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Impacts of Early Guideline-Directed 21-Gene Recurrence Score Testing on Adjuvant Therapy Decision Making.

Publication ,  Journal Article
Dzimitrowicz, H; Mougalian, S; Storms, S; Hurd, S; Chagpar, AB; Killelea, BK; Horowitz, NR; Lannin, DR; Harigopal, M; Hofstatter, E; Silber, A ...
Published in: J Oncol Pract
December 2017

PURPOSE: The 21-gene recurrence score (RS) assay is used to help formulate adjuvant chemotherapy recommendations for patients with estrogen receptor-positive, early-stage breast cancer. Most frequently, medical oncologists order RS after surgery. Results take an additional 2 weeks to return, which can delay decision making. We conducted a prospective quality-improvement project to assess the impact of early guideline-directed RS ordering by surgeons before the first visit with a medical oncologist on adjuvant therapy decision making. MATERIALS AND METHODS: Surgical oncologists ordered RS testing following National Comprehensive Cancer Network guidelines at time of diagnosis or at time of surgery between July 1, 2015 and December 31, 2015. We measured the testing rate of patients eligible for RS, time to chemotherapy decisions, rates of chemotherapy use, accrual to RS-based clinical trials, cost, and physician acceptance of the policy and compared the results to patients who met eligibility criteria for early guideline-directed testing during the 6 months before the project. RESULTS: Ninety patients met eligibility criteria during the testing period. RS was ordered for 91% of patients in the early testing group compared with 76% of historical controls ( P < .001). Median time to chemotherapy decision was significantly shorter in the early testing group (20 days; 95% CI, 17 to 23 days) compared with historical controls (32 days; 95% CI, 29 to 35 days; P < .001). There were no significant differences in time to chemotherapy initiation, chemotherapy use, RS-based trial enrollment, or calculated costs between the groups. CONCLUSION: Early guideline-directed RS testing in selected patients is an effective way to shorten time to treatment decisions.

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Published In

J Oncol Pract

DOI

EISSN

1935-469X

Publication Date

December 2017

Volume

13

Issue

12

Start / End Page

e1012 / e1020

Location

United States

Related Subject Headings

  • Receptors, Estrogen
  • Prospective Studies
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Neoplasm Recurrence, Local
  • Middle Aged
  • Humans
  • Genetic Testing
  • Female
  • Decision Making
 

Citation

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Dzimitrowicz, H., Mougalian, S., Storms, S., Hurd, S., Chagpar, A. B., Killelea, B. K., … Sanft, T. B. (2017). Impacts of Early Guideline-Directed 21-Gene Recurrence Score Testing on Adjuvant Therapy Decision Making. J Oncol Pract, 13(12), e1012–e1020. https://doi.org/10.1200/JOP.2017.022731
Dzimitrowicz, Hannah, Sarah Mougalian, Sherri Storms, Sandra Hurd, Anees B. Chagpar, Brigid K. Killelea, Nina R. Horowitz, et al. “Impacts of Early Guideline-Directed 21-Gene Recurrence Score Testing on Adjuvant Therapy Decision Making.J Oncol Pract 13, no. 12 (December 2017): e1012–20. https://doi.org/10.1200/JOP.2017.022731.
Dzimitrowicz H, Mougalian S, Storms S, Hurd S, Chagpar AB, Killelea BK, et al. Impacts of Early Guideline-Directed 21-Gene Recurrence Score Testing on Adjuvant Therapy Decision Making. J Oncol Pract. 2017 Dec;13(12):e1012–20.
Dzimitrowicz, Hannah, et al. “Impacts of Early Guideline-Directed 21-Gene Recurrence Score Testing on Adjuvant Therapy Decision Making.J Oncol Pract, vol. 13, no. 12, Dec. 2017, pp. e1012–20. Pubmed, doi:10.1200/JOP.2017.022731.
Dzimitrowicz H, Mougalian S, Storms S, Hurd S, Chagpar AB, Killelea BK, Horowitz NR, Lannin DR, Harigopal M, Hofstatter E, DiGiovanna MP, Adelson KB, Silber A, Abu-Khalaf M, Chung G, Zaheer W, Abdelghany O, Hatzis C, Pusztai L, Sanft TB. Impacts of Early Guideline-Directed 21-Gene Recurrence Score Testing on Adjuvant Therapy Decision Making. J Oncol Pract. 2017 Dec;13(12):e1012–e1020.

Published In

J Oncol Pract

DOI

EISSN

1935-469X

Publication Date

December 2017

Volume

13

Issue

12

Start / End Page

e1012 / e1020

Location

United States

Related Subject Headings

  • Receptors, Estrogen
  • Prospective Studies
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Neoplasm Recurrence, Local
  • Middle Aged
  • Humans
  • Genetic Testing
  • Female
  • Decision Making