Pregnancy screening prior to chemotherapy initiation: A retrospective review.

Abstract

165 Background: ASCO’s Quality Oncology Practice Initiative (QOPI) sets site standards to promote excellence in oncology care. One standard is screening appropriate female patients for pregnancy prior to chemotherapy. However, no formal guidelines exist regarding pregnancy screening protocols or timing of screening. We believe that women are inconsistently being screened for pregnancy prior to chemotherapy. Methods: A retrospective chart review was conducted using the UF Health (UFH) tumor registry and electronic health record (Epic) to identify women ages 18-55 who received chemotherapy or endocrine therapy by a medical oncologist between January 1, 2012 and December 31, 2014. Exclusions were prior hysterectomy or tubal ligation, known pregnancy, or treatment outside of UFH. The following data was collected: age, race, diagnosis date, cancer type, pregnancy screening test (urine or blood β-HCG) and date, specialty of ordering provider, name of chemotherapy or endocrine agent, and participation in interventional clinical trial. Results: Our search identified 501 potentially eligible women. Of these, 204 were excluded, 96% due to prior hysterectomy or tubal ligation. Of the remaining 297 eligible women, 103 (35%) received pregnancy testing prior to chemotherapy. Three screening tests were positive of the 103 pregnancy tests ordered. Follow up testing revealed 2 were true positives and 1 was a false positive. Of the 103 pregnancy tests, 23 (22%) were ordered by medical oncology, 51 (50%) were ordered by a surgery or anesthesia, and 16 (16%) were ordered by emergency medicine. 48% of the pregnancy tests were performed within 14 days prior to treatment start date. Conclusions: At our institution, pregnancy screening rates in women of childbearing potential were just 35%, and less than half of the women who were screened received pregnancy testing within 14 days of treatment start. Based on this data, a quality improvement project has been initiated in the outpatient medical oncology clinic and infusion center to improve pregnancy screening in this population. [Table: see text]