Molecular testing patterns and implications for treatment at a cancer center.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e13576-e13576
Author(s):  
Clarissa Lam ◽  
Adrianne Rose Mallen ◽  
Christine Marie Walko ◽  
Jing-Yi Chern
Keyword(s):  
Ovarian Cancer ◽  
Genetic Testing ◽  
Cancer Patients ◽  
Descriptive Analysis ◽  
Gynecologic Oncology ◽  
Tumor Board ◽  
Cancer Center ◽  
Time Period ◽  
Testing Patterns ◽  
Germline Testing

e13576 Background: Genetic testing has revolutionized the care of ovarian cancer, providing a potential for targeted therapies and cancer prevention through cascade testing. Previous historical control for genetic testing rate of 28.5% at our institution, this initiated a multilevel intervention to improve guideline concordant care. The main objective of this study is a descriptive analysis of genetic testing patterns with the implementation of a genetics tumor board (GTB) at an NCI comprehensive cancer center (CCC). Methods: All gynecologic oncology cancer patients who underwent somatic testing from 3/2019 to 1/2020 were included in gynecologic oncology GTB. A descriptive analysis was performed on the ovarian cancer patients. Information regarding patient demographics, cancer characteristics, treatment, and follow-up were obtained from the medical records. Results: There were a total of 81 patients included in GTB during this time period. Fifty-four of 81 (66.7%) received care at our CCC and 27 of 81 (33.3%) were seen as a second opinion case. The patients included in GTB were comprised of recurrent ovarian cancer cases and newly diagnosed ovarian cancer cases. Of the patients included in genetics tumor board, 58 of 81 (71.6%) of patients received both germline and somatic testing. Genetics referrals were placed for 16 of 23 (69%) of the patients who received somatic testing without subsequent germline testing. Twelve of 81 (14.8%) GTB patients were identified for clinical trials during this time period. Conclusions: Genetic testing has become a cornerstone to ovarian cancer care. Implementation of a genetics tumor board at our institution has increased rates of germline testing compared to historical controls. With genetic tumor board being made up of a third of patients seeking a second opinion, we are able to provide comprehensive care to such patients in the form of genetic counseling referrals and clinical trial opportunities. Genetics tumor board also appears to highlight the cohort of patients with the most aggressive cancers: high-grade, advanced stage, and high rates of recurrence. This can potentially improve care by providing an arena for a multidisciplinary discussion of our most complex patients. Ongoing studies with the implementation of our cancer pathways may help determine which modifiable factors can be targeted to help increase adherence to genetic testing recommendations as we continue to strive for guideline-based care.

Pattern of care study for treatment of ovarian cancer patients among Japanese gynecologists. A Japanese Gynecologic Oncology Group (JGOG) study

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 15029-15029
Author(s):  
K. Fujiwara ◽  
T. Sugiyama ◽  
E. Aotani ◽  
J. Kigawa ◽  
K. Kuzuya ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cancer Patients ◽  
Gynecologic Oncology ◽  
Intestinal Resection ◽  
Advanced Ovarian Cancer ◽  
Cancer Center ◽  
Base Line ◽  
Gynecologic Oncology Group ◽  
Pattern Of Care ◽  
Gynecologic Oncologist

15029 Background: The Japanese Society of Gynecologic Oncology started a training program for the subspecialty of board certified gynecologic oncologists in 2005. This study aimed to assess the attitude of Japanese gynecologists for the treatment of ovarian cancer in pre-gynecologic oncologist era. Methods: The JGOG distributed a survey to 217 member institutions in January 2005. The principal investigator (PI) of each institution answered 33 questionnaires regarding diagnostic, surgical and chemotherapy issues. The survey was returned from 156 institutions (71.9%). Results: Hospital settings were general (44%), academic (44%), Cancer Center (8%), or private (4%). Only two of PIs were medical oncologists and rests of them were gynecologists. As the staging procedure in early ovarian cancer, 67% institutions do systemic pelvic lymphadenectomy (LNX) but 22% do only sampling. For the paraaortic nodes, 36% do systemic LNX and 10% do sampling below renal vein, and 14% do LNX and 12% do sampling below inferior mesenteric artery. However, intraabdominal explorations such as multiple peritoneal biopsies have been done only less than 30% except for omentectomy (90%). With regard to the surgery for advanced ovarian cancer, 57% institutions do not do any intestinal resection and anastomosis during the primary surgery. Among them 7% of institutions prefer neoadjuvant chemotherapy (no debulking at all) for advanced ovarian cancer. However, 84% of the institutions do interval debulking and 57% of them are quite aggressive for the procedure. These results demonstrate the high expectation that chemotherapy may reduce the aggressiveness of surgery for advanced ovarian cancer. In terms of chemotherapy for the high-risk early and advanced ovarian cancer, taxane plus platinum is the most used regimen (93–95%). However, 45% of institutions prefer different regimen for clear cell carcinoma. CPT-11 is the most used (88.6%). Intraperitoneal chemotherapy has been performed in 28.2% of institutions. 37.2% of institutions do consolidation chemotherapy. Conclusions: This is an important base-line information to assess the pattern of care for ovarian cancer patients in the era before gynecologic oncologist subspecialty is applicable in Japan. No significant financial relationships to disclose.

