Genetic Counseling Referrals for Gynecologic Oncology, Are We Missing Opportunities? [29H

Abstract

INTRODUCTION: NCCN and SGO recommend genetic evaluation for women with epithelial ovarian cancer (EOC) and certain endometrial cancer (EC) patients. Despite guidelines, patients are not consistently receiving referrals. Our primary aim was to evaluate if patients at a tertiary care center were being referred per recommendations. Secondary aims were to determine demographic, socioeconomic or pathologic differences associated with referrals. METHODS: This is a retrospective cohort study of all patients diagnosed with EOC, EC before age 50, or EC with mismatch repair deficiency on tumor testing at a tertiary referral center between 2009 and 2018. Rates of referrals were calculated. Descriptive statistics compared patients who were and were not referred to genetics. A multivariable model was fit to identify potential predictive variables. RESULTS: 275 women were included (58 EC 217 EOC); per guidelines, 100% should have received referrals. Overall, 34.5% of the population were referred. 15.5% EC vs 39.6% EOC patients received referrals. On univariate analyses, family history, EOC diagnosis, grade and histology were the only variables that differed between those who were and weren't referred. Race, ethnicity, age, BMI, language spoken, insurance status, and stage were not associated with referral rates. EOC diagnosis and family history were the only independently associated variables on multivariable regression. Of referred patients, 73.8% attended genetic counseling appointments. CONCLUSION: Patients with epithelial ovarian and endometrial cancers are referred to genetics less frequently than recommended. The majority of patients who were referred attended the appointment. Family history was the only variable independently associated with referral.