Abstract P6-08-38: Evaluation of adherence to NCCN guidelines regarding genetic evaluation of patients with breast or ovarian cancer diagnoses in a community hospital setting

Abstract

Abstract Background: The National Comprehensive Cancer Network (NCCN) guidelines provide recommendations for which patients diagnosed with breast or ovarian cancer should have a referral for genetic evaluation. However, in a community setting without access to an on-site genetics provider, providing genetic counseling or testing could be more difficult. Objective: The study objective was to evaluate which patients within a community cancer program appropriate for genetic referral actually received counseling or testing, and identify any changes in practice after initiation of an on-site genetics program. Methods: Utilizing an institutional tumor registry database, patients from a community oncology program were identified who met a subset of NCCN guidelines for genetic referral from June 2015 through June 2017. Patients diagnosed with ovarian cancer, breast cancer diagnosed at or before age 45, male breast cancer, and triple negative breast cancer diagnosed at or before age 60 were included. A retrospective electronic chart review was performed to evaluate for genetic referral and uptake of genetic testing. Patients who received genetic testing prior to a cancer diagnosis were excluded from evaluation. Results: A total of 103 patients were included (35 ovarian cancer; 62 breast cancer ≤ age 45; 1 male breast cancer; 17 triple negative ≤ age 60). A total of 76 patients had genetic testing (74%). An additional 5 patients were offered genetic testing or referred for a genetic consult but declined, bringing the total referred or tested to 78.6%. Patients with breast cancer indications had the highest rate of genetic testing (88%). Patients with ovarian cancer were tested at a lower rate (45%). A secondary analysis was performed comparing the length of time between diagnosis and testing before and after the initiation of an on-site genetics program in late July 2016. For patients with breast cancer diagnosed at or under age 45, prior to on-site genetics availability, the average time to test was 62 days (6-1021 days, with 2 patients tested prior to their diagnosis). After the genetics program started, the average time to test was 23 days (6-141 days). For patients with triple negative breast cancer diagnosed at or under age 60, the time to test went from 106 days (8-767 days) to 29 days (6-116 days). For patients with ovarian cancer, time to test went from 296 days (80-810 days) to 116 days (13-230 days). Conclusions: Within our community cancer program, there was a reasonable rate of genetic referral or genetic testing for patients with breast cancer indications per a subset of the NCCN guidelines. The rates of referral or testing were worse for ovarian cancer patients, reflecting the more acute presentation of many of these patients. There exists opportunity for improvement for testing of ovarian cancer patients including availability of inpatient consultation or testing. In addition, this study did not evaluate those patients meeting NCCN guidelines for testing based on family history, which may reflect different referral or testing patterns. For all indications, the average time from diagnosis to testing decreased with the initiation of an on-site genetics program. Citation Format: Kristine M. King, Shannon Huffaker, Dione Froman. Evaluation of adherence to NCCN guidelines regarding genetic evaluation of patients with breast or ovarian cancer diagnoses in a community hospital setting [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-08-38.