Machine learning, artificial intelligence, immunotherapy, genomics, robotic limbs, wearable health-monitoring tech, mRNA vaccines—it is an exciting time in medical research and technology. Yet, we must be mindful that such advances may require a rethinking or reengineering of our underlying infrastructures to integrate new tools, therapies, and programs effectively. Discovering and addressing gaps in our processes and systems will require continued and enhanced collaboration among stakeholders so that all patients can benefit from the latest advances in medicine and technology. The articles in this issue focus on the need for continued care coordination to ensure access to CAR-T therapy, the role of electronic consultations (eConsults) in care, and how pathways programs are continuing to evolve—clinically and technologically.
Advances in cellular bioengineering are leading to novel cellular therapies, specifically the CAR-T therapies, and have transformed the treatment of hematologic malignancies. There are currently three CD19-directed CAR-T therapies approved by the FDA available to treat relapsed or refractory lymphoid malignancies. Though the current models are promising, challenges remain for patient access, such as the high product cost, long production times, and the logistical barriers associated with the delivery and administration of the CAR-T therapy. Praveen Ramakrishnan Geethakumari, MD, and colleagues present the current state of approved CAR T-cell therapies for hematologic malignancies, clinical and financial barriers, and a framework proposal to expand future access (page 48).
With the onset of the COVID pandemic, computer-assisted clinic visits and telemedicine have become a critical aspect of patient care. An eConsult is a rapid, user-friendly electronic communication between a patient care provider and a specialist. Dartmouth Hitchcock Medical Center has been utilizing eConsults for hematology patients, even prior to the pandemic. To examine their impact on care delivery, Joshua D Hickman, MHA, and colleagues performed a retrospective analysis of all hematology eConsults completed at the Center over a 23-month period to determine the utilization rate, patient outcomes, and the time required by the consulting hematologists (page 54). They found that a significant portion of patients engaging in an eConsult did not require a face-to-face appointment, and even a smaller portion of those patients required on-going care. Based on their findings, eConsults have been integrated into a new hematology patient referral clinical pathway.
Also in this issue is a summary of the December 2020 Clinical Pathways Forum conference call. On that call, Stephen B Edge, MD, FACS, FASCO, Roswell Park Comprehensive Cancer Center, spoke about the clinical pathways program at Roswell Park, with a focus on evaluation and review of care administered off-pathway (page 45). The next Forum call will take place in April 2021 and will feature a presentation from Kaiser Permanent leaders on their oncology clinical pathways.