[Abstract 256] Assessing Comprehensive Care Deficits in United States Ovarian Cancer Programs to Inform Quality Improvement Initiatives

Authors

Matthew Smeltzer¹, Monique Dawkins² , Leigh Boehmer², Sarah Madhu Temkin³, Premal H. Thaker⁴, Leigha Senter⁵, Anna Yemelyanova⁶, Michelle Bigg⁷, Jennifer Bires⁸, Sean Christopher Dowdy⁹, Anthony Magliocca¹⁰

¹ University of Memphis, School of Public Health; ² Assocation of Community Cancer Centers; ³ National Institutes of Health; ⁴ Washington U. School of Medicine, Department of Gyn Onc; ⁵ Ohio State University; ⁶ Weill Cornell; ⁷ HCA Healthcare Las Vegas; ⁸ George Washington U. Medical Center; ⁹ Mayo Clinic; ¹⁰ Protean BioDiagnostics

Background

Ovarian cancer is the leading cause of gynecologic cancer mortality in the US. Given the high burden of disease and complexities in the provision of quality care, a multidisciplinary team approach is critical to optimal care delivery. In 2019, the Association of Community Cancer Centers (ACCC) launched a multiphase, stakeholder-driven initiative to improve care for this patient population. Results of a national survey of cancer programs to identify the needs of patients are reported here.

Methods

A 20 question survey was developed by an expert steering committee including gynecologic oncologists, pathologists, genetic counselors, a nurse navigator, and cancer center administrators. The instrument was designed to collect data about cancer programs, key ovarian cancer patient needs, and barriers to and opportunities for improving ovarian cancer care. The online survey was open for participation for 4 weeks using the Qualtrics platform and distributed via email to ACCC and Society of Gynecologic Oncology members.

Results

We received 26 total responses from Comprehensive Community (26%), NCI-Designed Comprehensive (22%), Academic Comprehensive (22%), and Integrated Network (13%) Cancer Programs. Annual ovarian cancer cases ranged from 22 to 190 (median: 50.5). 85% of programs has a multidisciplinary team for ovarian cancer and 61% were part of a referral network. On average, programs has 1.5 phase II and 2 phase III clinical trials currently available for ovarian cancer (all programs had at least 1 trial available). Palliative care and comprehensive symptom management was integrated into the first appointment (15%), integrated at the time of recurrence (4%), and most frequently, available by consult (81%). We assessed genetic testing practices at each program. Aggregated across programs, 79% of patients received germline multipanel testing, 71% germline BRCA only, 50% somatic multigene, and 51% somatic BRCA only. The frequency of consultations included: genetic counseling (75%), nurse navigation (75%), social work (50%), dietetics (40%), financial counseling (25%). Genetic evaluations were typically ordered by Gynecologic Oncology (88%), genetic counseling (4%), or both (8%). When asked what topic they would choose for a quality improvement project, genetic testing and counseling was the most frequent choice (46%), followed by clinical trials enrollment and availability (23%), multidisciplinary team care (19%), education on best practices (15%), palliative care (15%), and ancillary services (15%).

Conclusions

Multidisciplinary care for ovarian cancer was common across a range of cancer programs but integration of palliative care, social work, dietetics, and financial counseling could be improved. Expanding clinical trials and genetic testing and counseling were the most frequently identified opportunities to improve ovarian cancer care.

Funding

This project is funded by AstraZeneca