Result card

  • ORG3: What kind of co-operation and communication of activities have to be mobilised when the tests (uPA/PAI-1/ Oncotype DX/ MammaPrint) are introduced in the clinical pathways of women with invasive breast cancer?

What kind of co-operation and communication of activities have to be mobilised when the tests (uPA/PAI-1/ Oncotype DX/ MammaPrint) are introduced in the clinical pathways of women with invasive breast cancer?

Authors: Jennifer Butt, Marco Marchetti, Angelica Carletto, Americo Cicchetti, Chiara Filippi

Internal reviewers: Paolo Giorgi Rossi, Claudia Wild, Anne Lee, Antonio Migliore, Stefan Mathis-Endenhofer, Cari Almazan

Analysis of selected studies extracted from the basic literature search and data from electronic clinician survey. Five articles were found to be relevant to this question. We found additional information by an internet search of grey literature performed on 20 March 2012 via the search engine Google. It was performed by one investigator using key words specific to the Organisational Aspects domain (“communication”, “cooperation”, “network”, “teamwork”, “multidisciplinary team”, “multiprofessional team”) combined with each test (uPA/PAI-1/ Oncotype DX/ MammaPrint). Two grey literature sources are referred to in these results.

All of the literature refers to the generic uPA/PAI-1 test rather than to the brand FEMTELLE.

Cooperation activities

Tissue collection and preservation

If one particular tissue collection and preservation system is normally used in the clinical setting, use of a test that requires a different system will have an impact on inter-departmental cooperation. For example, Mook S et al. (2007) found that the logistics for the collection of fresh-frozen tissue are complex and vary from hospital to hospital{7}.Therefore, performing microarray analysis, especially on a real-time basis, can cause some logistical problems such as insufficient freezing procedures, or transport-related issues. The authors concluded that close collaboration between pathologists, surgeons and oncologists is of paramount importance.

Cooperation between units compared with standard care

Compared with standard care, these tests may require some additional forms of cooperation between hospital units, outpatient services and hospital structures. For instance, the National Cancer Institute states that performing and evaluating these tests will need the implementation of an integrated process involving different units of the organisation, clinical participants and stakeholders. An integrated process of care presumes the standardisation of coordination and communication mechanisms among the different participants. Multidisciplinary teams of pathologists, surgeons and oncologists are the best suited to lead the evaluation of cancer recurrence risk with these tests. Interdisciplinary cooperation will likely affect current practice patterns. Modern practices require a more customised examination with more cooperation between those who order the test, those who perform it and those who interpret it. Genetic counsellors may have a role to play. These specially trained health professionals are skilled at supporting individuals when testing is being considered, when test results are received, and during the weeks and months afterwards {8}.

The electronic survey of clinicians showed that the relationship between those who prescribe the test, those who administer it and those who interpret the results is usually very close. Six out of eight respondents (75%) said that those who prescribe the test and those who administer it are part of the same team. One respondent (13%) stated that the prescribers and those who administer the test are linked by a relationship of “supply of services” and one respondent (13%) said the relationship was “professional advice”. A similar pattern is reported by respondents about those who administer the test and those who interpret the results: for five out of eight (63%) it is within the same team, for two (25%) it is a relationship of “professional advice” and for one (13%) it is a relationship of “supply of services”. The units within organisations that are in charge of administering the test vary: for four respondents (50%) it is a laboratory or pathology department, for three (38%) it is an oncological unit, for one (13%) the test is sent away to be performed and for one (13%) it is carried out in the private sector.


In a prospective community-based feasibility study (RASTER) for the use of the 70-gene signature, hospitals that wanted to be enrolled had to have uniformly structured multidisciplinary breast cancer care that used standard operating procedures, and had to have at least one dedicated physician (surgeon, pathologist, or medical oncologist) as a local coordinator. The coordinator’s role was to encourage and guarantee adequate information and communication activities among professionals involved in the patient pathway {9}.

Communication activities

Compared with standard care, the decision to introduce the tests (uPA/PAI-1/ Oncotype DX/ MammaPrint) in the clinical pathways of women with invasive breast cancer may need additional communication to all professionals involved and to eligible patients. Findings from the electronic survey show that in 75% of cases (6 out of 8) the availability of the test was communicated to clinicians. They were told about the need for careful identification of appropriate patients to use the test on and its rationale, or that the test would be discussed with relevant patients. One respondent from Spain reported also that clinicians were told that the test helps to make therapeutic decisions in some cases. In some places administrative staff and nursing staff were told about the need for careful identification of eligible patients and the rationale for the tests. (See {COL-3} for the full survey results.)

With patients

On the basis of patient interviews and questionnaires, Retal et al. (2007) felt that, given the level of knowledge on prognostic tests for cancer recurrence, there is room for improvement in the patient information {10}. The EGAPP (Evaluation of Genomic Applications in Practice and Prevention) working group (Berg et al. 2009) recommended that healthcare organisations should provide patients with counselling and educational materials to inform them about the potential benefits and harms associated with testing, and should discuss with patients whether the test results are likely to change their decision about therapy {11}. (See the Social Aspects domain of this HTA for more details about training and information activities for patients.)

Among professionals involved in the patient pathway

The Breast Centres Network takes the view that communication among professionals is essential in order to ensure that all the information coming from the prognostic tests is available quickly and is correctly interpreted. They also highlight that a molecular geneticist should be accessible for consultation by the specialists in the clinic {12}.

The literature contains little information on the cooperation and communication requirements for using these tests. Some points that were made in the literature are summarised above. However, since quality criteria have not been applied to these studies (see domain methodology), the real impact of these points on cooperation and communication activities is unknown.

Butt J et al. Result Card ORG3 In: Butt J et al. Organisational aspects In: Jefferson T, Vicari N, Raatz H [eds.]. Prognostic tests for breast cancer recurrence (uPA/PAI-1 [FEMTELLE], MammaPrint, Oncotype DX ) [Core HTA], Agenzia nationale per i servizi sanitari regionali (, Italy ; 2013. [cited 2 December 2022]. Available from: