OhioHealth Mansfield adjusts protocol to get breast cancer patients faster results

MANSFIELD — For breast cancer patients, the days between surgery and learning whether chemotherapy is necessary can feel agonizingly long. It’s a period filled with anxiety, questions and fear — one where every day carries emotional and medical weight.

For years, OhioHealth Mansfield Hospital’s cancer team watched their patients endure the wait. But recently, the team found a way to shorten it.

OhioHealth Mansfield Hospital — the only hospital in Northcentral Ohio accredited by the Commission on Cancer (COC) — recently completed a major quality improvement initiative.

The initiative speeds up the ordering process for the OncoType DX test, a genetic test determing a breast cancer patient’s risk of recurrence and whether they will need chemotherapy or radiation after surgery.

The change has already made a measurable difference: what once took roughly 14 days to initiate now begins in just five.

A two-week wait causing major anxiety for patients

The long wait for OncoType results had been a challenge for patients nationwide. Dr. Laura Avery, a general surgeon and the hospital’s Cancer Liaison Physician, has spent 11 years caring for breast cancer patients at Mansfield Hospital. She said the previous two-week timeline was standard, but emotionally difficult.

During that time, patients wondered whether they would need chemotherapy or radiation and what the next stage of their lives would look like.

For many, the answer would determine how they prepared themselves physically, emotionally and financially for treatment.

After surgeons remove a breast tumor, pathologists examine the tissue under a microscope, Avery said. The OncoType DX test then examines genetic information from the tumor to produce a recurrence score from zero to 100.

Scores above 25 generally indicate chemotherapy is beneficial, while lower scores often mean patients can safely avoid it. Avery said the results help prevent both over-treatment and under-treatment and even help estimate recurrence risk over the next decade.

Most patients hadn’t met their oncologist yet when they needed the test, so the test order often fell into a gap between appointments.

“That was really just a period of time that created a lot of anxiety for the patient,” Avery said. “We wanted to make sure we were getting them to their next step in treatment in a timely manner.”

11-day improvement comes from new testing protocol

This year, ahead of the hospital’s COC accreditation review, a multidisciplinary team of surgeons, oncologists and pathologists came together to improve the process. The team created a new reflex testing protocol.

Under the new system, pathologists can automatically order the test based on clear clinical criteria, under the supervision of a physician. This means staff can send out the test immediately, without waiting for an oncologist to see the patient and place an order.

“Coming together, we developed which patients should have this testing,” Avery said. “We created reflex testing, and now when the pathologist receives the specimen, they can look at the criteria and automatically send off the test much sooner. We are very excited the oncologist has that information when the patient comes in to see them.”

The results show an 11-day improvement. Instead of waiting two weeks, it now happens around day five. So far this year, Avery said, around 30 patients have benefited from the change. Last year, the number would have been more than 40.

And giving them an answer sooner helps them move forward in their lives.

Dr. Laura avery

Avery noted the change not only lowers anxiety but also cuts down on the number of appointments patients must attend.

“Being able to eliminate another visit is a big deal for a patient who is going to see a number of different physicians,” she said. “And giving them an answer sooner helps them move forward in their lives.”

Why faster results matter

Avery said the initiative reflects the hospital’s commitment to its COC accreditation, which holds programs to rigorous quality standards.

“We are meeting and exceeding their criteria for quality,” Avery said. “We are always looking for ways to improve the patient experience and see them as a whole person.”

She said she believes other hospitals could replicate the improvement.

“I absolutely think other hospitals could replicate this time change,” she said. “It has to be a collaborative effort. All the team members have to be on board.”

Although certain steps — like surgical recovery and specimen processing — naturally limit how quickly the team can deliver results, Avery said the team is proud of what they’ve achieved and continues to look for ways to improve.

“It’s something we are really excited about here,” she said. “We have a team of people who are really passionate about taking care of cancer patients.”

OhioHealth Mansfield gives a personal feel

Mansfield resident Molly McCue noted the importance of being able to have access to this type of testing so close to home.

(Story continues below photos. Photos of Molly McCue’s journey. Provided by Molly McCue.)

“There were a lot of benefits,” McCue said. “My general surgeon, plastic surgeon and oncologist all had a relationship and were communicating about me on a regular basis. That made me feel good.”

Proximity is another benefit, McCue noted, while she didn’t have to do daily treatments, visits on a regular basis were easier without having to drive far constantly.

“You’re not a number,” she said. “There is a real personal feel.”

After the surgery, McCue said she was in a fog. The wear took over not only physically, but mentally. The unknown those days following the surgery come with are the worst and not having a clear path for what to expect next, she said.

As someone experienced the longer waiting period, McCue said the change is huge for those going into this process in the future.

“The waiting is the worst,” she said. “You just have to be resilient.”

Personal communication is one of the factors McCue said stood out with her journey at OhioHealth Mansfield. The results were shared by her local oncologist who called to tell her, rather than McCue having to go and find the results herself.

“It felt so good to be excited about something,” McCue said. “Especially when you’re not feeling at your best after a major surgery, having that off your plate is huge.”