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Abstract：
To identify predictors of referral and completion of germline genetic testing among newly diagnosed ovarian cancer patients, with a focus on geographic social deprivation, oncologist-level practices, and time between diagnosis and completion of testing.
Clinical and sociodemographic data were abstracted from medical records of patients newly diagnosed with ovarian cancer between 2014 and 2019 in the University of North Carolina Health System. Factors associated with referral for genetic counseling, completion of germline testing, and time between diagnosis and test results were identified using multivariable regression.
307/459 (67%) patients were referred for genetic counseling and 285/459 (62%) completed testing. The predicted probability of test completion was 0.83 (95% CI: 0.77-0.88) for patients with a referral compared to 0.27 (95% CI: 0.18-0.35) for patients without a referral. The predicted probability of referral was 0.75 (95% CI: 0.69-0.82) for patients at the 25th percentile of ZIP code-level Social Deprivation Index (SDI) and 0.67 (0.60-0.74) for patients at the 75th percentile of SDI. Referral varied by oncologist, with predicted probabilities ranging from 0.47 (95% CI: 0.32-0.62) to 0.93 (95% CI: 0.85-1.00) across oncologists. The median time between diagnosis and test results was 137 days (IQR: 55-248 days). This interval decreased by a predicted 24.46 days per year (95% CI: 37.75-11.16).
We report relatively high germline testing and a promising trend in time from diagnosis to results, with variation by oncologist and patient factors. Automated referral, remote genetic counseling and sample collection, reduced out-of-pocket costs, and educational interventions should be explored.
Clinical and sociodemographic data were abstracted from medical records of patients newly diagnosed with ovarian cancer between 2014 and 2019 in the University of North Carolina Health System. Factors associated with referral for genetic counseling, completion of germline testing, and time between diagnosis and test results were identified using multivariable regression.
307/459 (67%) patients were referred for genetic counseling and 285/459 (62%) completed testing. The predicted probability of test completion was 0.83 (95% CI: 0.77-0.88) for patients with a referral compared to 0.27 (95% CI: 0.18-0.35) for patients without a referral. The predicted probability of referral was 0.75 (95% CI: 0.69-0.82) for patients at the 25th percentile of ZIP code-level Social Deprivation Index (SDI) and 0.67 (0.60-0.74) for patients at the 75th percentile of SDI. Referral varied by oncologist, with predicted probabilities ranging from 0.47 (95% CI: 0.32-0.62) to 0.93 (95% CI: 0.85-1.00) across oncologists. The median time between diagnosis and test results was 137 days (IQR: 55-248 days). This interval decreased by a predicted 24.46 days per year (95% CI: 37.75-11.16).
We report relatively high germline testing and a promising trend in time from diagnosis to results, with variation by oncologist and patient factors. Automated referral, remote genetic counseling and sample collection, reduced out-of-pocket costs, and educational interventions should be explored.
摘要：
目的：确定新诊断卵巢癌患者转诊和完成种系基因检测的预测因素，关注地理社会剥夺，肿瘤学家级别的实践，以及诊断和完成测试之间的时间。
方法：从2014年至2019年北卡罗来纳大学卫生系统新诊断卵巢癌患者的病历中提取临床和社会人口统计学数据。与遗传咨询转诊相关的因素，完成种系测试，使用多变量回归确定诊断和检测结果之间的时间.
结果：307/459（67%）名患者接受遗传咨询，285/459（62%）完成检测。转诊的患者完成测试的预测概率为0.83（95％CI：0.77-0.88），而未转诊的患者为0.27（95％CI：0.18-0.35）。ZIP代码水平社会剥夺指数（SDI）第25百分位的患者的预测转诊概率为0.75（95％CI：0.69-0.82），而SDI第75百分位的患者的预测转诊概率为0.67（0.60-0.74）。转诊因肿瘤学家而异，肿瘤学家的预测概率范围为0.47(95%CI：0.32-0.62)至0.93(95%CI：0.85-1.00)。诊断和测试结果之间的中位时间为137天（IQR：55-248天）。该间隔减少了预测的每年24.46天（95％CI：37.75-11.16）。
结论：我们报告了相对较高的种系检测和从诊断到结果的及时趋势，随着肿瘤学家和患者因素的变化。自动转诊,远程遗传咨询和样本收集，降低了自付成本，应该探索教育干预措施。
方法：从2014年至2019年北卡罗来纳大学卫生系统新诊断卵巢癌患者的病历中提取临床和社会人口统计学数据。与遗传咨询转诊相关的因素，完成种系测试，使用多变量回归确定诊断和检测结果之间的时间.
结果：307/459（67%）名患者接受遗传咨询，285/459（62%）完成检测。转诊的患者完成测试的预测概率为0.83（95％CI：0.77-0.88），而未转诊的患者为0.27（95％CI：0.18-0.35）。ZIP代码水平社会剥夺指数（SDI）第25百分位的患者的预测转诊概率为0.75（95％CI：0.69-0.82），而SDI第75百分位的患者的预测转诊概率为0.67（0.60-0.74）。转诊因肿瘤学家而异，肿瘤学家的预测概率范围为0.47(95%CI：0.32-0.62)至0.93(95%CI：0.85-1.00)。诊断和测试结果之间的中位时间为137天（IQR：55-248天）。该间隔减少了预测的每年24.46天（95％CI：37.75-11.16）。
结论：我们报告了相对较高的种系检测和从诊断到结果的及时趋势，随着肿瘤学家和患者因素的变化。自动转诊,远程遗传咨询和样本收集，降低了自付成本，应该探索教育干预措施。
