Oncology Clinical Pathways: Concerns Have Been Raised

Patients who are diagnosed with cancer may find their doctors and insurance companies follow protocols that are called "clinical pathways" to guide decisions related to recommended care. These pathways are intended to be evidence-based treatment protocols that take a number of factors into account. While they are meant to lay out best practices, some medical professionals are raising concerns that they aren’t always being used in patient or medical practices’ best interest.

The American Society of Clinical Oncology, in fact, recently formed its own Task Force on Clinical Pathways to address concerns its professionals have raised in regard to how pathways are used in American medicine. According to the task force, the pathways are creating burdens and may potentially be used in an inappropriate fashion to lower payer exposure.

The ASCO task force is recommending that clinical pathways undergo serious reform. Some of the biggest concerns raised center on the finding that pathways are sometimes being used to limit patient choice and create a "cookie cutter" approach to patient care. In turn, pathways are being employed in such a way that inflexible guidelines may limit physician ability to customize treatment plans to produce better outcomes. The study group also found that even if physician reasons for diverging from pathways is very well supported, insurance companies remain likely to deny coverage. This can delay treatment and may even threaten patient health in the process, the task force found.

ASCO is recommending a number of specific changes to how pathways are employed. They include:

• Reducing the administrative burdens associated with oncology pathways
• Ensuring that pathways address the full spectrum of cancer care. This would include diagnostic evaluation, treatments, testing, imaging, survivorship and end of life care, if required
• Paying close attention to patient variability to enable doctors to diverge from the pathway when evidence supports doing so

ASCO estimates that about 170 Americans are covered by insurance plans that rely on oncology pathways. Roughly 60 different individual health insurance plans use oncology pathways to guide treatment of patients diagnosed with cancer.

The bottom line, according to ASCO, is that cancer is not a cookie cutter disease. While best practices are most assuredly needed, there are always variations between patients. To enjoy the best possible outcomes, doctors need the flexibility to adjust care plans to fit the unique circumstances presented. Whether pathways will be adjusted based on the findings remains unclear. In the meantime, patients are urged to work with their healthcare providers to ensure they receive the best possible treatments for their unique case of cancer.

About Author

Choice Cancer Care is an independent, physician-owned cancer center network. Dr. Gregory Echt, a radiation oncologist with over two decades of experience, is the founder of Choice Cancer Care. Choice Cancer Care is among the busiest practices in the country for brachytherapy, or prostate seed implant therapy – a cancer treatment plan for prostate cancer that provides remarkable success rates and fewer life-limiting side effects.