Enhancing precision medicine testing process in a breast cancer population of a community oncology practice: Use of oncology patient navigators (OPN) and a molecular processing team (MPT) to improve germline testing.

Abstract

559 Background: In 2021, universal germline testing was recommended to breast cancer patients. Historically, germline testing has been ordered using manual paper requisition forms or via molecular vendor portal input with no capabilities of follow-up to ensure timely results. There are few reports of how to optimize universal germ line testing; we endeavored to determine benefit of OPN and a MPT in a breast cancer population in the private practice setting. Methods: For the baseline population, using the Electronic Health Record (EHR), a report was generated to identify breast cancer patients seen that were eligible for germline testing. The patient records from the report were manually reviewed to identify germline testing completed. In the intervention arm, OPN would review provider schedules in real time to identify any newly diagnosed breast cancer pts. Concurrently the pts were offered the opportunity for germline testing along with education by providers during their visit. Certified Medical Assistants (CMAs) placed all orders via vendor portals using OPN supplied templates completed by providers. The MPT would follow orders placed to confirm specimen procurement, receipt by vendor and collaboratively resolve any delays in specimen processing, insurance challenges and test selection revisions. Tracking activities were implemented within the EHR to document all progress in testing and to quantify the volume of tests. Results: For the baseline population, between 1/1/21-3/31/21, 29 (24%) of 120 breast cancer patients received germ line testing. Post intervention, between 1/1/22-3/31/22, 70 (45%) of 155 patients had germline testing. The mean turnaround time (TAT) for germline results for the baseline population was 12 days, and 44% percent were over 11 days. In the intervention arm, the mean TAT was 10 days and 20% were over 11 days. Conclusions: Our results illustrate the early benefit of OPN and a MPT in expediting result obtainment and increasing utilization of germline testing. Enhancing cohesion with the vendors and our MPT and more automated use of the EHR will further improve utilization. Continued practice wide education of providers in the necessity of germline testing in a breast cancer population is also essential.