Rates of genetic consultation in high-grade serous ovarian cancer patients in the era of PARP inhibitor therapy: A population-based study

Shannon E Brent; Jacob McGee; Danielle Vicus; Raymond Kim; Andrea Eisen; Andrew S Wilton; Lilian T Gien

doi:10.1002/ijgo.15391

Rates of genetic consultation in high-grade serous ovarian cancer patients in the era of PARP inhibitor therapy: A population-based study

Int J Gynaecol Obstet. 2024 Jan 29. doi: 10.1002/ijgo.15391. Online ahead of print.

Authors

Shannon E Brent¹, Jacob McGee², Danielle Vicus^{1

3}, Raymond Kim⁴, Andrea Eisen⁵, Andrew S Wilton⁶, Lilian T Gien^{1

3

6}

Affiliations

¹ Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada.
² Department of Obstetrics and Gynaecology, Western University, London, Ontario, Canada.
³ Division of Gynecologic Oncology, Sunnybrook Odette Cancer Center, Toronto, Ontario, Canada.
⁴ Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
⁵ Department of Medical Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, Ontario, Canada.
⁶ ICES Research, Toronto, Ontario, Canada.

PMID: 38284267
DOI: 10.1002/ijgo.15391

Abstract

Objective: The American Society of Clinical Oncology recommends all patients with high-grade serous ovarian carcinoma (HGSC) undergo germline genetic testing. Genetic consultation rates in Ontario, Canada, only reached 13.3% in 2011. In 2016, PARP inhibitor maintenance therapy became available in Ontario for BRCA-positive HGSC patients. Given expanding treatment options, we re-examined genetic consultation rates among HGSC patients.

Methods: This retrospective cohort study identified patients diagnosed with HGSC between 2012 and 2019 using population-based administrative data from Ontario. Genetics consultations were identified using Ontario Health Insurance Plan billing codes. Consultation rates over time were analyzed using Cochran-Armitage trend test and segmental regression analysis. Multivariable analysis identified factors associated with attending genetics consultation.

Results: This study included 4645 HGSC patients. The mean age was 64.2 years (±SD 12.3); 56.3% had stage 3-4 disease. Overall, approximately 35% attended genetics consultations. The genetic consultation rate per year increased significantly from 21.6% to 42.6% (P < 0.001). Shorter times between diagnosis and genetics consult were observed after PARP inhibitors became available (68.1 vs 34.1 weeks, P < 0.001). Patients treated at designated cancer centers (odds ratio [OR] 2.11, P < 0.001), diagnosed in later years (OR 1.33, P < 0.001), and from higher income groups (P < 0.05) were more likely to attend genetics consultation; older patients were less likely (OR 0.98, P < 0.001). After PARP inhibitors became available, consultation rates plateaued (P < 0.001).

Conclusions: Between 2012 and 2019, genetic consultation rates improved significantly among HGSC patients; however, a large proportion of patients never attended consultation. Further exploration of barriers to care is warranted to improve consultation rates and ensure equitable access to care.

Keywords: BRCA; genetic counseling; gynecologic oncology; ovarian cancer.

Grants and funding

Department of Obstetrics & Gynecology, University of Toronto