J Oncol Pract. 2017 Sep;13(9):e815-e820.
Implementation of Surgeon-Initiated Gene Expression Profile Testing (Oncotype DX) Among Patients With Early-Stage Breast Cancer to Reduce Delays in Chemotherapy Initiation.
Losk K, Freedman RA, Lin NU, Golshan M, Pochebit SM, Lester SC, Natsuhara K, Camuso K, King TR, Bunnell CA.
Dana-Farber Cancer Institute; Dana-Farber/Brigham and Womens Cancer Center; Brigham and Womens Hospital; Harvard Medical School, Boston, MA.
PURPOSE: Delays to adjuvant chemotherapy initiation in breast cancer may adversely affect clinical outcomes and patient satisfaction. We previously identified an association between genomic testing (Oncotype DX) and delayed chemotherapy initiation. We sought to reduce the interval between surgery and adjuvant chemotherapy initiation by developing standardized criteria and workflows for Oncotype DX testing.
METHODS: Criteria for surgeon-initiated reflex Oncotype DX testing, workflows for communication between surgeons and medical oncologists, and a streamlined process for receiving and processing Oncotype DX requests in pathology were established by multidisciplinary consensus. Criteria for surgeon-initiated testing included patients ≤ 65 years old with T1cN0 (grade 2 or 3), T2N0 (grade 1 or 2), or T1/T2N1 (grade 1 or 2) breast cancer on final surgical pathology. Medical oncologists could elect to initiate Oncotype testing for cases falling outside the criteria. We then examined 720 consecutive patients with breast cancer who underwent Oncotype DX testing postoperatively between January 1, 2014 and November 28, 2016 and measured intervals between date of surgery, Oncotype DX order date, result received date, and chemotherapy initiation date (if applicable) before and after intervention implementation.
RESULTS: The introduction of standardized criteria and workflows reduced time between surgery and Oncotype DX ordering, and time from surgery to receipt of result, by 7.3 days ( P < .001) and 6.3 days ( P < .001), respectively. The mean number of days between surgery and initiation of chemotherapy was also reduced by 6.4 days ( P = .004).
CONCLUSION: Developing consensus on Oncotype DX testing criteria and implementing streamlined workflows has led to clinically significant reductions in wait times to chemotherapy decision making and initiation.