Implementation of a stepwise process for somatic testing in patients with a new diagnosis of germline negative epithelial ovarian cancer

Objective

We sought to establish a process for increasing somatic tumor testing for patients with germline BRCA negative advanced stage epithelial ovarian cancer (EOC) and to gain insight into patients’ comprehension of their genetic testing.

Methods

A multidisciplinary team utilized quality improvement framework to address clinical needs. After implementation of a new somatic testing process, we compared the rates of genetic testing referral, germline testing and somatic testing recommendations between a historic cohort (January 1, 2019-June 20, 2019) and implementation cohort (October 1, 2020 – March 31, 2021). Patients diagnosed with stage III-IV EOC who underwent surgery were included for analysis. To explore patients’ comprehension of their genetic testing results, twenty-three patients in the historic cohort participated in semi-structured interviews.

Results

Patients with advanced stage EOC without a germline BRCA mutation received recommendations for somatic testing 53.5 % (23/43) of the time in the historic cohort. An improvement in the rate of somatic testing recommendations was seen in patients without a germline mutation in the implementation cohort (84.6 % [22/26], P = 0.010). There was no decrease in germline testing after implementation (90 % [63/70] and 96.3 % [52/54,] P = 0.30). Most patients (21/23) in the historic cohort were not aware that both germline and somatic testing were completed for their oncology care.

Conclusion

We successfully increased somatic testing recommendations in germline BRCA negative patients prior to completing upfront EOC treatment allowing for a timely, individualized discussion of maintenance PARP inhibitor use. Qualitative assessment of patients’ comprehension of genetic testing for EOC shows a deficit in patient knowledge.