Objectives: Women with epithelial ovarian cancer (EOC) who have a germline mutation, somatic mutation or are found to have homologous recombination deficiency (HRD) have been shown to have an improved survival with use of a PARP inhibitor after completion of first-line chemotherapy. A quality improvement project aimed to develop a pathway for somatic/HRD testing in all patients with EOC. Methods: Standard quality improvement methodology was employed to complete a stakeholder analysis, process mapping, an Ishikawa diagram, a pro/con brainstorming session and a provider survey. Additionally, we benchmarked with another academic institution. Patient education material on genetic testing was developed. Plan-Do-Study-Act (PDSA) cycles were employed throughout the quality improvement process. All newly diagnosed patients with EOC who underwent surgery between January - June 2019 (preimplementation) and June-August 2020 (post-implementation) were identified. Data was abstracted from medical records to determine which patients were referred to genetics and which patients were provided with somatic testing recommendations. Results: Prior to implementation, 42.9% (30/70) patients who completed primary treatment of EOC had somatic testing ordered prior to completing primary adjuvant chemotherapy. Post-implementation, 63% (17/27) of patients had somatic testing recommended. Confining analysis to those patients who returned for a postoperative visit at the surgical institution, 77.8% (14/18) had somatic testing recommended. Germline testing referral and rates (countermeasure) did not change 88.6% (62/70) vs 85.3% (29/34) (pre versus post-implementation). Conclusions: Development of a structured process for somatic/HRD testing after surgery for EOC results improved rates of somatic testing discussion. A stepwise process ensures that these patients still receive the necessary counseling about germline testing prior to undergoing somatic/HRD testing.
