ABSTRACT
OBJECTIVES: Industry-supported decision impact studies demonstrate that Oncotype Dx (ODX) changes treatment recommendations (TR) in 24-40% of hormone receptor+/HER2- patients. ODX is not reimbursed by third-party payers in Australia, potentially resulting in more selective use. We sought to evaluate the impact of self-funded ODX on TRs. METHODS: Data collected included demographics, tumor characteristics, indication for ODX and pre- and post-recurrence score (RS) TR. Primary endpoint was frequency of TR change and associations with TR change were sought. RESULTS: Eighteen physicians contributed 382 patients (median age 54). A total of 232 (61%) of tumors were T1 and were grade 1, 2 and 3 in 49 (13%), 252 (66%) and 79 (21%). A total of 257 (67%) were node negative. Assay indications were: confirm need for chemotherapy (CT) (36%), confirm omission of CT (40%) and genuine equipoise (24%). RS was low (≤17) in 55%, intermediate (18-31) in 36% and high (≥32) in 9%. Thirty-eight percent of patients had TR change post-ODX. Sixty-five percent of patients recommended CT pre-ODX changed to hormone therapy alone (HT)-more likely if lower grade and if ER and/or PR > 10%. Fourteen percent of patients with pre-ODX TR for HT added CT-more likely if ER and/or PR ≤10% and if Ki67 > 15% Overall, TR for CT decreased from 47% to 24%. CONCLUSION: Patient-funded ODX changed TRs in 38% of patients, de-escalating 65% from CT to HT and adding CT to 14% of those recommended HT. These changes were greater than an industry-funded study suggesting that physicians can identify situations where the assay may influence decisions.
Subject(s)
Breast Neoplasms/drug therapy , Carcinoma, Ductal, Breast/drug therapy , Carcinoma, Lobular/drug therapy , Decision Making , Gene Expression Profiling/economics , Practice Patterns, Physicians'/standards , Australia , Breast Neoplasms/economics , Breast Neoplasms/genetics , Carcinoma, Ductal, Breast/economics , Carcinoma, Ductal, Breast/genetics , Carcinoma, Lobular/economics , Carcinoma, Lobular/genetics , Chemotherapy, Adjuvant , Female , Gene Expression Profiling/methods , Humans , Middle Aged , PrognosisSubject(s)
Lymphoma, B-Cell/pathology , Lymphoma, Large B-Cell, Diffuse/pathology , Rectal Neoplasms/pathology , Aged , Aged, 80 and over , Biopsy , Humans , Lymphoma, B-Cell/epidemiology , Lymphoma, B-Cell/therapy , Lymphoma, Large B-Cell, Diffuse/epidemiology , Lymphoma, Large B-Cell, Diffuse/therapy , Male , Rectal Neoplasms/epidemiology , Rectal Neoplasms/therapyABSTRACT
Tuberculosis is a common disease in South Africa, but the diagnosis may be difficult when it presents in the miliary form. Two cases of miliary tuberculosis with pancytopenia are described.
