Improving referral for genetic risk assessment in ovarian cancer using an electronic medical record system.

OBJECTIVE: We sought to evaluate an electronic referral form to increase referral for genetic risk assessment of women with newly diagnosed epithelial ovarian cancer. METHODS: A form summarizing referral for genetic counseling for women with ovarian cancer was introduced into the electronic medical record allowing gynecologic oncologists to electronically submit a request for genetic services. Analysis compared patient and provider characteristics for women newly diagnosed with ovarian, fallopian tube, and primary peritoneal cancer referred 1 year before and after introducing the form. All patients were seen in a single fee-for-service university-based cancer center clinic. RESULTS: There were 86 newly diagnosed ovarian cancer patients seen before and 83 seen after the introduction of the electronic referral form. Most lived in the metropolitan area and had stage III to IV disease, serous histology, a documented family history, and a treating oncologist who was less than 10 years from completion of fellowship. Postintervention referral rates increased from 17% to 30% (P = 0.053). Factors best predicting referral were whether the patient was seen after the intervention (P = 0.009), resided in the metropolitan area (P = 0.006), and had been identified as at high hereditary risk (P < 0.0001). Sixty percent of the referred patients participated in counseling. There were no differences in baseline characteristics of the referred patients before and after the intervention. CONCLUSIONS: Referral rates increased with the introduction of an electronic medical record referral form suggesting that streamlining the physician referral process might be effective at increasing referrals for cancer genetic risk assessment.

Quality of life, body mass index, and physical activity among uterine cancer patients.

OBJECTIVE: The purpose of this study was to assess the independent and joint effects of body mass index (BMI) and physical activity (PA) on overall quality of life (QoL) in survivors of uterine cancer. METHODS: We conducted a survey among uterine cancer patients who received curative therapy at the University of Pennsylvania between 2006 and 2010. Surveys assessed the weight, height, PA (college alumnus survey), and QoL (Functional Assessment of Cancer Therapy-Gynecologic Oncology Group). RESULTS: The response rate to the survey was 43%. Among 213 patients, the mean (SD) BMI was 31.1 (8.9) kg/m, and 48% reported greater than or equal to 150 min·wk of PA. Higher BMI was independently associated with poorer overall QoL (P = 0.050), including physical (P = 0.002) and functional well-being (P = 0.008). Higher min·wk of PA was not independently associated with any QoL outcome. However, among patients who engaged in greater than or equal to 150 min·wk of PA, the negative association between BMI and overall QoL was attenuated (P = 0.558), whereas among patients who engaged in less than 150 min·wk of PA, the negative association between BMI and overall QoL persisted (P = 0.025). Among patients who engaged in greater than or equal to 150 min·wk of PA, the negative association between BMI and physical and functional well-being was attenuated (P = 0.765 and P = 0.284), whereas among patients who engaged in less than 150 min·wk of PA, the negative association between BMI and physical and functional well-being persisted (P < 0.001 and P = 0.010), respectively. CONCLUSIONS: Body mass index is associated with poorer QoL among uterine cancer patients. The findings from this cross-sectional study are consistent with the hypothesis that endometrial cancer survivors who are able to perform 150 min/wk of PA may be protected from the negative effects of BMI on QoL.

Acceptability of prophylactic salpingectomy with delayed oophorectomy as risk-reducing surgery among BRCA mutation carriers.

OBJECTIVE: Given the emerging evidence for the fimbria as the site of origin for many serous carcinomas in BRCA mutation carriers, consideration is being given in studying prophylactic salpingectomy with delayed oophorectomy (PSDO) as a risk-reducing surgery. We aimed to determine the interest in a study of PSDO among these women. METHODS: We evaluated the results of an online survey conducted by Facing Our Risk of Cancer Empowered (FORCE), a patient advocacy group, from October 2010 to August 2012. Premenopausal BRCA mutation carriers with no history of ovarian cancer or prior bilateral salpingo-oophorectomy (BSO) were included. RESULTS: Of the 204 women meeting inclusion criteria, median age was 35 years, 92.5% were white, 25.7% were Jewish, and 16.7% had a history of breast cancer. Overall, 34.3% reported interest in a study of salpingectomy, 35.3% were unsure, and 30.4% were not interested in the study. Women noted the possibility of lowering ovarian cancer risk without menopause as a compelling reason to participate (83.8%). Reasons for not participating in a salpingectomy study included surgical complications (46.6%), potential ovarian damage (42.2%), planning BSO soon (32.4%), and surgical costs (32.8%). Acceptable study risks included the need for two surgeries (77.2%), possibility of not lowering ovarian cancer risk (68%), and disruption of ovarian blood supply (66.5%). CONCLUSIONS: One-third of BRCA mutation carriers indicated definite interest in a PSDO study. Potential study risks were acceptable to most women. These findings suggest that patient accrual for a clinical trial of prophylactic salpingectomy with delayed oophorectomy is possible.

Timing of referral for genetic counseling and genetic testing in patients with ovarian, fallopian tube, or primary peritoneal carcinoma.

OBJECTIVE: The objective of this study was to assess patients' preferences of the timing of referral for genetic counseling and testing in relation to the diagnosis, treatment, and recurrence of ovarian, tubal, or primary peritoneal cancers. METHODS: Ninety-two patients who underwent counseling and testing by 1 certified genetic counselor were identified. An introductory letter, consent form, and questionnaire were mailed to gather information regarding factors influencing the decision to undergo genetic counseling and testing and opinions regarding optimal timing. Medical records were reviewed for demographic and clinical data. RESULTS: Of 47 consenting women, 45 underwent testing. Eight (18%) were found to have a genetic mutation. Women lacked consensus about the optimal time for referral for and to undergo genetic testing, although women with stage I disease preferred testing after completion of chemotherapy. Most women were comfortable receiving the results by phone, but one third preferred an office visit. CONCLUSIONS: Patients' views regarding the best time to be referred for and undergo counseling and testing varied greatly. Because of the high mortality of this disease, clinicians should discuss referral early and personalize the timing to each patient. The subset of patients who prefer results disclosure during an office visit should be identified at the time of their initial counseling.