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Increasing genetic counseling referral rates after ovarian cancer diagnosis: Improving the quality of ovarian cancer care
Abstracts / Gynecologic Oncology 141 (2016) 2–208
doi:10.1016/j.ygyno.2016.04.499
468 – Poster Patient reported clinical outcomes and personal perspectives after risk reducing surgery S.M. Kehoe, M. Mann, D.L. Richardson, J.S. Lea, D.S. Miller, C. Mauer. University of Texas Southwestern Medical Center, Dallas, TX, USA
Table 1
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RR
EC
TE
DP
Objectives: Risk-reducing bilateral salpingo-oophorectomy (RRBSO) is recommended for women at increased risk for gynecologic cancers because of a genetic mutation. This procedure is recommended of premenopausal women, which may lead to long-term physical and emotional symptoms. We sought to evaluate the patients’ perspective on psychological and physical changes after RRBSO. Methods: Institutional review board approval was obtained and institutional databases were used to identify patients with a genetic mutation. Eligible patients were unaffected with gynecologic cancer and had undergone RRBSO between 2004 and 2014. Patients were contacted either in clinic or by mail and asked to fill out the questionnaire. Results: Ninety-one questionnaires were sent, and 42 patients (46%) returned questionnaires. Seventeen patients (40%) were BRCA1 positive, 21 patients (50%) were BRCA2 positive, and 4 patients (10%) had Lynch syndrome. The median age was 47 years. Thirty-five (83%) patients felt they were provided with information about expected menopausal symptoms. Twenty-seven patients (61%) reported being informed about possible changes in sexual function. Forty patients answered questions specifically about vasomotor symptoms. Of this group, 19 patients (48%) reported increase in hot flashes, and 23 patients (58%) reported an increase in vaginal dryness. Twenty-five patients (63%) reported worsening sleep and 14 patients (35%) reported an increase in depression. Twenty-six women (62%) were premenopausal before surgery, of whom 15 (58%) reported using a form of hormone therapy after surgery to treat bothersome vasomotor symptoms. Six patients (15%) reported an increase in anxiety, and most patients (93%) reported that their RRBSO relieved their worry about developing cancer. Overall, 41 patients (98%) were content with their decision to undergo risk-reducing surgery. Conclusions: Most patients who underwent risk-reducing surgery reported no regret and a sense of relief. However, patients did report bothersome clinical symptoms related to surgical menopause as well as worsening anxiety and depression. Our study identified areas for improvement in counseling patients before RRBSO, as well as areas in which to focus treatment after surgery.
referral for women with epithelial ovarian cancer (EOC), current rates are 14.5% to 32.3%. We aimed to increase our rate of genetic counseling referral using a toolkit based on the results of a practice gap analysis. Methods: All new EOC patients evaluated at a single academic tertiary referral cancer center from July 1, 2013, to December 31, 2013, were retrospectively identified, and a chart and electronic order review was performed. Clinicopathologic factors and whether genetic referral, counseling, and testing were completed were abstracted. A practice gap analysis was performed to identify points of intervention, and a multipronged toolkit (Table 1) was built with the goal of increasing genetic referral rates to 75%. The toolkit was implemented in April 2015. Data from new EOC patients evaluated from May 1, 2015, to June 30, 2015, was abstracted to determine postintervention referral rates. This was a quality improvement project involving a multidisciplinary team from oncology, genetics, and nursing. Results: The preintervention EOC cohort included 83 women with a primary presentation of EOC, with a mean age of 61.8 years at diagnosis. Sixty percent had stage III or IV disease, and serous histology was present in 59%. The postintervention EOC cohort included 23 women with primary EOC presentation, with a mean age of 60.6 years. Stage III or IV disease was present in 82.6%, and 60.9% had serous histology. Forty-one percent (34/83) of women in the preintervention cohort were referred for genetic counseling. After toolkit implementation, the referral rate increased to 91.3% (21/23; P b .05, with the Fisher exact test). In the preintervention cohort, 76.5% referred completed genetic counseling, and, of those, 77.0% underwent genetic testing. In the postintervention cohort, to date, 34.8% have completed genetic counseling, and 75% of them have undergone genetic testing thus far. Conclusions: Implementation of a multipronged toolkit designed to improve adherence to NCCN and SGO guidelines resulted in a significant increase in the genetic counseling referral rate among women with newly diagnosed EOC. Continued maintenance of this practice change is under way.
