Tumor profiling is most likely to be useful if one of the following statements describes your situation:
- “I am having a recurrence since my first diagnosis and my doctor has planned another surgery or a biopsy to remove tumor tissue.”
- “I have had a recurrence since my first diagnosis and another surgery or biopsy was performed to remove tumor tissue during the last year.”
- “I have had a recurrence or my cancer progressed within a year of my first diagnosis.”
If you have questions about the type of tumor specimen that is needed for this profiling, please contact us at (858) 657-0282 or patientsupport@clearityfoundation.org prior to filling out the forms.
Please discuss profiling with your physician prior to filling out the forms as his or her authorization is required. You can download our Physician Brochure here.
- Patient Background Form (submit electronically)
This form provides contact information for you and your doctor, as well as some background about your cancer and treatment you have received. We will use this information, together with data from your molecular profile, to generate our tumor profiling report. Please fully complete the form and submit your information to Clearity using our secure online system. Please consult your doctor’s office if you have questions about the details of your medical history. - Clearity Consent and Authorization Forms (download via computer, NOT tablet, to retain pre-printed information)
- Consent Form: gives Clearity permission to have your tissue samples tested and to have your results and clinical information incorporated into the Clearity Foundation Database
- Repository Consent Form (OPTIONAL): gives Clearity permission to have your tumor molecular profiling data and associated clinical information incorporated into the Repository and used for research purposes
- Clearity Authorization for Release Form: allows Clearity to request and obtain your tumor sample and medical records
- Foundation Medicine Authorization for Release Form: complete this form if you are considering clinical trials (e.g., PARP inhibitors); NextGen sequencing analysis will be included in your tumor profile. Note: international patients should contact us for more information.
Cost of the Tumor Blueprint
As a non-profit organization, The Clearity Foundation provides its patient support services free of charge. These services include test coordination, reporting and interpretation of test results, and identification of clinical trials for which you may be eligible.
The cost of the biomarker testing will vary depending on your insurance.
We are committed to helping women with ovarian cancer make more informed treatment decisions regardless of their ability to pay. Our grant process exists as a way of identifying patients that need financial assistance to cover the cost of biomarker testing. If you are in need of financial assistance, please do not hesitate to fill out our Financial Assistance Form (submit electronically).
In addition to the forms, we also need you to provide the following information:
- Insurance Card(s)
If you are insured, please include a front and back copy of your insurance card(s) - Most recent pathology report (corresponding to sample you would like us to profile)
- Pathology report(s) from original diagnosis as well as staging surgery
- Oncology flowsheets (records indicating drug(s), doses, and dates given) OR pharmacy records for the chemo regimen received prior to collection date of sample to be profiled AND subsequent treatments, if any
- Summary of chemotherapy treatments with dates since diagnosis (e.g., from recent oncology office visit/progress note)
- CA-125 data summary from at least the past year (from diagnosis, if possible)
- CT/PET/MRI reports from each recurrence and from the past year
Please note: Submitting all of the requested forms and records will help Clearity ensure you receive your testing results in a timely manner. Feel free to contact us at (858) 657-0282 or patientsupport@clearityfoundation.org with questions or concerns.
