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The End of Clinical Pathways?

October 01, 2016

In a presentation at the inaugural Clinical Pathways Congress, Dr Kolodziej argued that clinical pathways as we know them will cease to exist as a result of the rise of immunotherapies for the treatment of cancer. “I’m going to talk about why I think clinical pathways are going to die,” he told the audience.

Clinical pathways guide physicians through the treatment options for a given disease, most often by weighing the evidence for efficacy, then toxicity, and then cost for each treatment. However, Dr Kolodziej pointed out that “efficacy always rules the day in pathways content,”and any highly efficacious treatment that is far superior to the alternatives must be on the pathway regardless of its toxicity and cost. This is the case with immunotherapies, Dr Kolodziej argued. Thus, “immunotherapies make pathways irrelevant,” he concluded.

Despite this claim, Dr Kolodziej acknowledged that there will continue to be a need for clinical pathways, albeit in a different form. He asserted that clinical pathways will evolve from simply helping physicians to choose appropriate therapy to optimizing processes for the delivery of care. For example, Dr Kolodziej said, therapies for cancer must increasingly become personalized. “Personalized therapy is not just precision therapy,” he clarified, suggesting that each patient’s treatment must be based not only on their genetics but also on other patient factors such as age, comorbidities, and preferences. Such personalization will require process improvements, such as better integration and coordination of different care teams as well as better collection and analysis of data on outcomes. Pathways can provide much needed structure to such process improvements.

“Care reform cannot happen without the intellectual rigor of pathways,” he concluded.

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