Feature article

Clinical Cancer Pathways: Optimizing Oncology Care

Cancer care pathways are collaborative tools that involve patients, caregivers, healthcare providers, and health insurance companies. They can help optimize the quality of a patient's oncologic care by incorporating established best practices. Also called clinical pathways, care models, and care maps, care pathways use evidence-based medicine and collaborative care to standardize the treatment path a patient takes. Care pathways have been shown to have a number of positive net effects, including a reduction in non-standard treatment plans that may prove less effective, efficiency in how care is delivered and received, and opportunities for cost savings for the patient, the healthcare provider, and the patient's health insurer.1

Growing oncologic care costs—and a concurrent trend in leveraging researched, evidence-based medical practices—have led to a significant increase in the use of pathways. These standardized treatment plans are carefully constructed based on research data that apply to patients with specific disease types and stages. For example, there are a number of care pathways for particular kinds of cancer, but they go much deeper than just treatment plans by type. For example, two patients with lung cancer may follow two very different pathways, depending on staging, imaging results, demographics, and other important factors.

When properly researched and used, cancer care pathways become critical tools for helping provide patients with the best possible evidence-based care, as well as opportunities for cost reductions.2 

What is a cancer care pathway?

Oncologic pathways match patients with similar circumstances—such as cancer type, staging, prognosis, and treatment plans—to evidence-based, predictable courses of clinical care. These pathways are a form of holistic care; they connect patients, healthcare providers, and health insurance companies to promote clinical care that is based heavily on established data and especially clinical outcomes.

Patients battling cancer tend to fall within defined groups that have predictable treatment options that work best for that group. Each group for which care pathways exist have been defined, refined, and benchmarked over many years of research and analysis. Each step has a wellspring of data to support its inclusion.

For patients in the U.S., the standard resource for clinical pathways is the National Comprehensive Cancer Network (NCCN) Guidelines. The NCCN is a non-profit alliance of 28 leading cancer centers that provides tools and resources for oncologists and patients.

The NCCN guidelines apply to roughly 97 percent of cancers that affect U.S. patients. The comprehensive resource was developed by incorporating over 25 years of research to prescribe specific steps for the diagnosis, staging, treatment, and management of cancer cases. Although comprehensive, they adapt and evolve based on new data and findings to continually improve cancer care pathways.7

Each pathway is broken up into a series of steps, often called interventions. An intervention is a specific action or group of related actions that specify the ways in which healthcare providers make treatment decisions for their patients. These decisions are supported by data-driven, benchmarked, and scientifically sound evidence, with the goal of reducing or eliminating untested or unsafe practices, instead leveraging those that have demonstrated better outcomes.

The concept of clinical pathways may have different meanings to different stakeholders. Managed care organizations, most commonly health insurance companies or employers who sponsor their employees' health plans, approach cancer care pathways how they approach the health plan itself—logically, definitively, and deliberately. Pathways can range in scope from approaches to medication, specifically chemotherapy treatment, to a targeted, holistic treatment plan, but the goal remains the same: to standardize oncologic treatment plans to help improve a patient's quality of life and optimize clinical outcomes.3

Pathways usually comprise complex electronic guideline tools. These tools integrate with electronic health records that allows other participants in a patient's oncologic care, for example, a health insurance company, a hospital management team, or other physicians, to evaluate whether a patient's treatment plan follows the recommendations and standards of a defined pathway. This kind of information sharing is critical to further refining, benchmarking, and optimizing effectiveness.

Cancer care pathways can be quite individualized, but they all optimize three standard criteria: efficacy, toxicity, and cost.

  1. Efficacy: Treatments with higher levels of demonstrated success receive priority.
  2. Toxicity: Medications or other treatments (e.g., radiation therapy) with lower toxicity and similar efficacy receive priority.
  3. Cost: Treatments that cost less, but have similar efficacy receive priority.4

How do patients and healthcare providers benefit from cancer care pathways?

Clinical pathways, whether they apply to oncologic or another form of medical care, represent a continual assessment and application of years worth of data. They correlate patients who share key characteristics, and empower healthcare providers to find treatments that match those characteristics. Because pathways are structured, standardized plans of care, patients who meet the criteria of a specific pathway can begin an optimal treatment immediately. Providers who use pathways to guide treatment decisions leverage standards of coordinated care and limit undesirable outcomes.

But pathways are not rigid descriptions, they're flexible benchmarks. There is no step-by-step guide to treating a patient, even if that patient's circumstances match up well with established data sets. How to proceed is still a complex group decision. Physicians maintain the final say in recommending treatment plans to patients, but the use of pathways ensures that those recommendations have strong data behind them and are responsive to the patient as treatment progresses.

Clinical pathways are unique in that they become stronger and benefit from more data about patient outcomes at each step of the process. So for large organizations like hospitals, government health agencies, research groups, and health insurers, pathways can be adapted and improved by incorporating new clinical data and technological advancements. As such, they play a powerful role in closing the gap between existing evidence and real-time clinical decision making by:

  • empowering oncologic care teams to provide patients with cutting-edge, evidence-based expertise; 
  • reducing the opportunities for unnecessary changes or variations in clinical care;
  • providing the framework and tools necessary to measure the quality of care patients receive;
  • and encouraging healthcare providers and organizations to incorporate new evidence and information from patient feedback and data into oncologic care.5

How can patients and caregivers learn more about cancer care pathways?

Individuals and organizations, touching all aspects of oncologic care, have in-depth resources available for anyone to look through. These resources vary in complexity, but can provide an invaluable reference for patients, loved ones, and caregivers.

In addition to the NCCN Guidelines, the University of Washington School of Medicine has a searchable repository where healthcare providers can access and review standardized pathways. A quick search of Memorial Sloan Kettering Cancer Center's (MSKCC) Patient & Caregiver portal provides readers with clinical pathways that MSKCC continues to update.

In many cases, patients and caregivers can also check how their specific health plans define, regulate, and cover the implementation of cancer care pathways. For example, AIM Specialty Health, part of Anthem Blue Cross, has a searchable index of clinical pathways by cancer type.

Pathways can also help create an efficient, informative dialogue between patients and their healthcare providers. For oncologists, providing information that is useful and timely is a fundamental part of patient-centric care, and pathways can help improve that flow of information. Ideally, choosing a treatment plan is a collaborative process that considers all aspects of a patient’s unique situation. And incorporating an established pathway where possible and appropriate enriches and optimizes not only clinical outcomes, but also a patient's experience throughout treatment.6

References 

  1. "The care pathway: concepts and theories: an introduction." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3602959/. Accessed December 8, 2018.

  2. "Clinical Pathways." https://www.asco.org/practice-guidelines/cancer-care-initiatives/clinical-pathways. Accessed December 8, 2018.
  3. "What is a clinical pathway?" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2893088/. Accessed December 8, 2018.

  4. "Cancer Care Pathways: Hopes, Facts, and Concerns." https://www.ajmc.com/journals/evidence-based-oncology/2016/april-2016/cancer-care-pathways-hopes-facts-and-concerns. Accessed December 8, 2018.
  5. "About the Clinical Pathways." https://www.chop.edu/pathways/about. Accessed December 9, 2018.
  6. "Clinical Pathways." https://www.cancercare.org/blog/survey_finds_patients_unfamiliar_clinical_pathways. Accessed December 9, 2018.
  7. "About the NCCN Clinical Practice Guidelines in Oncology." https://www.nccn.org/professionals/. Accessed January 9, 2019.