Utilization of Oncotype DX testing in a community hospital system: How did this affect patient care?

Abstract

19 Background: The Oncotype DX Breast Cancer Assay is a multigene assay which quantifies risk of distant recurrence at 10 years and predicts benefit of chemotherapy in women with stage I/II, lymph node negative, estrogen receptor positive breast cancer. This retrospective study examines utilization of Oncotype DX for appropriate patients in a community hospital system. We hypothesize that chemotherapy administration follows the Oncotype DX score recommendation that patients with low recurrence scores not receive chemotherapy and patients with high recurrence scores receive chemotherapy and intermediate recurrence scores receive chemotherapy half of the time. Methods: In this retrospective study, 302 female patients from 1/1/12 – 1/1/14, were identified by breast cancer ICD9 codes from the system’s cancer registry. Data including imaging findings, pathology, and treatment information was then compared using chi square tests for categorical variables and two sample t tests or Wilcoxon rank sum tests for continuous variables. Results: Three hundred two female patients with stage I/II, lymph node negative, HR+, HER2/neu, breast cancer from a community hospital system were identified as appropriate candidates by NCCN guidelines, for Oncotype DX testing between 1/1/12 - 1/1/14. In patients receiving Oncotype DX, mass sizes were larger and were a higher proportion of stage 2 cancers (p < 0.001). Utilization of Oncotype DX in our CoC and NAPBC accredited hospital system was lower than hypothesized with only 73% of patients receiving testing. Following Oncotype DX testing, appropriate treatment ensued 94% of the time (low and high recurrence risk). Intermediate recurrence scores received treatment 36% of the time. Conclusions: In our CoC and NAPBC accredited hospital system, utilization of Onocotype DX testing was lower than hypothesized. For the patients who received testing, expected treatment was administered. Oncotype DX testing when performed influences patient care, however with 27% of patients not receiving testing and 25 % of the time this was due to patient preference, this observation supports that testing not be ordered reflexively, but rather with patient input and appropriate consent.