Abstract PS3-10-09: Improving Timeliness of Adjuvant Therapy Through Reduction of Oncotype DX Turnaround Time: A Multi-Site Quality Improvement Initiative at a Rural-Academic Cancer Network in West Virginia

Abstract Introduction: Timely initiation of adjuvant therapy is critical for patients with early-stage, HR-positive, HER2-negative breast cancer and is optimally achieved within 4 to 8 weeks post-surgery. At the West Virginia University Cancer Institute (WVUCI), a single health system serving both rural and urban patients at 16 cancer centers, delays in Oncotype DX Recurrence Score testing and prolonged time intervals between testing results and adjuvant therapy initiation can lead to suboptimal care delivery. This quality improvement (QI) initiative targeted Oncotype DX turnaround time (TAT) as a modifiable factor to facilitate timely, risk-adapted adjuvant therapy, and increase the rate of treatment initiation within guideline-recommended timeframes. Methods: Using a Plan–Do–Study–Act (PDSA) model, a multi-phase QI project was implemented at 15 WVUCI sites. Interventions included: (1) EMR integration of Oncotype DX ordering and reporting via Epic Aura (August 2025) and (2) insurance pre-authorization bypass for specimen processing and release of results (January 2025). An IRB-approved protocol was used to collect patient demographics and treatment history for all patients that underwent Oncotype DX testing between January 2024 and May 2025. Patients were divided into three groups by intervention phase: (1) pre-intervention, (2) post-EMR integration, and (3) post-full interventions. Primary outcomes included Oncotype TAT, time from surgery to adjuvant chemotherapy, and time from surgery to first adjuvant therapy with chemotherapy or radiation. Statistical analyses included the Kruskal-Wallis test due to non-normal data distribution, the post-hoc Dunn’s test, and Chi square test. Results: A total of 339 Oncotype DX orders were analyzed across the system during the QI initiative. The patient population was 97% female and 57% were aged ≥65 years. There were 89% of patients with stage I disease and 11% with stage II. A total of 75% of patients received adjuvant chemotherapy and/or radiation, with 15% treated with chemotherapy and 69% treated with radiation. Following implementation of the interventions, median TAT decreased from a median of 12 days (IQR 8-20) at baseline to 9 (IQR 8-13) and 8 days in groups 2 and 3, respectively. A significant difference in TAT between groups was observed (p