[Abstract 10529] Genetic counseling and testing rates among community cancer programs for patients with breast cancer following site-directed quality improvement

Leigh Boehmer¹, Latha Shivakumar¹, Christine B. Weldon², Julia Rachel Trosman³, Stephanie A. Cohen³, Dawn Nixon³, Zohra Ali-Khan Catts⁴, Susan Miesfeldt⁵, Stephanie Sharp⁵, Lorraine Tafra⁶, Lisa Muto⁷, Natalie Fadrowski⁸, Melissa Kaptanian⁹, Tiana Pallister⁹, Catherine Gaines¹⁰, Charles Hendrix Shelton¹¹

¹Association of Community Cancer Centers, Rockville, MD; ²Center for Business Models in Healthcare, Chicago, IL; ³Ascension St. Vincent, Indianapolis, IN; ⁴Christiana Care, Helen F. Graham Cancer Center and Research Institute, Newark, DE; ⁵Maine Medical Center, Portland, ME; ⁶Anne Arundel Medical Center, Annapolis, MD; ⁷Edwards Comprehensive Cancer Center at Cabell Huntington Hospital, Huntington, WV; ⁸University of Maryland Upper Chesapeake Health, Bel Air, MD; ⁹Kalispell Regional Healthcare, Kalispell, MT; ¹⁰Southeastern Health Gibson Cancer Center, Lumberton, NC; ¹¹Vidant Health, Nags Head, NC

Background

National Comprehensive Cancer Network (NCCN) guidelines recommend testing for highly penetrant breast/ovarian cancer genes in several clinical scenarios, including women with early-onset (≤ 45 years) or metastatic HER-2 negative breast cancer regardless of family history. A 2018 Association of Community Cancer Centers (ACCC) survey (N=95) showed that > 80% of respondents reported ≤ 50% testing rate of patients with breast cancer who met guidelines. To improve rates of genetic counseling(GC)/testing, ACCC partnered with 15 community cancer programs to support site-directed quality improvement (QI) interventions.

Methods

Pre- and post-intervention data from 9/15 partner programs for genetically at-risk women with early-onset or HER-2 negative metastatic breast cancer (MBC) were analyzed. Pre-intervention data were collected between 01/01/2017 and 06/30/2019 while post-intervention data were collected as early as 07/01/2019 and as late as 10/01/2020. QI project scope ranged from creation and dissemination of testing eligibility education to implementation of a fully virtual GC clinic. De-identified data collected included: family history documentation; GC appointment; test results; and timing of results relative to surgical date.

Results

The pre-intervention cohort included 2691 women and the post- cohort included 3104 women who were eligible for GC. Early-onset patients in the post-intervention group attended a GC appointment 83% (331/401) of the time and 74% (296/401) had genetic test results, with 92% (271/296) receiving results before surgery. Sixty-one percent (1387/2267) of women with HER-2 negative MBC in the post-intervention group received GC, compared to 36% (658/1845) in the pre-intervention group. There was an overall increase in the number of MBC patients with documented test results following GC in the post-intervention cohort (55% (1243/2267) versus 15% (273/1845); p<0.0001).

Rates of GC appointments improved overall, regardless of family history documentation. Rates among those with a documented high-risk family history improved from 57% (729/1284) to 85% (1485/1741) following QI interventions (p<0.0001). There was also a significantly higher rate of GC provided in the post-intervention group among women with negative family histories (40% (462/1155) versus 23% (181/778); p<0.0001). GC also increased from 6% (35/629) to 45% (94/208) of women in the post-intervention cohort with no documentation of family history (p<0.0001).

Conclusion

Genetic testing is underutilized in women with breast cancer. Significant improvement was achieved with QI initiatives specifically designed to target easily identified populations meeting guidelines for GC and testing. This project demonstrates the importance of attention to practice-directed strategies aimed at improving identification of risk as well as follow through to GC/testing.