Rives Taylor A, Pavlik Heather, Li Ning, Qasrawi Lien, Yan Donglin, Pickarski Justine, Dietrich Charles S, Miller Rachel W, Ueland Frederick R, Kolesar Jill M
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY 40536, USA.
Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA.
Cancers (Basel). 2023 Jun 15;15(12):3192. doi: 10.3390/cancers15123192.
The purpose of this study was to assess the impact of implementing a Nurse Navigator (NN) to improve the rate and timeliness of molecular tumor testing.
This is an evaluation of the impact of education sessions, consensus building, and NN implementation for molecular tumor testing in patients with epithelial ovarian cancer. The NNs' responsibilities included attending tumor boards and ensuring Next Generation Sequencing (NGS) is ordered, reviewed, and coordinated for appropriate patients.
NNs significantly improved NGS testing rates from 35.29% to 77.27%, = 0.002. Ordering a targeted panel test (TPT) was the most common reason for not ordering NGS in the pre-NN cohort (13/22, 59%). The total turnaround time for testing was reduced after the introduction of NNs from 145.2 days to 42.8 days, < 0.0001. The post-NN group had a significantly higher rate of actionable mutations identified for the recurrent setting [67.6% versus 20.8% ( = 0.0005)] and a trend towards a higher rate of actionable mutations identified in the frontline setting [41.2% versus 33.3% ( = 0.41)].
NNs significantly improved somatic tumor testing rates and timeliness for patients with ovarian cancer. Discontinuing TPT in favor of NGS revealed a higher rate of actionable tumor mutations that would have been missed with TPT alone.
本研究的目的是评估实施护士导航员（NN）对提高分子肿瘤检测的率和及时性的影响。
这是一项关于上皮性卵巢癌患者分子肿瘤检测的教育课程、共识建立和NN实施影响的评估。NN的职责包括参加肿瘤病例讨论会，并确保为合适的患者安排、审查和协调下一代测序（NGS）。
NN显著提高了NGS检测率，从35.29%提高到77.27%，P = 0.002。在NN实施前的队列中，未安排NGS的最常见原因是安排了靶向 panel 检测（TPT）（13/22，59%）。引入NN后，检测的总周转时间从145.2天减少到42.8天，P < 0.0001。NN实施后的组在复发情况下鉴定出可操作突变的比例显著更高[67.6%对20.8%（P = 0.0005）]，并且在一线情况下鉴定出可操作突变的比例有更高的趋势[41.2%对33.3%（P = 0.41）]。
NN显著提高了卵巢癌患者的体细胞肿瘤检测率和及时性。停用TPT而采用NGS显示出单独使用TPT会遗漏的可操作肿瘤突变比例更高。
