an EOC diagnosis (ICD C56.x) between January 2015 and January 2020. Structured genomic data was sourced from laboratory information systems and manual abstraction of molecular sequencing reports. This dataset encompasses patient population data among diverse hospital settings and urban/rural environments. Institution types were broken down into academic setting which contain a residency program (Academic), Commission on Cancer (CoC) accredited programs, or smaller community sites (Community) without CoC accreditation. Descriptive statistics and logical regression are utilized to summarize key findings.
Results: Within this EOC cohort (3,007 patients), 34% (n=1,027 patients) completed some type of genomic testing (GT). The percentage of patients tested increased from 31% in 2015 to 46% in 2019, reflecting uptake of testing guidelines. The increase in GT rates was largely attributable to an increase in somatic tumor testing (14-39%); while germline testing rates were stable across the interval (25-33%). Patients were more likely to receive testing if they received care at an academic or CoC institution vs community institution (p=0.0001). Logistic regression analysis demonstrated the following factors impacted tested rates: institution type, insurance, and stage at diagnosis (p=0.001, p= 0.0019 and p < 0.0001, respectively). Race/ethnicity did not contribute significantly to the model but did have a significant effect when analyzed independently.
Conclusion: This study is the first to analyze practice patterns in GT for EOC across a broad community-based healthcare system servicing 5 states. The data highlight discrepancies in GT heavily influenced by practice setting, insurance status, and stage of diagnosis (likely reflecting payer coverage/ increased need for information in advanced stage disease).
Significance: There is a need for a universally defined approach to testing to provide equitable access to evidence based cancer care.
Presenting Author: Nicole Kretzer, MD, PhD, Obstetrics and Gynecology, First Hill Campus, nicole.kretzer@providence.org
Clinical Institute
Cancer
Clinical Institute
Women & Children
Specialty/Research Institute
Obstetrics & Gynecology
Specialty/Research Institute
Oncology
