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Critical Considerations in Colorectal Pathway Development

October 01, 2016

In an early session at the Clinical Pathways Congress, Bert H O’Neil, MD, Indiana University Simon Cancer Center, discussed some of the important factors to consider when developing a clinical pathway for colorectal cancer.

He began by emphasizing the importance of efficacy and toxicity when gathering evidence for the creation of a pathway. Efficacy should be the primary and most important measure to consider, followed by toxicity. “If one treatment is the clear choice, that is the pathway,” he stated, echoing Dr Kolodjiez’s comments earlier in the day. He acknowledged that there is some disagreement with regard to toxicity considerations, because toxicity is difficult to quantify, and determining which type of toxicity is most important depends on the patient.

Cost, he said, should only be factored into the development process when efficacy and toxicity are comparable. He added that this is especially important with the recent availability of a number of new therapies for patients with colorectal cancer, whereas before there were very few.

However, these new therapies have also complicated decision-making for patients and providers, which is where pathways can help to streamline process and ensure that best practice is utilized.

“Pathways can provide a forum for driving consensus where data are unclear,” Dr O’Neil explained. They can also “demonstrably affect physician prescribing behavior and have the potential to help decrease cost.”

Dr O’Neil also pointed to the changing landscape of diagnostics as complicating the pathway for colorectal cancer, as factors such as tumor sidedness, genetics, and tumor sampling practices have all been demonstrated to influence treatment outcomes.

During the question portion of the session, Dr O’Neil also emphasized that pathways can be developed for a wide range of disease states, as Via Oncology currently has pathways for 91 types of cancers. Expressing his agreement with ASCO’s recommendations regarding pathway adherence rates, Dr O’Neil said that, while the on-pathway rates for Via Oncology colorectal cancer pathways are 81–82%, this may not be appropriate for other types of cancers.

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