OF
of methylation is seen in both primary tumors and expressing cell lines. A clear difference was seen in the methylation of FOXA2 nonexpressing blood DNA and expressing primary tumor DNA. Further analysis is ongoing to determine true sequencing of CpG islands to assess full methylation status.
RO
194
UN
doi:10.1016/j.ygyno.2016.04.500
469 – Poster Increasing genetic counseling referral rates after ovarian cancer diagnosis: Improving the quality of ovarian cancer care C.L. Swansona, J.M. Beissela, A. Kumarb, M. Wicka, G. Beeka, J. Kemppainena, K.M. Goodmana, M. Weinholda, K. Sorgatza, J.N. Bakkum-Gameza. aMayo Clinic, Rochester, MN, USA, bMayo Clinic College of Medicine, Rochester, MN, USA Objectives: Despite guidelines from the National Comprehensive Cancer Network (NCCN) in 2007 and Society of Gynecologic Oncology (SGO) in 2014 recommending universal genetic counseling
doi:10.1016/j.ygyno.2016.04.501
470 – Poster Implementation of an enhanced recovery after gynecologic oncology surgery pathway: Improving compliance with key elements of preoperative care J.D. Lasala, I.C. Ifeanyi, J. Singh, T.W. Earles, L.D. Palmer, M. Harris, P.T. Ramirez, T. Moon Calderon, A.M. Nick, L.A. Meyer, T.A. Jackson. The University of Texas MD Anderson Cancer Center, Houston, TX, USA Objectives: To describe a process change and evaluate compliance with the use of preventive analgesia and deep vein thromboembolic (DVT) prophylaxis in an enhanced recovery pathway (ERP). Methods: The ERP at MD Anderson Cancer Center was initiated in the Department of Gynecologic Oncology in November 2014. We used the following medications for preventive analgesia: pregabalin
doi:10.1016/j.ygyno.2016.04.499
468 – Poster Patient reported clinical outcomes and personal perspectives after risk reducing surgery S.M. Kehoe, M. Mann, D.L. Richardson, J.S. Lea, D.S. Miller, C. Mauer. University of Texas Southwestern Medical Center, Dallas, TX, USA
Table 1
CO
RR
EC
TE
DP
Objectives: Risk-reducing bilateral salpingo-oophorectomy (RRBSO) is recommended for women at increased risk for gynecologic cancers because of a genetic mutation. This procedure is recommended of premenopausal women, which may lead to long-term physical and emotional symptoms. We sought to evaluate the patients’ perspective on psychological and physical changes after RRBSO. Methods: Institutional review board approval was obtained and institutional databases were used to identify patients with a genetic mutation. Eligible patients were unaffected with gynecologic cancer and had undergone RRBSO between 2004 and 2014. Patients were contacted either in clinic or by mail and asked to fill out the questionnaire. Results: Ninety-one questionnaires were sent, and 42 patients (46%) returned questionnaires. Seventeen patients (40%) were BRCA1 positive, 21 patients (50%) were BRCA2 positive, and 4 patients (10%) had Lynch syndrome. The median age was 47 years. Thirty-five (83%) patients felt they were provided with information about expected menopausal symptoms. Twenty-seven patients (61%) reported being informed about possible changes in sexual function. Forty patients answered questions specifically about vasomotor symptoms. Of this group, 19 patients (48%) reported increase in hot flashes, and 23 patients (58%) reported an increase in vaginal dryness. Twenty-five patients (63%) reported worsening sleep and 14 patients (35%) reported an increase in depression. Twenty-six women (62%) were premenopausal before surgery, of whom 15 (58%) reported using a form of hormone therapy after surgery to treat bothersome vasomotor symptoms. Six patients (15%) reported an increase in anxiety, and most patients (93%) reported that their RRBSO relieved their worry about developing cancer. Overall, 41 patients (98%) were content with their decision to undergo risk-reducing surgery. Conclusions: Most patients who underwent risk-reducing surgery reported no regret and a sense of relief. However, patients did report bothersome clinical symptoms related to surgical menopause as well as worsening anxiety and depression. Our study identified areas for improvement in counseling patients before RRBSO, as well as areas in which to focus treatment after surgery.
