Effects of telehealth on uptake and timeliness of genetic counseling and genetic testing among patients with endometrial cancer.

Abstract

e22531 Background: The COVID-19 pandemic prompted genetic counseling (GC) services to shift from in-person to remote telehealth visits. Prior studies identified that telehealth allowed uninterrupted access to cancer GC during the pandemic. However, germline genetic testing (GT) completion decreased. Before the pandemic, studies found that patients with endometrial cancer (EC) had suboptimal rates of referral to GC and GT for Lynch syndrome (LS). We sought to determine how the transition to telehealth impacted EC patients’ uptake of and timeliness to, guideline-recommended GC and GT. Methods: Adults with newly diagnosed EC who completed outpatient gynecologic oncology visits were identified from a tertiary care oncology center’s tumor registry and through retrospective review of electronic medical records. Patients were assigned to the pre-pandemic and pandemic cohorts if diagnosed 9/1/2018-3/31/2020 and 4/1/2020-12/31/2020, respectively. Patients were also assigned based on whether they met guideline-based criteria for LS GT (diagnosed under the age of 50, had abnormal MSI/IHC testing, or had a synchronous LS tumor). Chi-square, two-sample t-test, and descriptive statistics were performed, with a statistically significant p-value < 0.05. In total,443 patients with EC were included; 330 and 113 in pre-pandemic and pandemic cohorts, respectively.The pandemic cohort had higher rates of GC (24% vs 19%, p = 0.22) and GT (23% and 16%, p = 0.08). Eighty-five (25.8%) of the pre-pandemic and 23 (20.4%) of the pandemic cohorts met LS criteria for GT. Of patients who met LS criteria, the pandemic cohort also had higher rates of GC (57% vs 42%, p = 0.23) and GT (48% vs 40%, p = 0.08). Results: The median time from diagnosis to GC was 138 days for the pre-pandemic and 87 days for the pandemic cohorts (p = 0.09) The median time to GT was 144 days for the pre-pandemic and 114 days for the pandemic cohorts (p = 0.19). Of patients who met GT criteria, the pre-pandemic cohort had a median of 135 days from diagnosis to GC compared to the pandemic cohort’s median of 86 days (p = 0.37). The median time to GT was 131 days for pre-pandemic and 112 days for pandemic cohorts (p = 0.27). Conclusions: Uptake of GC and GT among patients with newly diagnosed EC, including those who met GT criteria, was higher and more timely in the pandemic cohort. While differences were not statistically significant, results suggest that telehealth may have improved delivery of GC and GT for EC patients. Overall, rates of GC and GT remain low (less than 50%), and further study of sustained effects of telehealth in this population after 2020 is needed.