The effect of the Affordable Care Act on genetic testing patterns and outcomes for inheritable cancer syndromes: A single institution experience.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e13157-e13157
Author(s):  
Zhen Ni Zhou ◽  
Melissa Kristen Frey ◽  
Jessica Fields ◽  
Sushmita Gordhandas ◽  
Maria Paula Ruiz ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Genetic Testing ◽  
Affordable Care Act ◽  
Cancer Center ◽  
Insurance Status ◽  
Single Institution ◽  
Breast And Ovarian Cancer ◽  
Panel Testing ◽  
Testing Patterns ◽  
Multigene Panel

e13157 Background: National guidelines recommend genetic testing for women at increased risk for pathogenic mutations, however insurance coverage is a commonly cited barrier to test completion. The major provisions of the Affordable Care Act (ACA) became available in New York State (NYS) in January 2014. We sought to evaluate the effect of insurance status on genetic testing patterns following introduction of the ACA. Methods: Insurance status and genetic testing patterns at the hereditary breast and ovarian cancer center at a single institution were reviewed between 1/1/2013 and 12/31/2016. Insurance status and association with testing type and clinical outcomes were evaluated before and after January 2014. Results: During the study period, 1535 women underwent genetic counseling and genetic assessment. When comparing the cohort of women undergoing genetic testing prior to and following January 2014, significant increases in patients undergoing multigene panel testing were observed across all insurance types (6.3% vs. 40.6%, p < 0.001). While a significant increase in the number of patients with private insurance or Medicaid as primary coverage was seen, the increase in insured women was largely attributed to insurance polices through the ACA exchange (p < 0.001), with the majority being Medicaid ACA plans (80.3%). Conclusions: Since expansion of health insurance through the ACA in NYS, there has been a shift in the demographics of women undergoing genetic testing at a hereditary breast and ovarian cancer center with significantly more insured women and a rise in multigene panel testing. With insurance expansion and improved access to comprehensive genetic testing, insurance status should not be an obstacle for genetic testing.

The impact of live education on the competence and performance of oncology practitioners who care for patients with ovarian cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e23010-e23010
Author(s):  
Vanessa Carranza ◽  
Bryan Carson Taylor ◽  
Susan H. Gitzinger ◽  
Joan B. Fowler ◽  
Jessica Hall
Keyword(s):  
Ovarian Cancer ◽  
Genetic Testing ◽  
Cancer Patients ◽  
Parp Inhibitor ◽  
Inhibitor Therapy ◽  
Community Based ◽  
Educational Initiatives ◽  
Post Test ◽  
Chi Square Analysis

e23010 Background: About a third of ovarian cancer patients in the US have limited access to a gynecologic oncologist (GO) due to geographic disparities. A survey by The Society of Gynecologic Oncology (SGO) found that the majority of GOs found it was vital to coordinate local access to care, from diagnosis to survivorship, for patients living in areas of disparity. This allows rural/underserved patients broader access to novel therapies, as they increasingly become standard of care. It is critical for not only GOs to be current on the latest ovarian cancer data, but all clinicians who care for these patients. Methods: CEC Oncology developed two educational initiatives focused on PARP inhibitor therapy in ovarian cancer, which was targeted to all US healthcare professionals caring for ovarian cancer patients. Evaluations were collected from attendees attending an SGO Symposium and Ground Round (GR) series to assess impact on practice, increased competency, and intent to make a change in practice. Learning, knowledge, and competence was objectively assessed by analyzing pre-test, post-test, and follow-up survey data (sent 4-6 weeks post-activity). Chi-square analysis was conducted with a priori significance set at 0.05. Results: A total of 830 clinicians were educated, with SGO attendees primarily practicing in academic settings and GR attendees mostly from community practices. SGO attendees were asked case questions at baseline, immediately after the activity, and 4-6 weeks after the activity. Knowledge increased from pre- to post-test regarding current genetic testing recommendations (23% increase; P= .004) and appropriate selection of PARP inhibitor therapy (25% increase; P= .017). Knowledge was sustained at follow-up analysis. At follow-up, 90% of SGO and 84% of GR attendees made a change as a result of attending the activities. More attendees were able to incorporate germline multigene testing into practice, than originally intended; increase of 29% for SGO and 7% for GR audiences. All attendees experienced the barrier lack of patient education about the importance of genetic testing/counseling more than anticipated; increase of 7% for SGO and 13% for GR audiences. At follow-up, there was a 9% increase in GR attendees listing staying current with trial data and practice guidelines as a barrier. Conclusions: There were some notable differences seen in competence/performance among attendees of the two ovarian cancer educational initiatives. Differences may be attributed to practice setting (SGO primarily academic; GR primarily community.) Overall, GR attendees were more likely to face barriers, suggesting that community-based clinicians have fewer resources and experience more barriers to implementing best practices. Thus, it is vital to offer education for clinicians in community-based practices, particularly in areas that are considered ‘geographically disparate’.