referral for women with epithelial ovarian cancer (EOC), current rates are 14.5% to 32.3%. We aimed to increase our rate of genetic counseling referral using a toolkit based on the results of a practice gap analysis. Methods: All new EOC patients evaluated at a single academic tertiary referral cancer center from July 1, 2013, to December 31, 2013, were retrospectively identified, and a chart and electronic order review was performed. Clinicopathologic factors and whether genetic referral, counseling, and testing were completed were abstracted. A practice gap analysis was performed to identify points of intervention, and a multipronged toolkit (Table 1) was built with the goal of increasing genetic referral rates to 75%. The toolkit was implemented in April 2015. Data from new EOC patients evaluated from May 1, 2015, to June 30, 2015, was abstracted to determine postintervention referral rates. This was a quality improvement project involving a multidisciplinary team from oncology, genetics, and nursing. Results: The preintervention EOC cohort included 83 women with a primary presentation of EOC, with a mean age of 61.8 years at diagnosis. Sixty percent had stage III or IV disease, and serous histology was present in 59%. The postintervention EOC cohort included 23 women with primary EOC presentation, with a mean age of 60.6 years. Stage III or IV disease was present in 82.6%, and 60.9% had serous histology. Forty-one percent (34/83) of women in the preintervention cohort were referred for genetic counseling. After toolkit implementation, the referral rate increased to 91.3% (21/23; P b .05, with the Fisher exact test). In the preintervention cohort, 76.5% referred completed genetic counseling, and, of those, 77.0% underwent genetic testing. In the postintervention cohort, to date, 34.8% have completed genetic counseling, and 75% of them have undergone genetic testing thus far. Conclusions: Implementation of a multipronged toolkit designed to improve adherence to NCCN and SGO guidelines resulted in a significant increase in the genetic counseling referral rate among women with newly diagnosed EOC. Continued maintenance of this practice change is under way.
OF
of methylation is seen in both primary tumors and expressing cell lines. A clear difference was seen in the methylation of FOXA2 nonexpressing blood DNA and expressing primary tumor DNA. Further analysis is ongoing to determine true sequencing of CpG islands to assess full methylation status.
RO
194
UN
doi:10.1016/j.ygyno.2016.04.500
469 – Poster Increasing genetic counseling referral rates after ovarian cancer diagnosis: Improving the quality of ovarian cancer care C.L. Swansona, J.M. Beissela, A. Kumarb, M. Wicka, G. Beeka, J. Kemppainena, K.M. Goodmana, M. Weinholda, K. Sorgatza, J.N. Bakkum-Gameza. aMayo Clinic, Rochester, MN, USA, bMayo Clinic College of Medicine, Rochester, MN, USA Objectives: Despite guidelines from the National Comprehensive Cancer Network (NCCN) in 2007 and Society of Gynecologic Oncology (SGO) in 2014 recommending universal genetic counseling
doi:10.1016/j.ygyno.2016.04.501
470 – Poster Implementation of an enhanced recovery after gynecologic oncology surgery pathway: Improving compliance with key elements of preoperative care J.D. Lasala, I.C. Ifeanyi, J. Singh, T.W. Earles, L.D. Palmer, M. Harris, P.T. Ramirez, T. Moon Calderon, A.M. Nick, L.A. Meyer, T.A. Jackson. The University of Texas MD Anderson Cancer Center, Houston, TX, USA Objectives: To describe a process change and evaluate compliance with the use of preventive analgesia and deep vein thromboembolic (DVT) prophylaxis in an enhanced recovery pathway (ERP). Methods: The ERP at MD Anderson Cancer Center was initiated in the Department of Gynecologic Oncology in November 2014. We used the following medications for preventive analgesia: pregabalin