Purpose/objectives: The Oncotype DX genomic test is a treatment decision-making tool. Test results are presented as recurrence scores which are used to help decide between adjuvant hormonal therapy (low recurrence score) or chemotherapy (high recurrence score). Since 2014, the Oncotype DX test has been funded at the cancer treatment centres in our province for patients with early breast cancer. Eligibility criteria for funding include patient and tumour characteristics. Pharmacy technicians were assigned to review and approve requests based on the eligibility criteria and with access to consultation to an oncology pharmacist and a medical oncologist. We assessed the clinical role of pharmacy technicians in this review process and the impact of recurrence score on treatment decisions.
Methods: This was a retrospective, multi-centre study to evaluate the Oncotype DX test eligibility review process from June 2014 to May 2015. The main objectives were to assess (1) the discrepancy rate of approval by the pharmacy technicians in this review process and (2) the concordance rate between the recurrence score from the Oncotype DX test and the adjuvant treatment given.
Results: Four hundred and forty requests for Oncotype DX test were received during the study period. A total of 90.8% of requests were approved and 9.2% were denied. The discrepancy rate of approval by pharmacy technicians was 1.1%. The average review time was 13.8 min, with the reviewing pharmacist and oncologist consulted in 5.5 and 15.2% of the requests, respectively. The concordance rate between the recurrence score and given treatment was 96%.
Discussion: The discrepancy rate of our pharmacy technicians appears to be similar to that reported with other expanded technician roles in literature, suggesting that the current task and other similar clinical tasks can be reliably delegated to technicians. The concordance rate of the recurrence score and given treatment in our study was higher than what has been reported in literature, suggesting that most of our patients were treated in accordance to recurrence score-based recommendations.
Conclusion: Pharmacy technicians were able to expand their clinical role by accurately reviewing the Oncotype DX test requests with a low discrepancy rate. The Oncotype DX test results appeared to successfully guide the adjuvant treatment given to patients in accordance to recurrence score-based recommendations.
Keywords: Breast cancer; Oncotype DX; pharmacy; pharmacy technician; recurrence scores.