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Clinical Impact of 21-Gene Recurrence Score Test Within the Veterans Health Administration: Utilization and Receipt of Guideline-Concordant Care.

Publication ,  Journal Article
Hull, LE; Lynch, JA; Berse, BB; DuVall, SL; Chun, DS; Venne, VL; Efimova, OV; Icardi, MS; Kelley, MJ
Published in: Clin Breast Cancer
April 2018

INTRODUCTION: Ensuring guideline-concordant cancer care is a Department of Veterans Affairs (VA) priority, especially as the number of breast cancer patients at VA medical centers (VAMCs) grows. We assessed the utilization and clinical impact of the 21-gene Recurrence Score test, which predicts 10-year risk of breast cancer recurrence and the likelihood of chemotherapy benefit, on veterans newly diagnosed with breast cancer. PATIENTS AND METHODS: We conducted a retrospective cohort study using 2011-2012 VA Central Cancer Registry, chart review, and laboratory test data. Independent variables assessed included patient and site-of-care characteristics. The outcome of interest was whether newly diagnosed, eligible (node negative, hormone-receptor positive, human epidermal growth factor receptor 2 [HER2] negative) veterans underwent the 21-gene test. We performed descriptive statistics on all patients and multivariate logistic regression to determine associations. We correlated treatments received with test results. RESULTS: Among 328 eligible veterans, 82 (25%) had the 21-gene test; 100 eligible veterans (30%) sought care at a VAMC where no tests were ordered. Receiving care at a VAMC that had women's health services (odds ratio [OR], 1.84, 95% confidence interval [CI], 1.05-3.22) and having tumor characteristics meeting the National Comprehensive Cancer Network 2010 test criteria (OR, 3.06, 95% CI, 1.69-5.57) were positive predictors of testing; increasing age (OR, 0.93, 95% CI, 0.91-0.96 per year) and fee-based care (OR, 0.46, 95% CI, 0.26-0.82) were negative predictors. The majority of tested patients received guideline-concordant care. CONCLUSION: Site of care and tumor characteristics were important predictors of test uptake. Facilitating delivery of guideline-concordant cancer care requires improved laboratory informatics and clinical decision support.

Duke Scholars

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Published In

Clin Breast Cancer

DOI

EISSN

1938-0666

Publication Date

April 2018

Volume

18

Issue

2

Start / End Page

135 / 143

Location

United States

Related Subject Headings

  • Young Adult
  • Veterans
  • United States Department of Veterans Affairs
  • United States
  • Retrospective Studies
  • Receptors, Progesterone
  • Receptors, Estrogen
  • Receptor, erbB-2
  • Receptor, ErbB-2
  • Prognosis
 

Citation

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Hull, L. E., Lynch, J. A., Berse, B. B., DuVall, S. L., Chun, D. S., Venne, V. L., … Kelley, M. J. (2018). Clinical Impact of 21-Gene Recurrence Score Test Within the Veterans Health Administration: Utilization and Receipt of Guideline-Concordant Care. Clin Breast Cancer, 18(2), 135–143. https://doi.org/10.1016/j.clbc.2017.11.018
Hull, Leland E., Julie A. Lynch, Brygida B. Berse, Scott L. DuVall, Danielle S. Chun, Vicki L. Venne, Olga V. Efimova, Michael S. Icardi, and Michael J. Kelley. “Clinical Impact of 21-Gene Recurrence Score Test Within the Veterans Health Administration: Utilization and Receipt of Guideline-Concordant Care.Clin Breast Cancer 18, no. 2 (April 2018): 135–43. https://doi.org/10.1016/j.clbc.2017.11.018.
Hull LE, Lynch JA, Berse BB, DuVall SL, Chun DS, Venne VL, et al. Clinical Impact of 21-Gene Recurrence Score Test Within the Veterans Health Administration: Utilization and Receipt of Guideline-Concordant Care. Clin Breast Cancer. 2018 Apr;18(2):135–43.
Hull, Leland E., et al. “Clinical Impact of 21-Gene Recurrence Score Test Within the Veterans Health Administration: Utilization and Receipt of Guideline-Concordant Care.Clin Breast Cancer, vol. 18, no. 2, Apr. 2018, pp. 135–43. Pubmed, doi:10.1016/j.clbc.2017.11.018.
Hull LE, Lynch JA, Berse BB, DuVall SL, Chun DS, Venne VL, Efimova OV, Icardi MS, Kelley MJ. Clinical Impact of 21-Gene Recurrence Score Test Within the Veterans Health Administration: Utilization and Receipt of Guideline-Concordant Care. Clin Breast Cancer. 2018 Apr;18(2):135–143.
Journal cover image

Published In

Clin Breast Cancer

DOI

EISSN

1938-0666

Publication Date

April 2018

Volume

18

Issue

2

Start / End Page

135 / 143

Location

United States

Related Subject Headings

  • Young Adult
  • Veterans
  • United States Department of Veterans Affairs
  • United States
  • Retrospective Studies
  • Receptors, Progesterone
  • Receptors, Estrogen
  • Receptor, erbB-2
  • Receptor, ErbB-2
  • Prognosis