scholarly journals COST ANALYSIS OF TAXANE-BASED AND CISPLATIN-BASED CHEMOTHERAPY REGIMENS FOR EPITHELIAL OVARIAN CANCER IN DHARMAIS NATIONAL CANCER HOSPITAL

2017 ◽  
Vol 9 ◽  
pp. 172
Author(s):  
Bambang Dwipoyono ◽  
Septyana Choirunisa ◽  
Mardiati Nadjib ◽  
Amal C Sjaaf
Keyword(s):  
Ovarian Cancer ◽  
Cost Analysis ◽  
Epithelial Ovarian Cancer ◽  
Cancer Patients ◽  
Surgical Procedures ◽  
Exploratory Study ◽  
Descriptive Analysis ◽  
Treatment Costs ◽  
Kaplan Meier ◽  
Disease Free

Objective: This exploratory study aimed to evaluate and compare the treatment costs of taxane-based versus cisplatin-based chemotherapy.Methods: This study used data from the medical and financial records of ovarian cancer patients who were admitted to Dharmais NationalCancer Hospital (RSKD) between 2008 and 2012 and subsequently underwent surgery and were treated with chemotherapy. Data were analyzedusing descriptive analysis, and a Kaplan–Meier graph was plotted to compare the survival of the patients in the taxane-based and cisplatin-basedchemotherapy groups.Results: Of 41 patients, treatment costs were available for nine patients who had undergone taxane-based chemotherapy and for 31 patients who hadundergone cisplatin-based chemotherapy. In general, surgical procedures accounted for the highest proportion of the treatment costs, followed bychemotherapy. Taxane-based chemotherapy (six cycles) was 4 times more expensive than cisplatin-based therapy. The pre- and post-chemotherapycosts of care among those treated with the taxane-based regimen were 3-4 times more expensive than those of the patients who received cisplatinbasedtreatment. The disease-free recurrence duration of the patients treated with taxane was longer (median=18 months) than that of the patientstreated with cisplatin (median=5 months).Conclusions: Taxane-based therapy increased the disease-free recurrence duration of the patients, with disease-free recurrence 3 times longer thanthat of the patients treated with the cisplatin-based regimen. However, the treatment costs of the taxane-based regimen were 4 times higher thanthose of the cisplatin-based treatment.

scholarly journals Racial and Ethnic Disparities in Genetic Testing at a Hereditary Breast and Ovarian Cancer Center

2020 ◽  
Author(s):  
Eloise Chapman-Davis ◽  
Zhen Ni Zhou ◽  
Jessica C. Fields ◽  
Melissa K. Frey ◽  
Bailey Jordan ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Genetic Testing ◽  
Ethnic Disparities ◽  
Cancer Center ◽  
Racial And Ethnic Disparities ◽  
Breast And Ovarian Cancer

Quality assessment of tumor boards across an academic and community cancer network.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 122-122
Author(s):  
Daniel Aaron Roberts ◽  
Robert Stuver ◽  
Igor Schillevoort ◽  
Jessica A. Zerillo
Keyword(s):  
Quality Assessment ◽  
Response Rate ◽  
Gynecologic Oncology ◽  
The United States ◽  
Tumor Board ◽  
Cancer Center ◽  
Measurement Tool ◽  
Tumor Boards ◽  
Assessment Survey ◽  
Cancer Network

122 Background: Cancer tumor boards (TB), or multidisciplinary team meetings are standard of care in oncology care worldwide. Specific components are described by the American College of Surgeon's Commission on Cancer Program. Most data show consistent improvement in outcomes including a change in diagnostic findings, treatment, and possibly improved survival with TBs. Methods: We adapted a performance assessment tool based on a validated survey implemented in the United Kingdom. An initial survey aimed at assessing tumor board structure and design was sent to 21 TB leaders, and subsequently a tumor board quality assessment survey was sent to 175 participants throughout an academic and community network. The quality assessment survey required participants to identify an answer on a 5-point Likert scale in the categories of "very poor, poor, average, good, and very good". Results: TB leaders representing 16 of 21 (response rate 76%) TBs responded to the structure/design survey. Twelve TBs were from the academic center and included diseases such as Gynecologic Oncology, Cutaneous Oncology, Genitourinary Oncology, and Sarcoma, while four were from community sites. TB leaders indicated that 55% of TBs did not receive CME credit and 60% did not document their recommendations. One hundred eleven TB participants of 175 (response rate 63%) responded to the quality assessment survey. Participants identified the following strengths: 1) all relevant subspecialties present for meetings, 2) respectful teamwork and culture, and 3) operating on an organized agenda. Areas for improvement included: 1) inconsistent tumor board recommendation documentation and 2) post-meeting coordination of care. Results were reviewed with network and cancer center leadership as well as with the Cancer Committee. Conclusions: We assessed our own tumor boards across our cancer network by utilizing an adapted version of a validated TB performance measurement tool for the first time in the United States. Through this assessment we identified key areas for improvement including the need for obtaining CME credit for TB attendance, and developed a policy, process, and template for documenting TB recommendations in an easily accessible centralized location.

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