A. Keshinro1, E. Johnson1, E. Horowitz1, E. Warnack1, K. Joseph1 1NYU School of Medicine,Surgery,New York, NEW YORK, USA
Introduction:
Oncotype DX is a useful assay that helps oncologists and patients determine whether patients should undergo adjuvant chemotherapy or hormonal therapy. Testing for Oncotype may lead to delays in chemotherapy that can lead to clinically adverse outcomes. In order to decrease the delays in ordering the test as well as the turn around time, and as a result, initiation of chemotherapy, we implemented a new ordering protocol at Bellevue Hospital involving pathology, breast surgery to standardize the criteria for ordering Oncotype DX.
Methods:
As part of a quality improvement process to standardize the ordering process for Oncotype DX post-operatively, pathology and breast surgery met with representatives of Genomic Health to determine new workflows to improve the ordering process for Oncotype DX. In addition, methods for communicating pathology results and insurance status were identified. After new workflows were put in place, any patient that fit the criteria for Oncotype DX testing was ordered by breast surgery as soon as the final pathology was received (May-August 2018). Time from surgery to order, time from surgery to report, number of Oncotype DX orders, method by which oncotype dx is ordered, and type of insurance were examined.
Results:
There was a significant decrease in the overall turnaround time from surgery to Oncotype DX result from 64 days to 29 (55% reduction) (p<0.05). Implementation of the new workflow had the largest impact on reducing time from surgery to ordering the test (50 days to 17 days), a 66% reduction (p<0.05). 72% of the orders are now being placed by portal vs 6% before standardization, 14% by paper vs 88% before standardization, 14% by fax vs 6% before standardization. In addition, the payor mix has changed to include 11.3% Medicare vs 0% before standardization. Total number of Oncotype orders for 2017 were 16 (eligible cases 41), and cases YTD 2018-18.
Conclusions:
Implementation of a new ordering process has allowed access to individualized treatment planning to more eligible patients; 12.5% increase over 2017 orders within 7 months into the year (16 orders in 2017 vs. 18 orders by July 2018), ordering by portal helps to improve efficiency of ordering and receiving results.
Less than half of eligible patients were offered Oncotype DX in 2017, before adoption of the new protocol. By implementing this protocol more eligible patients will receive appropriate management.
Given the medically underserved population that our clinic serves (64% are immigrants and 73% have Medicaid or self pay), we can improve the level of care to our patients.
As we continue the protocol we will examine the impact on reduction on chemotherapy wait times.
