Gynecologic Oncology Reports (Oct 2025)

Implementation of a stepwise process for somatic testing in patients with a new diagnosis of germline negative epithelial ovarian cancer

  • Casey L. Lawler,
  • Sara M. Klennert,
  • Kristin C. Cole,
  • Karen S. Schaepe,
  • Laura J. Ongie,
  • Megan E. Grudem,
  • Carolyn M. Klampe,
  • Myra J. Wick,
  • Vonda M. Wall,
  • Sanjna Rajput,
  • Clarissa L. Polen-De,
  • Amanika Kumar

DOI
https://doi.org/10.1016/j.gore.2025.101935
Journal volume & issue
Vol. 61
p. 101935

Abstract

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Objective: We sought to establish a process for increasing somatic tumor testing for patients with germline BRCA negative advanced stage epithelial ovarian cancer (EOC) and to gain insight into patients’ comprehension of their genetic testing. Methods: A multidisciplinary team utilized quality improvement framework to address clinical needs. After implementation of a new somatic testing process, we compared the rates of genetic testing referral, germline testing and somatic testing recommendations between a historic cohort (January 1, 2019-June 20, 2019) and implementation cohort (October 1, 2020 – March 31, 2021). Patients diagnosed with stage III-IV EOC who underwent surgery were included for analysis. To explore patients’ comprehension of their genetic testing results, twenty-three patients in the historic cohort participated in semi-structured interviews. Results: Patients with advanced stage EOC without a germline BRCA mutation received recommendations for somatic testing 53.5 % (23/43) of the time in the historic cohort. An improvement in the rate of somatic testing recommendations was seen in patients without a germline mutation in the implementation cohort (84.6 % [22/26], P = 0.010). There was no decrease in germline testing after implementation (90 % [63/70] and 96.3 % [52/54,] P = 0.30). Most patients (21/23) in the historic cohort were not aware that both germline and somatic testing were completed for their oncology care. Conclusion: We successfully increased somatic testing recommendations in germline BRCA negative patients prior to completing upfront EOC treatment allowing for a timely, individualized discussion of maintenance PARP inhibitor use. Qualitative assessment of patients’ comprehension of genetic testing for EOC shows a deficit in patient knowledge.

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