QIM19-139: Reflex Testing of Oncotype DX Recurrence Score: A Single Institution Review of a Quality Improvement Protocol
Background: Implementation of genomic assays has led to treatment of early-stage breast cancers with high risk of recurrence with adjuvant systemic chemotherapy while sparing those with a low risk of recurrence from systemic therapy with minimal benefit. Genomic assays are becoming a more widely used tool, evident by the eighth edition of the American Joint Committee on Cancer (AJCC) Breast Cancer Staging System, which includes recurrence score as part of the treatment algorithm in certain subgroups of tumors. Our institution identified the time to assay result as a quality improvement opportunity. We instituted a protocol to have a reflex testing of Oncotype DX based on certain criteria to decrease time to assay results and ultimately time to treatment. Methods: Our Multidisciplinary Breast Leadership Committee instituted a policy for reflex Oncotype DX testing on patients under the age of 70 with estrogen receptor positive, HER2-neu protein–negative, and node-negative invasive breast cancers measuring between 0.5 cm to 5 cm in January 2018. We compared our data available from pre- and postimplementation using the single factor analysis of variance (ANOVA) as well as an independent t-test and a post-hoc Tukey-Kramer test. Results: We have observed 45 cases that met the criteria for reflex Oncotype Dx testing since the initiation of this quality improvement protocol. The recurrence scores ranged from 0 to 55. There was a statistically significant difference in the number of days from operation to result day from 2016 to 2018 (55 days vs 18 days; P<.001). The number of days from the test order date to result date also saw a significant improvement from 2016 to 2018 (12 vs 9 days; P<.05). Conclusions: Breast cancer treatment options continue to evolve, particularly with the use of genomic assays. Our single institution review confirms the utility of our reflex Oncotype DX protocol with a decreased time to result with reflex testing of patients in the appropriate clinical setting. Further development of similar pathways may be necessary to streamline our patients’ care in the treatment of breast cancer.
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