Comprehensive molecular pathology review service to reduce barriers to precision oncology in rural eastern North Carolina.

Abstract

11129 Background: ECU Health system serves a rural 29-county region where cancer mortality rates exceed those of the state’s remaining 71 counties combined. Insufficient tissue and lack of local infrastructure contribute to suboptimal precision oncology care. We aimed to enhance the clinical utility of send-out molecular tests for patients with solid cancers through a quality improvement (QI) initiative. Methods: We used the EPIDEM model of QI to explore, promote, and implement a molecular review service, which includes intervening on send-out molecular orders that would otherwise have been insufficient for the requested molecular pathology test. The interventions include combining blocks, sending alternative specimens, and/or modifying testing strategy. We documented cases in a molecular send-out database and electronic health records, evaluated the service's impact, and modified it to include an orderable molecular consultation. Results: In 2023, We reviewed 699 send-out comprehensive genomic tests on solid tumors (173 cytology, 192 resections, 332 biopsies), including 582 (83.3%) advanced cancers. In total, there were 576 sufficient reports. Actions taken on 185 orders (26.5% of reviewed cases) led to 156 reported results. Of these, 70 showed clinically significant findings, and 31 patients received targeted therapy because of those interventions. In March 2023, we initiated a formal consultation service with in-depth review. From 3/3/2023-1/29/2024, we performed 50 pre-test (e.g., specimen to use, testing strategy, tumor origin testing) and 60 post-test (e.g., result interpretation, treatment based on molecular data) consultations; 10 patients received both pre and post-test support. The molecular pathologist tended to initiate post-test, while clinicians preferentially initiated pre-test consultations (p<.01). Clinician-initiated consultations were more frequent in community practices (p <.01). Conclusions: Even without the resources for in-house testing, our molecular review service provides essential pre- and post-analytic support by successfully rescuing cases that would have otherwise been insufficient molecular tests and by providing comprehensive consultative support. The positive impact and reception among community oncologists suggest that our strategy holds potential to alleviate barriers to precision oncology in underserved areas. [Table: see text]