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<0.001, Kruskal-Wallis test) with significant differences in all pairwise comparisons in a post-hoc analysis (p<0.001, Dunn’s test). Time from surgery to initiation of first adjuvant treatment decreased from a baseline median of 63 days (IQR 46-77) to 62 (IQR 48-86) and 54 days (IQR 41-75) in groups 2 and 3, respectively. There were significant differences in time from surgery to initiation of adjuvant treatment between groups (p<0.05, Kruskal-Wallis test). The proportion of patients who initiated adjuvant treatment within 8 weeks of surgery increased from 40.0% at baseline to 42.4% and 55.0% in groups 2 and 3, respectively (p=0.12, Chi-square test). This increase reflected an approximately 38% relative improvement from baseline. Conclusions: This QI initiative led to significant and sustained reductions in Oncotype DX turnaround time and improved timeliness of adjuvant therapy initiation. Although the increased proportion of patients who initiated adjuvant treatment within 8 weeks of surgery did not reach statistical significance, the trend suggests improved timeliness of care delivery. System-level process redesign with Oncotype DX EMR integration and insurance streamlining proved feasible and impactful across a rural-academic network. Ongoing efforts will focus on reducing the interval between result availability and therapy initiation, with a goal to increase the rate of adjuvant therapy initiation within 8 weeks from 55% to 80%. Citation Format: M. Hartzell, S. Nethagani, N. Holley, O. Chintuya, S. Wen, K. Barnett, D. Safi, S. Kurian, M. Hafez, B. Jiang. 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]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS3-10-09.