For women with ovarian cancer, an oncologist-led BRCA1/2 (BRCAm) counseling process is associated with favorable waiting times for test results and high levels of satisfaction, according to results of a prospective observational study.

The median turnaround time from initial counseling to receiving a test result was 9.1 weeks, investigators reported in the Journal of Clinical Oncology .

“Following a pathway similar to the one used in this study could allow faster treatment decisions and better use of resources in the management of patients with ovarian cancer,” said lead author Nicoletta Colombo, MD, of European Institute of Oncology, University of Milan-Bicocca, Italy, and her associates.

Establishing an ovarian cancer patient’s BRCAm status provides useful prognostic information and helps identify patients most likely to benefit from therapy with poly(ADP-ribose) polymerase (PARP) inhibitors, Dr. Colombo and her colleagues wrote.

However, despite guideline recommendations, many patients with an ovarian cancer diagnosis are currently not receiving BRCAm testing, they added.

“Given the high volume of BRCAm tests now being ordered, a new, more streamlined testing approach is needed to shorten testing turnaround times and to ease the pressure on genetic counselors,” the authors said.

In a pilot study from the United Kingdom, a streamlined, oncologist-led BRCAm testing model reduced a 20-week average turnaround time by fourfold, Dr. Colombo and her colleagues said.

Accordingly, the prospective, observational ENGAGE study sought to evaluate a streamlined oncologist-led BRCAm testing pathway in 700 patients with ovarian cancer at 26 sites in the United States, Spain, and Italy.

Oncologists and oncology nurses involved in the study received training on pretest genetic counseling techniques and on how to discuss the role of BRCAm testing with patients, according to the study description. Patients with a positive test were recommended for an appointment with a geneticist or genetic counselor.

The median time from initial counseling to receiving a test result was 9.1 weeks, the investigators reported. For patients in the United States, that median turnaround time was 4.1 weeks, while turnaround times in Spain and Italy were 12.0 and 20.4 weeks, respectively.

“BRCAm testing usually occurred shortly after the initial oncology team counseling, whereas the average time from patient consent to BRCAm testing was expected to be more than 1 month in approximately 25% of patients using standard procedures,” the investigators said in their report.

More than 99% of patients expressed satisfaction with the oncologist-led testing pathway, Dr. Colombo and her associates said. In addition, more than 80% of oncologists said the testing worked well and that counseling was an efficient use of their time.

Geneticists and genetic counselors showed less enthusiasm for the oncologist-led approach, according to investigators.

Less than half of surveyed geneticists or genetic counselors felt that patients received accurate information about the BRCAm test in the pretest counseling session, according to the report.

“It should be noted that the purpose of the oncologist-led pretest counseling was to provide enough information on why the patient should have the test, rather than full genetic counseling, which is appropriate once the test result is known,” investigators said in the report.

The study was supported by AstraZeneca. Dr. Colombo and her associates reported potential conflicts of interest related to AstraZeneca, Genentech, PharmaMar, Amgen, Clovis Oncology, Pfizer, MSD, Tesaro, and others.

SOURCE: Colombo N et al. J Clin Oncol. 2018 Mar 20. doi: 10.1200/JCO.2017.76.278 .


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