Impacts of Early Guideline-Directed 21-Gene Recurrence Score Testing on Adjuvant Therapy Decision Making.

PURPOSE: The 21-gene recurrence score (RS) assay is used to help formulate adjuvant chemotherapy recommendations for patients with estrogen receptor-positive, early-stage breast cancer. Most frequently, medical oncologists order RS after surgery. Results take an additional 2 weeks to return, which can delay decision making. We conducted a prospective quality-improvement project to assess the impact of early guideline-directed RS ordering by surgeons before the first visit with a medical oncologist on adjuvant therapy decision making. MATERIALS AND METHODS: Surgical oncologists ordered RS testing following National Comprehensive Cancer Network guidelines at time of diagnosis or at time of surgery between July 1, 2015 and December 31, 2015. We measured the testing rate of patients eligible for RS, time to chemotherapy decisions, rates of chemotherapy use, accrual to RS-based clinical trials, cost, and physician acceptance of the policy and compared the results to patients who met eligibility criteria for early guideline-directed testing during the 6 months before the project. RESULTS: Ninety patients met eligibility criteria during the testing period. RS was ordered for 91% of patients in the early testing group compared with 76% of historical controls ( P < .001). Median time to chemotherapy decision was significantly shorter in the early testing group (20 days; 95% CI, 17 to 23 days) compared with historical controls (32 days; 95% CI, 29 to 35 days; P < .001). There were no significant differences in time to chemotherapy initiation, chemotherapy use, RS-based trial enrollment, or calculated costs between the groups. CONCLUSION: Early guideline-directed RS testing in selected patients is an effective way to shorten time to treatment decisions.

The needs of men with prostate cancer: results of a focus group study.

Prostate cancer is the most common type of cancer diagnosed in men in the United States and accounts for 43% of all newly diagnosed malignancies. This year, approximately 218,890 men were diagnosed with prostate cancer (American Cancer Society, 2007). Of all men diagnosed with cancer each year, more than 30% will be diagnosed with prostate cancer. Receiving a diagnosis of cancer can be very difficult and emotionally challenging for patients and their families. There is limited research surrounding the psychosocial and educational needs of men diagnosed with prostate cancer and the effectiveness of existing support services for this population. The purpose of this qualitative and grounded theory study was to explore the psychosocial needs of men with prostate cancer using a previously developed cancer model. Demographic questionnaires and focus groups were used with a sample of 16 men aged between 49 and 81 years. The results of the qualitative analysis revealed consistency with a previously tested breast cancer model and identified unique concerns of men within three stages of the prostate cancer experience. Implications for nursing research and practice are presented.