Implementation of Nurse Navigation Improves Rate of Molecular Tumor Testing for Ovarian Cancer in a Gynecologic Oncology Practice

SIMPLE SUMMARY: The National Comprehensive Cancer Network recommends somatic tumor testing for all patients with epithelial ovarian cancer, as harboring specific mutations has implications for therapy. Targeted panel testing includes some of these genes; however, Next Generation Sequencing is preferred for the complete gene complement. The rate of guideline-concordant molecular tumor testing is low; therefore, we implemented a nurse navigator to improve rates. This study confirms that education sessions, consensus building, and NN implementation improves the rate and timeliness of molecular testing in patients with epithelial ovarian cancer. Next Generation Sequencing revealed a higher rate of actionable mutations that would have been missed using targeted panel testing alone. ABSTRACT: Purpose: The purpose of this study was to assess the impact of implementing a Nurse Navigator (NN) to improve the rate and timeliness of molecular tumor testing. Methods: This is an evaluation of the impact of education sessions, consensus building, and NN implementation for molecular tumor testing in patients with epithelial ovarian cancer. The NNs’ responsibilities included attending tumor boards and ensuring Next Generation Sequencing (NGS) is ordered, reviewed, and coordinated for appropriate patients. Results: NNs significantly improved NGS testing rates from 35.29% to 77.27%, p = 0.002. Ordering a targeted panel test (TPT) was the most common reason for not ordering NGS in the pre-NN cohort (13/22, 59%). The total turnaround time for testing was reduced after the introduction of NNs from 145.2 days to 42.8 days, p < 0.0001. The post-NN group had a significantly higher rate of actionable mutations identified for the recurrent setting [67.6% versus 20.8% (p = 0.0005)] and a trend towards a higher rate of actionable mutations identified in the frontline setting [41.2% versus 33.3% (p = 0.41)]. Conclusion: NNs significantly improved somatic tumor testing rates and timeliness for patients with ovarian cancer. Discontinuing TPT in favor of NGS revealed a higher rate of actionable tumor mutations that would have been missed with TPT alone.