ASCO Raises Concerns Over Clinical Pathways in Oncology Practices

Designed to improve the quality of care that cancer patients receive, clinical pathways are evidence-based treatment protocols that take efficacy, safety, toxicity, and cost of therapy into account. However, the American Society of Clinical Oncology (ASCO) created the Task Force on Clinical Pathways to address their concerns about the ways in which these pathways are being utilized within the US healthcare system. According to the task force, these tools are creating administrative burdens for oncology practices and are potentially being used inappropriately due to payer requirements.

The task force established new guidelines for use of clinical pathways, which were published in the Journal of Oncology Practice.

“It’s time to seriously examine the way clinical pathways are designed and implemented to ensure they consistently enhance, rather than diminish, patient care,” said ASCO President Julie M. Vose, MD, MBA, FASCO, in a statement. “In too many cases, clinical pathways are undermining physicians’ ability to optimally care for their patients with cancer and limiting patient choice.”

The ASCO task force, including lead author of the policy statement, Robin T. Zon, MD, a medical oncologist at the Michiana Hematology-Oncology P.C. in South Bend, Indiana, is calling for clinical pathways to be used in a more flexible manner, to be updated regularly, to adhere to the latest evidence-based clinical practices, and to be used in a transparent and patient-centric way.

In their guidelines, the ASCO task force recommends specific measures to reform the way pathways are developed, so as to ease the administrative load for oncology practices, in the interest of better serving their cancer patients. According to the policy statement, “Practicing oncologists should play a central role in developing and revising oncology pathways.”

“Oncologists are finding that ‘cookie cutter’ approaches to treatment can impede our ability to personalize care and meet every patient’s needs,” said Zon in the ASCO press release. “In an era when medical advances come more quickly than ever, inflexible pathways may get in the way of better outcomes. When doctors diverge from a clinical pathway, even for well-justified reasons, payers are likely to either deny coverage or require prior authorization, which can delay treatment and threaten patients’ health.”

The ASCO policy statement includes the following recommendations:

• Pursue a collaborative national approach to reduce the unsustainable administrative burdens associated with the unmanaged proliferation of oncology pathways.

• Ensure that pathways address the full spectrum of cancer care, from diagnostic evaluation through medical, surgical, and radiation treatments, and include imaging, laboratory testing, survivorship, and end-of-life care.

• Recognize patient variability and autonomy and allow for physicians to easily diverge from pathways when evidence and patient needs dictate.

• Promote education, research, and access to clinical trials in oncology clinical pathways.

According to ASCO’s press release, more than 170 million people in the United States covered by insurance plans may be treated by a health plan–sponsored pathway, and about 60 individual health insurance plans are already using oncology pathways.