Surgeon-Initiated Gene-Expression Profile Testing in Early-Stage Breast Cancer Reduces Time to Start of Chemotherapy


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In a single-center study reported in the Journal of Oncology Practice, Katya Losk, MPH, of Dana-Farber Cancer Institute, and colleagues found that an intervention including surgeon initiation of gene-expression profile testing with Oncotype DX significantly reduced the time to testing, receipt of testing results, and initiation of chemotherapy in patients with early-stage breast cancer.1 The group had previously found that patients undergoing Oncotype DX recurrence score testing were seven times more likely to have a delay of > 6 weeks from the last definitive surgery to the start of chemotherapy.2

Study Details

The study involved comparison of the time between surgery to Oncotype DX test ordering, receipt of test results, and time to initiation of chemotherapy among 720 consecutive women undergoing postoperative testing at Dana-Farber Brigham and Women’s Cancer Center. Included were 472 women undergoing first surgery between January 1, 2014, and January 28, 2016 (baseline cohort), and 248 undergoing first surgery between January 29, 2016, and November 28, 2016, after implementation of the surgeon initiation intervention (postintervention cohort).

After identification of barriers to timely ordering of Oncotype DX testing, criteria for surgeon-initiated reflex testing were developed by multidisciplinary consensus. Streamlined processes for communication between surgeons and medical oncologists and workflows for receiving and processing test requests in pathology were established. The criteria for surgeon-initiated testing included patient age ≤ 65 years and T1cN0 (grade 2 or 3), T2N0 (grade 1 or 2), or T1/T2N1 (grade 1 or 2) disease on final surgical pathology. Medical oncologists could order testing for patients not meeting these criteria. Overall, patients had a mean age of 55 years (range = 27–77 years), 87% were white, and 78% had private insurance.

Reduced Delays in Testing and Start of Chemotherapy

Among the 472 patients in the baseline cohort and the 248 patients in the postintervention cohort, 84 (17.8%) and 40 (16.1%) received chemotherapy. Among the patients in the postintervention cohort who received chemotherapy, 3 had recurrence scores < 18, 26 (65%) had scores of 18 to 30, and 11 (28%) had scores > 30.


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.
— Katya Losk, MPH

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For the postintervention vs baseline cohorts, the mean (standard deviation) number of days between surgery and Oncotype DX ordering was 12.9 (7.3) vs 20.2 (13.5; difference = 7.3 days, P < .001), and the mean number of days between surgery and receipt of test results was 22.2 (8.7) vs 28.5 (14.7; difference = 6.3 days, P = .004). Among patients receiving chemotherapy, the mean number of days between the last definitive surgery and initiation of chemotherapy was 37.3 (7.7) vs 43.7 (16.6; difference = 6.4 days, P = .004). Overall, 75% vs 52% of patients receiving chemotherapy started chemotherapy within 42 days of the last definitive surgery.

The investigators concluded: “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.” ■

DISCLOSURE: For full disclosures of the study authors, visit www.jop.ascopubs.org.

REFERENCES

1. Losk K, Freedman RA, Lin NU, et al: Implementation of surgeon-initiated gene expression profile testing (Oncotype DX) among patients with early-stage breast cancer to reduce delays in chemotherapy initiation. J Oncol Pract 13:e815-e820, 2017.

2. Losk K, Vaz-Luis I, Camuso K, et al: Factors associated with delays in chemotherapy initiation among patients with breast cancer at a comprehensive cancer center. J Natl Compr Canc Netw 14:1519-1526, 2016.


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