2018 ASCO Annual Meeting!
Session: Health Services Research, Clinical Informatics, and Quality of Care
Type: Poster Session
Time: Saturday June 2, 1:15 PM to 4:45 PM
Location: Hall A
Implementation of breast cancer pathway for genetic counseling and testing in multi-state health system.
Care Delivery/Models of Care
Health Services Research, Clinical Informatics, and Quality of Care
2018 ASCO Annual Meeting
Poster Board Number:
Poster Session (Board #347)
J Clin Oncol 36, 2018 (suppl; abstr 6521)
Author(s): Stephanie L. Graff, Dax Kurbegov, David Moorman; Sarah Cannon Cancer Institutes HCA Midwest Health, Overland Park, KS; Sarah Cannon Research Institute, Nashville, TN
Background: Genetic counseling and/or testing (GC/T) are important aspects of breast cancer care. The National Comprehensive Cancer Network has guidelines for GC/T but reports demonstrate variable compliance. Across the Sarah Cannon Cancer Network (SCCN), pathways were developed and implemented by physician leadership teams to select patients (pts) who meet criteria for GC/T. Participating physicians receive pathways training. Adherence metrics are tracked in real time. This study evaluates compliance with GC/T for pts treated on and off pathway in the SCCN. Methods: Data was collected from seven SCCN markets in six states to create 3 data sets. 1. Pre-pathway: treated prior to implementation of pathways. 2. Off pathway: treated off pathway by physicians not yet trained on pathways after pathways implementation. 3. On pathway: treated by at least one physician trained on pathways. Pathway criteria for GC/T include: age < 50 years, male breast cancer, ≥ 2 affected relatives, ovarian cancer (family or self), triple negative biology < 60 years of age, 2 primary breast cancers, Ashkenazi Jewish ancestry. All pts were navigated by nurse navigators who entered the data into iNavigate, SCCN’s proprietary software. Data represents all breast cancer pts in iNavigate between December 2012 and November 2017. Pathways were implemented March 2016. Chi-squared tests were performed without continuity correction, using Bonferroni correction methods to account for multiple comparisons Results: Summarized in Table 1. Conclusions: Following implementation of pathways guiding genetic counseling and/or testing (GC/T), patient referral improved by 61.3% (95% CI: 56.1%, 66.4%; p < 0.0001). For pts not managed on pathway, GC/T improved by 15.7% (95% CI: 10.9%, 20.6%; p < 0.0001), possibly due to increased navigator or system awareness. These findings support pathways as one way to ensure best practice and guidelines based care across a large, multi-state health system.
|Total Patients||Eligible GC/T||GC/T Offered|
|Pre-Pathway||4321||1151||245 (21.3%; 95% CI: 19.0%, 23.7%)|
|Off Pathway||2711||889||329 (37.0%; 95% CI: 33.9%, 40.2%)|
|On Pathway||1277||453||374 (82.6%; 95% CI: 78.8%, 85.8%)|