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Preferences of women with epithelial ovarian cancer for aspects of genetic testing.

ABSTRACT: Background:Although genetic testing is recommended for women with epithelial ovarian cancer (EOC), little is known about patient preferences for various testing options. We measured relative preferences for attributes of testing in women with EOC referred for genetic counseling. Methods:Subjects were recruited to participate in a discrete-choice-experiment survey to elicit preferences for attributes of genetic testing: out-of-pocket cost ($0, $100, $250, or $1000), probability of a deleterious mutation (60, 80%, or 88%), probability of a variant of uncertain significance (VUS) result (5, 20%, or 40%), sample requirements (blood or saliva), and turn-around time (1, 2 or 4?weeks). Subjects viewed educational videos followed by a series of choices between pairs of constructed genetic tests with varying attribute levels. Random-parameters logit was used to estimate preference weights for attribute levels. Relative importance weights and money-equivalent values were calculated. Results:Ninety-four patients were enrolled; 68 (76.4%) presented for genetic counseling. Test cost was the most important attribute to subjects (importance weight?=?41 out of 100) followed by probability to detect deleterious mutations (36) and probability of a VUS result (20). Sample requirements and turnaround time did not drive test choices. Subjects were willing to pay an additional $155 and $70 for incremental 5% improvements in the probability to detect deleterious mutations and probability of a VUS result. At genetics consultation, 55/68 (80.9%) subjects chose multigene testing. Conclusions:Low out-of-pocket cost, high probability of detecting deleterious mutations and high probability of a VUS result are preferred by patients with EOC considering genetic testing.

SUBMITTER: Davidson BA

PROVIDER: S-EPMC6341581 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Preferences of women with epithelial ovarian cancer for aspects of genetic testing.

Davidson Brittany A BA Ehrisman Jessie J Reed Shelby D SD Yang Jui-Chen JC Buchanan Adam A Havrilesky Laura J LJ

Gynecologic oncology research and practice 20190122

<h4>Background</h4>Although genetic testing is recommended for women with epithelial ovarian cancer (EOC), little is known about patient preferences for various testing options. We measured relative preferences for attributes of testing in women with EOC referred for genetic counseling.<h4>Methods</h4>Subjects were recruited to participate in a discrete-choice-experiment survey to elicit preferences for attributes of genetic testing: out-of-pocket cost ($0, $100, $250, or $1000), probability of ...[more]

PMID: 30693090

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Project description:PurposeTo provide recommendations on genetic and tumor testing for women diagnosed with epithelial ovarian cancer based on available evidence and expert consensus.MethodsA literature search and prospectively defined study selection criteria sought systematic reviews, meta-analyses, randomized controlled trials (RCTs), and comparative observational studies published from 2007 through 2019. Guideline recommendations were based on the review of the evidence.ResultsThe systematic review identified 19 eligible studies. The evidence consisted of systematic reviews of observational data, consensus guidelines, and RCTs.RecommendationsAll women diagnosed with epithelial ovarian cancer should have germline genetic testing for BRCA1/2 and other ovarian cancer susceptibility genes. In women who do not carry a germline pathogenic or likely pathogenic BRCA1/2 variant, somatic tumor testing for BRCA1/2 pathogenic or likely pathogenic variants should be performed. Women with identified germline or somatic pathogenic or likely pathogenic variants in BRCA1/2 genes should be offered treatments that are US Food and Drug Administration (FDA) approved in the upfront and the recurrent setting. Women diagnosed with clear cell, endometrioid, or mucinous ovarian cancer should be offered somatic tumor testing for mismatch repair deficiency (dMMR). Women with identified dMMR should be offered FDA-approved treatment based on these results. Genetic evaluations should be conducted in conjunction with health care providers familiar with the diagnosis and management of hereditary cancer. First- or second-degree blood relatives of a patient with ovarian cancer with a known germline pathogenic cancer susceptibility gene variant should be offered individualized genetic risk evaluation, counseling, and genetic testing. Clinical decision making should not be made based on a variant of uncertain significance. Women with epithelial ovarian cancer should have testing at the time of diagnosis.

Project description:ObjectiveAlthough ovarian cancer is a deadly disease, approximately a third of women survive ≥9 years after diagnosis. The factors associated with achieving long-term survival are not well understood. In this study, data from the Surveillance, Epidemiology, and End Results (SEER) program were used to determine predictors of survival trajectories among women with epithelial ovarian cancer and across histotype (high-grade serous carcinoma (HGSC) and non-HGSC).MethodsData on 35,868 women diagnosed with epithelial ovarian cancer in 2004-2016 were extracted from SEER. Extended Cox proportional hazards regression was used to estimate overall and histotype-specific associations between patient and tumor characteristics and all-cause mortality within each survival time (t) interval (t < 3, 3 ≤ t < 6, 6 ≤ t < 9, and 9 ≤ t < 13 years).ResultsAge at diagnosis, marital status, race/ethnicity, stage, and surgery were more strongly associated with mortality in the short-term survival period, and these associations waned with increasing survival time. Exceptions to this pattern were age >70 years at diagnosis, where a high risk of mortality was observed in both the t < 3 and t ≥ 9 year time periods, and non-Hispanic Asian/Pacific Islanders, where a more pronounced inverse association with mortality was observed in t ≥ 9 years after diagnosis. Similar associations were observed for HGSC, although the waning effect was not apparent for most characteristics. Mortality associations for non-HGSC were more pronounced for stage and race/ethnicity, primarily for non-Hispanic Asian/Pacific Islanders.ConclusionsMost patient and tumor characteristics were more strongly associated with mortality in the years following diagnosis, but have declining impact with increasing survival time. Given this waning effect, it is critical to identify factors impacting risk of mortality as ovarian cancer patients advance through the survival trajectory.

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Preferences of women with epithelial ovarian cancer for aspects of genetic testing.

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Preferences of women with epithelial ovarian cancer for aspects of genetic testing.

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