Nurse Navigator Reference Guide
Supporting Patients Through Post-Surgical Molecular Risk Assessment for Early-Stage Lung Cancer
Overview
RiskReveal is a 14-gene RNA expression assay performed on surgically resected tumor tissue that stratifies early-stage NSCLC patients into low-risk and high-risk groups for cancer recurrence. As a nurse navigator, you play a central role in ensuring patients are offered this testing, understand their results, and are guided through the appropriate care pathway.
The Clinical Problem RiskReveal Solves
The Clinical Gap RiskReveal Addresses:
How RiskReveal Works
Low Risk
Surgical resection is likely curative.
Routine surveillance with standard follow-up intervals is appropriate.
Adjuvant chemotherapy is not indicated based on molecular profile.
High Risk
A pattern of tumor gene expression indicates an elevated likelihood of recurrence.
Referral to medical oncology for adjuvant chemotherapy discussion is recommended.
With treatment, clinical study data show ~96% of high-risk patients are cancer-free at 2 years, compared to only 79% of untreated high-risk patients.
Key Clinical Data Points
- High-risk patients in stages I-IIA who received adjuvant chemotherapy enjoyed a 78% reduction in risk of recurrence or death (96% DFS) at a 24-month endpoint
- The stage IA subset of high-risk patients also enjoyed an 85% reduction in risk of recurrence or death (98% DFS) at the same 24-month endpoint
- Results returned within 10 business days of tissue receipt, most often sooner
- The dramatic improvement in DFS was achieved with 3-4 cycles of simple platinum doublet chemotherapy, with complication rates consistent with known platinum-doublet chemotherapy profiles
Navigator Note:
When patients express concern about adjuvant chemotherapy, these data provide meaningful context: mortality risk from chemotherapy is only about 1%, while a molecular high-risk designation by RiskReveal entails at least a 20-times or higher risk of recurrence and death without this treatment. Frame the risk-benefit conversation around what is known, not what is assumed.
Dispelling Confusion About Other Prognostic Tests in NSCLC
Workflow Integration: When and How to Order
Point 1: Pre-Operative Discussion
This is the ideal time to introduce patients to the full breadth of modern integration of molecular technology into the management of early-stage NSCLC. Avoid a sudden, disconcerting introduction of the high risk of recurrence (even for stage IA patients) during the post-operative period by explaining up front that although surgery for lung cancer was traditionally associated with high recurrence rates, recurrence in stage IA-IIA can now be dramatically lowered by taking a two-stage approach when necessary: gold-standard surgery followed by molecular analysis of the resected tumor and a short course of well-tolerated post-operative chemotherapy when necessary to raise survival rates from the 60s to 70s into the high 90s.
Point 2: Ordering the Test Prior to the First Post-Operative Visit (14 days after operative admission)
Surgical resection complete
Physician places test order
Results returned in ≤10 business days, generally within 2-3 days of tissue receipt
Navigator facilitates care pathway
sent for testing
chemotherapy
chemotherapy
Dispelling Confusion About Other Prognostic Tests in NSCLC
Some doctors are considering using blood based Minimal Residual Disease (MRD) circulating tumor DNA testing as a part of post-operative decision making in NSCLC. This approach is not supported by available data, and should not distract from definitive, predictive 14-gene risk assessment with RiskReveal.
Patient Communication: Key Messages by Scenario
Use these conversation guides to introduce the test, explain results clearly, and support patients through the next decision.
“This test looks at the genetic activity inside your tumor tissue — the same tissue that was already/will be removed during surgery. You don’t need any additional procedures.”
“The test tells us whether your cancer was likely cured in the operating room, or whether your cells carry signals that suggest it may have already spread even before surgery. Either way, knowing helps your care team make the right plan for you.”
“Results come back within about two weeks, and then your doctor will go over them with you at your next appointment. I’ll be here to help you understand what they mean.”
“Your results are reassuring. The genetic profile of your tumor does not show the markers associated with recurrence.”
