由外科医生发起早期乳腺癌患者基因表达谱检测可减少化疗启动延迟
乳腺癌术后辅助化疗启动延迟可能对临床结局和患者满意度产生不利影响，既往研究已经明确21基因检测（Oncotype DX）可减少化疗启动延迟。
2017年9月，美国临床肿瘤学会《肿瘤学实践杂志》正式发表哈佛大学医学院、达纳法伯癌症研究所、布列根医院和波士顿妇女医院的研究报告，通过制定21基因检测的标准化方案和工作流程，以减少手术与辅助化疗启动之间的时间间隔。
该研究通过多学科共识，建立由外科医生发起21基因检测的反馈方案、外科医生和肿瘤内科医生之间沟通的工作流程、病理科接收和处理21基因检测请求的简化手续。外科医生发起检测的标准包括：年龄≤65岁的最终手术病理提示T1cN0（2～3级）、T2N0（1～2级）或T1/T2N1（1～2级）乳腺癌患者。肿瘤内科医生可以选择对超出标准的病例进行21基因检测。随后检查了2014年1月1日～2016年11月28日连续720例接受21基因检测的乳腺癌患者，计算干预实施前后手术日期、21基因检测申请日期、收到检测结果日期、化疗（如果有适应证）启动日期的间隔。
结果发现，标准化方案和工作流程实施后：
手术至基因检测申请减少7.3天（P<0.001）
手术至收到检测结果减少6.3天（P<0.001）
手术至辅助化疗启动减少6.4天（P=0.004）
因此，制定21基因检测标准共识、实施简化工作流程可使临床显著减少化疗决策和启动的等待时间。
J Oncol Pract. 2017 Sep;13(9):e815-e820.
Implementation of Surgeon-Initiated Gene Expression Profile Testing (Oncotype DX) Among Patients With Early-Stage Breast Cancer to Reduce Delays in Chemotherapy Initiation.
Losk K, Freedman RA, Lin NU, Golshan M, Pochebit SM, Lester SC, Natsuhara K, Camuso K, King TR, Bunnell CA.
Dana-Farber Cancer Institute; Dana-Farber/Brigham and Women's Cancer Center; Brigham and Women's Hospital; Harvard Medical School, Boston, MA.
PURPOSE: Delays to adjuvant chemotherapy initiation in breast cancer may adversely affect clinical outcomes and patient satisfaction. We previously identified an association between genomic testing (Oncotype DX) and delayed chemotherapy initiation. We sought to reduce the interval between surgery and adjuvant chemotherapy initiation by developing standardized criteria and workflows for Oncotype DX testing.
METHODS: Criteria for surgeon-initiated reflex Oncotype DX testing, workflows for communication between surgeons and medical oncologists, and a streamlined process for receiving and processing Oncotype DX requests in pathology were established by multidisciplinary consensus. Criteria for surgeon-initiated testing included patients ≤ 65 years old with T1cN0 (grade 2 or 3), T2N0 (grade 1 or 2), or T1/T2N1 (grade 1 or 2) breast cancer on final surgical pathology. Medical oncologists could elect to initiate Oncotype testing for cases falling outside the criteria. We then examined 720 consecutive patients with breast cancer who underwent Oncotype DX testing postoperatively between January 1, 2014 and November 28, 2016 and measured intervals between date of surgery, Oncotype DX order date, result received date, and chemotherapy initiation date (if applicable) before and after intervention implementation.
RESULTS: The introduction of standardized criteria and workflows reduced time between surgery and Oncotype DX ordering, and time from surgery to receipt of result, by 7.3 days ( P < .001) and 6.3 days ( P < .001), respectively. The mean number of days between surgery and initiation of chemotherapy was also reduced by 6.4 days ( P = .004).
CONCLUSION: Developing consensus on Oncotype DX testing criteria and implementing streamlined workflows has led to clinically significant reductions in wait times to chemotherapy decision making and initiation.
PMID: 28858535
DOI: 10.1200/JOP.2017.023788