Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
Oncologist. 2022 Nov 3;27(11):930-939. doi: 10.1093/oncolo/oyac134.
Precision oncology relies on molecular diagnostics, and the value-proposition of modern healthcare networks promises a higher standard of care across partner sites. We present the results of a clinical pilot to standardize precision oncology workflows.
Workflows are defined as the development, roll-out, and updating of disease-specific molecular order sets. We tracked the timeline, composition, and effort of consensus meetings to define the combination of molecular tests. To assess clinical impact, we examined order set adoption over a two-year period (before and after roll-out) across all gastrointestinal and hepatopancreatobiliary (GI) malignancies, and by provider location within the network.
Development of 12 disease center-specific order sets took ~9 months, and the average number of tests per indication changed from 2.9 to 2.8 (P = .74). After roll-out, we identified significant increases in requests for GI patients (17%; P < .001), compliance with testing recommendations (9%; P < .001), and the fraction of "abnormal" results (6%; P < .001). Of 1088 GI patients, only 3 received targeted agents based on findings derived from non-recommended orders (1 before and 2 after roll-out); indicating that our practice did not negatively affect patient treatments. Preliminary analysis showed 99% compliance by providers in network sites, confirming the adoption of the order sets across the network.
Our study details the effort of establishing precision oncology workflows, the adoption pattern, and the absence of harm from the reduction of non-recommended orders. Establishing a modifiable communication tool for molecular testing is an essential component to optimize patient care via precision oncology.
精准肿瘤学依赖于分子诊断，现代医疗保健网络的价值主张承诺在合作伙伴站点提供更高标准的护理。我们展示了标准化精准肿瘤学工作流程的临床试点结果。
工作流程被定义为疾病特异性分子订单集的开发、推出和更新。我们跟踪了共识会议的时间表、组成和努力，以定义组合分子测试。为了评估临床影响，我们在推出前后的两年内（推出前和推出后）检查了所有胃肠和肝胆（GI）恶性肿瘤以及网络内提供商位置的订单集采用情况。
开发 12 个疾病中心特定的订单集大约需要 9 个月，每个适应症的测试数量从 2.9 减少到 2.8（P=.74）。推出后，我们发现 GI 患者的请求显著增加（17%；P <.001），检测建议的符合率（9%；P <.001），以及“异常”结果的比例（6%；P <.001）。在 1088 名 GI 患者中，只有 3 名患者根据非推荐订单得出的结果接受了靶向药物治疗（推出前 1 例，推出后 2 例）；表明我们的做法并没有对患者的治疗产生负面影响。初步分析显示，网络站点的提供商 99%遵守规定，确认了订单集在整个网络中的采用。
我们的研究详细介绍了建立精准肿瘤学工作流程的努力、采用模式，以及减少非推荐订单对患者没有造成伤害。建立一个可修改的分子测试沟通工具是通过精准肿瘤学优化患者护理的必要组成部分。