“This means surgery most likely occurred before the tumor had a chance to spread. Your doctor will continue to monitor you with regular follow-up, but you do not need additional treatment at this time.”
“This is genuinely good news — and it’s based on a close look at your specific cancer, not just your stage.”
“A high-risk result does not mean the cancer has come back — it means your tumor has molecular signals that suggest it could, and that we can act now to prevent that.”
“The encouraging part is that we know this before there is any detectable tumor. This is exactly the moment when treatment is most effective at completely preventing recurrence.”
“Your doctor is recommending a referral to a medical oncologist to discuss adjuvant chemotherapy. In patients like you who receive this treatment, nearly all are cancer-free two years later.”
“I’m going to stay closely involved to help you through this next step. Let’s talk about what to expect.”
If patient is reluctant: “It’s completely understandable to feel overwhelmed. The fact that we have this information is actually a sign that your care team is being as thorough as possible for you. We are very lucky that this test has just recently become available. Unlike in the past when high-risk tumors would recur without warning, we now have a very high chance of preventing any recurrence.”
If patient questions chemotherapy: “The chemotherapy regimen used with this approach has been in use safely for decades. We can talk through what the full course looks like and what support is available to you.”
If patient asks about watching and waiting: “That’s a valid question to bring to your oncologist. What I can share is that acting before a recurrence happens gives you the best possible outcome. I can help you prepare questions for that conversation.”
When the Ordering Physician Is Unfamiliar with RiskReveal
Although RiskReveal has been helping to save lives for over a decade, the most definitive, prospective randomized predictive data only became available in 2025. Some surgeons and oncologists may not yet be familiar with it. As a navigator, you may be the one to bring it to their attention. Suggested language:
For Surgeons:
“I’ve been reviewing options for post-surgical molecular risk stratification in early-stage lung cancer patients. There’s one test that has actually completed a Phase 3 prospective randomized study and therefore has definitive predictive data that will allow oncologists to treat high-risk stage I-IIA patients with simple adjuvant chemotherapy and dramatically reduce their otherwise very high risk of recurrence. The test is called RiskReveal, and it analyzes RNA expression from the resected tumor tissue. Would you like me to pull the clinical data for your review?”
For Medical Oncologists:
“The patient’s surgical team mentioned RiskReveal for molecular risk assessment. It’s a 14-gene mRNA expression profile that is run on the resected tissue. Phase 3 prospective randomized data were published in Lancet Respiratory Medicine in 2025 documenting definitive predictive data that stage I-IIA patients identified by the test as molecular high-risk do have a dramatic positive response to adjuvant platinum doublet chemotherapy. These surgeons are now referring all their high-risk stage IA-IIA patients for adjuvant therapy.”
Reimbursement & Patient Financial Support
Razor Genomics manages billing directly. As a navigator, your role is to ensure patients know that cost should not be a barrier to testing or treatment.
Medicare Patients
Commercial Insurance
Financial Assistance
Phone: 1-844-662-6298
Secure Fax: (949) 271-5753
For coverage verification, prior authorization questions, or patient financial assistance.
Questions to Prompt at Key Care Transitions
At Surgical Discharge / Post-Op Follow-Up
At Results Discussion
For High-Risk Patients Entering Adjuvant Treatment
- Has RiskReveal been ordered?
- Does the patient understand what the test is and when results will be available?
- Has a follow-up appointment been scheduled for results discussion?
- Does the patient understand what their result means in practical terms?
- For high-risk patients: has a medical oncology referral been placed?
- Does the patient have a point of contact (you) for questions between visits?
- Has the chemotherapy regimen and expected schedule been reviewed with the patient?
- Are supportive care referrals in place (social work, nutrition, palliative care)?
- Is there a plan for monitoring during treatment and surveillance after completion?
Insurance Coverage & Resources
Razor Genomics, Clinical and Patient Support:
Materials available from Razor Genomics:
RiskReveal® is a product of Razor Genomics. This reference guide is intended for use by clinical nurse navigators supporting RiskReveal in the post-surgical care pathway for early-stage NSCLC.
