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ASCO's Role in the Future of Pathways

September 09, 2017

Perhaps more than any other specialty, clinical pathways have taken the oncology world by storm. Approximately 170 million covered lives in oncology are potentially impacted by clinical pathways, representing 57% of the patient population. The American Society of Clinical Oncology (ASCO) has taken notice, and has actively participated in the conversation surrounding clinical pathways.

The 2017 Clinical Pathways Congress (CPC) highlighted ASCO’s ongoing clinical pathway efforts in a wide-ranging presentation given by Robin T Zon, MD, FACP, FASCO, Journal of Clinical Pathways Editorial Advisory Board member and hematologist/oncologist with Michiana Hematology Oncology (South Bend, IN), and Robert Daly, MD, medical oncologist at Memorial Sloan Kettering Cancer Center (New York, NY). Dr Zon chairs ASCO’s Clinical Pathways Task Force, and Dr Daly was one of ASCO’s inaugural health policy fellows.

According to ASCO data, the percent of practices practicing in clinical pathways has precipitously risen in recent years, from 16% in 2014 to 58% in 2016. Dr Zon identified “the potential to protect patients” as a major reason for the increased uptake in pathway use. “Pathways can reduce variation in treatment and protect against over-, under-, or mistreatment,” she said.

ASCO’s interest in clinical pathways has largely centered around ensuring that oncologists can continue to provide the best possible care to their patients. Areas of concern within clinical pathways identified by ASCO include administrative burdens, a lack of transparency, and patient autonomy. “We want to be sure that doctors are caring for the patient, not the pathway,” said Dr Zon.

To this end, ASCO published nine recommendations to improve the development and use of clinical pathways in 2016. These criteria for high-quality pathways center on expert-driven pathway development, clear and achievable goals and outcomes, and outcomes-driven results.

However, questions remain about the ideal development of pathway programs, and many have identified potential issues that must be addressed. In his portion of the talk, Dr Daly focused on research into conflicts of interest among pathway developers at three major firms. He found that between 69% and 92% of voting members at United States pathway vendors received an industry general payment in 2015. These payments may negatively affect perceptions of clinical pathways, Dr Daly said.

The future of clinical pathways are necessary to ASCO’s mission of fostering the highest level of oncology care around the world, according to Dr Zon. “We are in a field that uses very expensive diagnostics and very expensive drugs,” she said. “We need to promote education, information, and transparency as we move forward.”

One future area of interest for ASCO is a California state legislation bill called The Oncology Clinical Pathways Act of 2017, which would “prohibit a plan or health insurer from, among other things, developing or implementing a clinical pathway that discourages clinical pathways or interferes with the independent clinical judgment of a provider.”

ASCO supports this legislation. In an official statement, Daniel F Hayes, MD, the organization’s then-president, called the bill “a critical first step towards ensuring that the process for developing oncology clinical pathways is consistent and transparent.” The bill is currently being held in the state appropriations committee, with no further legislative action expected in 2017.—Cameron Kelsall

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