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Implementation and Clinical Adoption of Precision Oncology Workflows Across a Healthcare Network.
Dias-Santagata, Dora; Heist, Rebecca S; Bard, Adam Z; da Silva, Annacarolina F L; Dagogo-Jack, Ibiayi; Nardi, Valentina; Ritterhouse, Lauren L; Spring, Laura M; Jessop, Nicholas; Farahani, Alexander A; Mino-Kenudson, Mari; Allen, Jill; Goyal, Lipika; Parikh, Aparna; Misdraji, Joseph; Shankar, Ganesh; Jordan, Justin T; Martinez-Lage, Maria; Frosch, Matthew; Graubert, Timothy; Fathi, Amir T; Hobbs, Gabriela S; Hasserjian, Robert P; Raje, Noopur; Abramson, Jeremy; Schwartz, Joel H; Sullivan, Ryan J; Miller, David; Hoang, Mai P; Isakoff, Steven; Ly, Amy; Bouberhan, Sara; Watkins, Jaclyn; Oliva, Esther; Wirth, Lori; Sadow, Peter M; Faquin, William; Cote, Gregory M; Hung, Yin P; Gao, Xin; Wu, Chin-Lee; Garg, Salil; Rivera, Miguel; Le, Long P; John Iafrate, A; Juric, Dejan; Hochberg, Ephraim P; Clark, Jeffrey; Bardia, Aditya; Lennerz, Jochen K.
Affiliation
  • Dias-Santagata D; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Heist RS; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
  • Bard AZ; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • da Silva AFL; Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
  • Dagogo-Jack I; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
  • Nardi V; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Ritterhouse LL; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Spring LM; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
  • Jessop N; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Farahani AA; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Mino-Kenudson M; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Allen J; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
  • Goyal L; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
  • Parikh A; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
  • Misdraji J; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Shankar G; Present affiliation: Department of Pathology, Yale University, New Haven, CT, USA.
  • Jordan JT; Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Martinez-Lage M; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
  • Frosch M; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Graubert T; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Fathi AT; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
  • Hobbs GS; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
  • Hasserjian RP; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
  • Raje N; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Abramson J; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
  • Schwartz JH; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
  • Sullivan RJ; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
  • Miller D; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
  • Hoang MP; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
  • Isakoff S; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Ly A; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
  • Bouberhan S; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Watkins J; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
  • Oliva E; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Wirth L; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Sadow PM; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
  • Faquin W; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Cote GM; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Hung YP; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
  • Gao X; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Wu CL; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
  • Garg S; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Rivera M; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Le LP; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • John Iafrate A; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Juric D; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Hochberg EP; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
  • Clark J; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
  • Bardia A; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
  • Lennerz JK; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
Oncologist ; 27(11): 930-939, 2022 11 03.
Article in En | MEDLINE | ID: mdl-35852437
ABSTRACT

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSION:

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.
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Full text: 1 Database: MEDLINE Main subject: Neoplasms Type of study: Diagnostic_studies / Guideline / Prognostic_studies Limits: Humans Language: En Year: 2022 Type: Article
Fulltext
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PubMed Links
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Full text: 1 Database: MEDLINE Main subject: Neoplasms Type of study: Diagnostic_studies / Guideline / Prognostic_studies Limits: Humans Language: En Year: 2022 Type: Article