Understanding patterns of genetic risk evaluation (GRE) referral and uptake in patients (pts) with epithelial ovarian cancer (EOC).

254 Background: EOC is the most common cause of gynecologic cancer death and fifth leading cause in women. ~20% cases are due to identifiable genetic risk (BRCA1/2 in 15%, Lynch syndrome 2%, other germline mutations 6%). Since 2013, National Comprehensive Cancer Network (NCCN) guidelines recommend all women with EOC be referred for GRE, to optimize risk stratification, genetic testing decisions, clinical management, with goal to reduce mortality. Yet physicians under-refer and pts under-utilize genetic services. Identifying clinically meaningful quality metrics and associated adherence is critical to improving cancer care. We aimed to characterize patterns of GRE referral and uptake in pts with EOC.

METHODS: Completed GRE was tracked in pts with EOC 2009-2015, using City of Hope (COH) cancer registry and genetics appointments system. Targeted chart review was done for pts identified as without GRE completion in 2014 (18 cases), 2015 (2 cases).

RESULTS: 91/191 (48%) analytic pts with EOC from 2009-15 registry data were identified with completed GRE. Targeted chart review of non-adherent cases: 2015: 1/2 pts did not complete GRE (at COH primarily for surgery). 2014: 7/18 pts documented with completed GRE; Pareto chart was constructed for 11 unaccounted non-adherent pts: see Table.

CONCLUSIONS: 2014-15 GRE completion rate (68%) suggests a higher GRE referral rate, above that reported in literature (<35%). In 2014, 75% pts seen by medical oncology had documented reasons for not completing GRE; 2/11 pts who did not complete GRE lacked a documented reason (see chart). Inability to track paper referrals (used prior to 2014) limited analysis. Promoting multidisciplinary educational interventions for specific audiences, collaboration between community and COH referring physicians, studying physician perceptions of GRE risks/benefits/barriers, EHR enhancements (e.g. creating a GRE check-off item, or documentation aids), and pt-centered assessment of GRE awareness and utilization may improve adherence with NCCN guidelines to 100% (CA33572). [Table: see text].