Genetic Testing Underused Among Patients With Ovarian Cancer Who Have Commercial Insurance

Despite universal recommendations for genetic testing, data indicate that the use of germline testing remained underused among women with ovarian cancer who had commercial insurance.

Genetic testing remains underused among patients with ovarian cancer who have commercial insurance despite recommendations for universal testing, according to data from a cross sectional study published in JAMA Network Open.

Between 2008 and 2018, 33.9% of patients with commercial insurance underwent germline BRCA testing for ovarian cancer, despite unequivocal evidence in favor of testing for patients, according to the investigators. Testing increased from 14.7% in 2008 to 46.4% in 2018. Additionally, within that time period, the median time to testing decreased from 280.0 days to 72.5 days.

“Since 2010, guidelines have recommended universal testing in ovarian cancer. However, testing rates are reportedly between 10% and 30%, and few studies have examined commercially insured populations or identified patient-, physician-, and practice-level characteristics associated with testing rates,” the investigators wrote.

Patients younger than 18 years, who did not have surgery or outpatient visits, who had less than 12 months of continuous insurance, and with missing zip codes were excluded from the study population.

The primary outcome of the study was gBRCA testing incorporating gene-specific and methodology-based procedure codes. Secondary outcomes of interest included timeliness and median time from first chemotherapy claim to testing.

A total of 3603 women with ovarian cancer were included in the study. The mean patient age was 57.0 years. Most patients in the study were between the ages of 50 and 59 years (37.6%), had a Charlson comorbidity score of 0 (63.5%), and were in the southern region of the United States (41.3%).

Adjusted analyses found that testing was lower by 20.8% among women aged 65 years or older compared with women less than 50 years of age (95% CI, −25.8% to −16.4%). Further, testing was also lower by 4.6% among women who had a Charlson comorbidity score of 2 or more vs 0 (95% CI, −8.9% to 4.7%).

Testing rates between medical and gynecologic oncologists were similar, with an adjusted difference of 1.5% (95% CI, −1.8% to 4.7%), with rates being lower among other physicians (–5.9; 95% CI, –10.3 to –1.5). Compared with community practices, testing was increased at academic and National Cancer Institute cancer centers. A statistically significant increase in testing from 2008 to 2018 was observed, although the rate of testing remained below 50% for most years. Similar results were observed in analyses focused on gBRCA testing timeliness, with investigators reporting significant improvements from 2010 to 2018.

“Future studies should examine barriers to timely testing to identify scalable strategies for increasing testing, particularly for older women in community practices. Interventions targeting clinicians are essential because the absence of physician recommendations remains the largest barrier to testing,” the investigators concluded.

Reference

Cham S, Landrum MB, Keating NL, Armstrong J, Wright AA. Use of germline BRCA testing in patients with ovarian cancer and commercial insurance. JAMA Netw Open. Published online January 4, 2022. doi:10.1001/jamanetworkopen.2021.42703