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In the last decade there has been widespread adoption of clinical pathways in the United States healthcare delivery system. A high-quality oncology clinical pathway is a detailed, evidence-based protocol for delivering cancer care, including but not limited to anticancer drug regimens for specific patient populations.
The rapid proliferation of clinical pathways in oncology is due in part to rising healthcare costs and the overall shift toward a value-based healthcare delivery system. When properly designed and implemented, oncology pathways can serve as an important tool in improving care quality and reducing costs.
Payers, institutions, and clinicians use pathways to reduce variabilities in treating specific conditions and control costs, with evidence suggesting that well-designed clinical pathways could address the cost of cancer care without compromising patient access to medically appropriate treatments, even when the cost is high.
Concerns have been raised that not all clinical pathways in oncology have been developed and implemented in a high-quality, transparent, and efficient way. Furthermore, the proliferation of clinical pathways has created an overwhelming and counterproductive administrative burden for many oncology providers. Patients with identical clinical characteristics treated by a single clinician can be on different pathways, based solely on the payer, leading to differences in treatment and related administrative complexity that may represent obstacles to quality and efficiency within a practice
For several years ASCO has been examining and working to improve oncology clinical pathways, beginning with establishing its Task Force on Clinical Pathways. In January 2016, the society released "ASCO Policy Statement on Clinical Pathways in Oncology," which called for the development of robust criteria to support a high standard of quality among oncology pathway programs. ASCO’s criteria for high-quality oncology pathways were released in November 2016 and became the foundation for the society's 2018 clinical pathways landscape assessment.
What’s New in 2018
In February 2018, ASCO released its review of leading oncology pathway vendors in the United States. "Oncology Clinical Pathways: Charting the Landscape of Pathway Providers," published in the Journal of Oncology Practice (JOP), examines the clinical pathways offered by six commercial vendors using the society's criteria for high-quality clinical pathways. The report found that overall, with a few exceptions, prominent commercial pathway programs in this country are largely aligned with ASCO's criteria and that all vendors met key criteria for being expert driven, patient-focused, up-to-date, and comprehensive. They also offered integrated decision support and provided outcomes-driven results.
The review also revealed that oncology clinical pathways, as a group, met fewer aspects of the criteria with regard to having clear and achievable expected outcomes and public reporting of performance metrics. This indicates that as pathway programs permeate the healthcare delivery system, more information should be available on the specific cancer type that the pathway is intended to cover, as well as what constitutes on-pathway versus off-pathway treatment. Additionally, there is a need to ensure that pathway programs offer more robust reporting that reflects valid occasions when the provider has gone off-pathway.
"We're encouraged to see that, by and large, prominent pathway programs are adhering to ASCO's criteria for high-quality clinical pathways," said Robin Zon, MD, FACP, FASCO, chair of ASCO's Task Force on Clinical Pathways. "We hope our assessment of the pathways landscape will help these programs make further refinements, with the ultimate goal of improving the care of our patients."
All of ASCO’s oncology pathways resources, including the new checklist, designed to help oncology practices conduct their own evaluation of clinical pathways, are available on the Clinical Pathways page on ASCO's website at asco.org/pathways.
Key Data Points
- ASCO’s State of Cancer Care in America 2017 report documented a 42% increase from 2014 to 2016 in practices reporting compliance with a pathway program.1
- An estimated 60 individual health insurance plans in the United States are implementing oncology pathways, and more than 170 million individuals covered by those plans are potentially being treated under a plan-sponsored pathway—many of whom are in active treatment for cancer.
- ASCO's Clinical Pathways Webpage
- Oncology Clinical Pathways: Charting the Landscape of Pathway Providers
- ASCO Criteria for High-Quality Clinical Pathways in Oncology
- ASCO Policy Statement on Clinical Pathways in Oncology
- Checklist: Evaluating Oncology Clinical Pathways Programs
1. American Society of Clinical Oncology: The state of cancer care in America, 2017: A report by the American Society of Clinical Oncology. J Oncol Pract 13:e353-e394, 2017
Figure 1: Clinical Pathways
"2017 State of Cancer Care in America." American Society of Clinical Oncology. https://www.asco.org/sites/new-www.asco.org/files/content-files/research.... Accessed May 2018.