November 5, 2021
Although all Kaiser Permanente members who have been diagnosed with ovarian cancer in Northern California are given the opportunity to undergo genetic assessment and testing for the identification of hereditary cancer genes, only about 67% previously did.
To help close this gap, Bethan Powell, MD, a gynecologic oncologist at Kaiser Permanente San Francisco, along with members of the Hereditary Cancer Program and the Northern California Genetics Department, established an easier way for patients to undergo genetic testing.
In January 2021, Kaiser Permanente Northern California implemented a new clinical workflow in which patients newly diagnosed with ovarian cancer can opt in for genetic testing. This starts with their gynecologist oncologist who provides education on genetic testing then orders a quick blood test. Genetic counseling is then provided after, based on the test results.
Previously, patients were referred to their nearest genetics department and asked to schedule an appointment.
“Testing is offered by their provider they know and trust, eliminating additional appointments and making it easier for our patients,” Dr. Powell said. “The more women with ovarian cancer who undergo genetic testing, the more specific genetic mutations can be identified, which leads to more effective cancer care including treatment that can directly target specific mutations in the tumors.”
Among the first 74 women who were informed of genetic testing by their physician under the new process, 84% agreed to undergo genetic testing immediately — a nearly 20% increase prior to implementation. The results of a 6-month pilot of the streamlining in Oakland and San Francisco showed a 100% opt-in rate for genetic testing.
Reducing barriers improves care, saves lives
By eliminating additional appointments for women and their families, barriers to care such as transportation, limited technology access, and economic challenges are greatly reduced.
This was true for Heather Amato, a Kaiser Permanente member who tested positive for the BRCA1 mutation and was diagnosed with ovarian cancer in 2019.
“Dr. Powell advocated for genetic testing, explaining that it was a simple blood draw and that I wouldn’t have to go anywhere or do anything else. It was all wrapped up in my regular care,” said Amato, a teacher in Marin County.
“Knowledge is power,” she said. “Although I don’t have children or family who would benefit from getting genetic testing, I am hopeful this can save lives and make people more aware.”
Faster results, higher satisfaction
Streamlining this process has also reduced the time that patients receive test results. Leslie Manace, MD, regional director for Precision Medicine and Genomics programs for Kaiser Permanente Northern California, said it now takes on average just 22 days to get test results in patients’ hands.
“Everything about streamlining is focused on patient experience,” Dr. Manace said. “The process has been made seamless during one of the scariest times of the patient’s life. The faster we can get results, the faster we can create their personalized care plans.”
Outcome data from the East Bay pilot also showed higher satisfaction among patients, providers, and genetic counselors. “In managing fewer scheduling appointments, our genetic counselors can focus more on their one-on-one counseling with patients and their families,” Dr. Manace said.
Most importantly, Dr. Powell explained that streamlining aims to saves lives and deliver more effective cancer treatment and awareness to at-risk women.
“It’s not just women with newly diagnosed cancer who are benefiting. It’s also the unaffected relatives whose cancer can possibly be prevented.”
Learn more about the Hereditary Cancer Program.