In patients with ovarian cancer effective testing for homologous recombination deficiency (HRD) is crucial to guide the use of PARP inhibitors, with or without bevacizumab. However, variations in uptake of testing and the quality and quantity of specimens are major barriers to the implementation of rapid universal molecular profiling. There are no national standards for diagnostic biopsies to ensure their suitability for molecular diagnostics. The aims of this study are to identify and mitigate the causes of demographic (including ethnicity) and clinical pathway variation for molecular testing in patients diagnosed with ovarian cancer.
DEMO is a multi-centre quality improvement study based on a Plan-Do-Study-Act approach. The three components include 1) the establishment of a patient advisory group to explore the variations in uptake and co-produce multimedia, multilingual patient information package to support informed decision making; 2) use of improvement methodology to analyse existing diagnostic pathways and 3) the development of a multidisciplinary consensus guideline to increase the reliability of current biopsy pathways for molecular diagnostics.
A retrospective combined audit from Cambridge and Birmingham of 75 patients over 8 months in 2021 showed high failure rates for somatic molecular testing (tumoural BRCA or HRD testing). Failure rates of 25% (3/12) and 35% (11/31) failed when samples from image-guided biopsies and after chemotherapy were used, respectively. Low uptake of mainstreamed genetic testing in Cancer Centers with high ethnic diversity (∼15% of women diagnosed with ovarian cancer are in the ethnic minorities groups at Birmingham City Hospital) can be related to a gap in understanding the importance of tumour testing in the wider multidisciplinary team and to language and culture barriers.
Failure to address the systemic problems of the biopsy pathway will perpetuate substandard treatments and clinical trial opportunities for women receiving neoadjuvant chemotherapy. Provision of easily accessible video information to initiate patient dialogue and decision making could address the information gap to support informed decision making in women whose English is not their first language.
The authors.
Ovarian Cancer Action.
S. Sundar: Financial Interests, Personal, Invited Speaker for conference: AstraZeneca; Financial Interests, Personal, Invited Speaker for conference: MSD; Financial Interests, Personal, Invited Speaker at workshop: GSK; Non-Financial Interests, Personal, Leadership Role, President of the British Gynaecological Cancer Society: BGCS. J.D. Brenton: Financial Interests, Personal, Invited Speaker: GSK; Financial Interests, Personal, Invited Speaker: AstraZeneca; Financial Interests, Personal, Advisory Board: AstraZeneca; Financial Interests, Personal, Invited Speaker: Tailor Bio; Financial Interests, Personal, Stocks/Shares: Tailor Bio; Financial Interests, Institutional, Invited Speaker: Clovis Oncology; Financial Interests, Institutional, Invited Speaker: Aprea AB; Non-Financial Interests, Personal, Member: Association of Cancer Physicians. All other authors have declared no conflicts of interest.