Satisfaction in HER2 Testing among Medical Oncologists - Aiming for Multidisciplinary HER2 Testing in the Philippines

Ivy D. de Dios,1 Jerry Y. Tan Chun Bing,1 Susano B.Tanael,1
Corazon A. Ngelangel1 and Ma. Lourdes A. Tiambeng2

1Section of Medical Oncology, Department of Medicine, College of Medicine and
Philippine General Hospital, University of the Philippines Manila
2Department of Medicine, Cardinal Santos Medical Center, Mandaluyong City

Introduction. A multidisciplinary approach is essential to optimize patient care. In the practice of oncology, surgeons, medical oncologists, and pathologists are essential for the histology-based diagnosis of cancer patients. In breast cancer hormone receptor and HER2 positivity are both predictive and prognostic, and so testing for these has been strongly recommended for every newly diagnosed breast cancer patient. A unique but meaningful information that can be provided by medical oncologists, as cutomers, is their satisfaction to the services (e.g. HER2 testing) and product (e.g. reports) of the pathology laboratory. Any quality initiative effort to improve HER2 testing can also be extended to hormone receptor (ER/PR) testing. This study measures the general satisfaction of medical oncologists practicing in Metro Manila with local HER2 testing services and reports.

Methods. This cross-sectional study had survey questionnaires distributed to medical oncologists practicsing in Metro Manila chosen on the basis of their considerable experience with requesting HER2tests and with the use of anti-HER2 therapy in their management of breast carcinoma patients. Demographics, practice information, rating of satisfaction per laboratory service category, and a checklist of elements of IHC/FISH reports were collected.

Results. 32 medical oncologists participated in the survey, most of whom were from tertiary hospitals. Breast carcinoma cases make up around 36-50% of cancer cases in their practice. More than half request HER2 testing for their breast cancer patients. Medical oncologists are generally satisfied with the services for IHC and FISH HER2 testing (composite scores >2) provided by the laboratories. Overall, medical oncologists were very satisfied with diagnostic accuracy and completeness of relevant infomation in the report. Laboratory services were mostly rated good, with the exception of pathologists' responsiveness to problems and notification of equivocal results. For both IHC and FISH, patient/ physician identification, date of service, specimen identification/ site/ type, results, and interpretation were reported to be included in the report. However, time to/duration of/type of fixation, method and image analysis method, antibody clone/vendor, and comment that an FDA-approved method was used, were reported missing by the many.

Conclusion. For both IHC and FISH, overall satisfaction was found to be moderately directly correlated with diagnostic accuracy. In a country like the Philippines where quality initiatives of laboratories may still be far from ideal, medical oncologists can demand inclusion of their preferences into assessment processes by laboratories and correct assumptions of laboratory managers as to what element of the services and products they value most. Measurement of customer satisfaction can be integrated into the quality assurance programs of laboratories and corresponding hospitals.

Key Words: satisfaction with HER2 testing, multidisciplinary, breast cancer