With the commencement of the American Society of Clinical Oncology (ASCO) Conference, the largest cancer-focused conference in the world, we are reminded of the extraordinary number of innovations and achievements in research, in areas such as precision medicine and immunotherapy, that are helping to reshape the practice of cancer care today.
Need for Cancer Clinical Pathways
With an aging population, there is, unfortunately, an unprecedented influx of patients being diagnosed with cancer and this is putting huge stresses on the healthcare system from a diagnostic and drug cost standpoint. All stakeholders, including cancer patients, have a vested interest in finding solutions to keep cancer treatments accessible and affordable while maintaining proper incentivization for researchers and manufacturers. There is a movement in finding new payment and cancer care delivery models that will result in innovative and practice changing payment models. We are seeing a shift from the volume based, provider-centric reimbursement models to more patient-centric, value based reimbursement models. This is being conducted in hopes of maintaining high quality cancer care while at the same time reducing healthcare delivery costs over the long term.
To assist with this goal, task forces are being set up all over the country in hopes of creating evidence based clinical pathways and protocols for cancer care delivery that are both flexible in allowing the myriad of new options to appear but also comprehensive enough that they incorporate all of the supporting data available at the time of development. Also, there is increased emphasis on leveraging more stakeholders in the collaborative process of protocol development and utilizing secure and compliant online portals to increase the level of transparency in the development of these clinical pathways.
ASCO Criteria for Cancer Pathway Development
ASCO recently released nine criteria to create an overarching framework in which working committees can leverage when developing and assessing their own cancer pathways, protocols and consensus documents:
- Pursue a collaborative, national approach to reduce the unsustainable administrative burdens associated with the unmanaged proliferation of oncology pathways.
- Adopt a process for development of oncology pathways that is consistent and transparent to all stakeholders.
- Ensure that pathways address the full spectrum of cancer care, from diagnostic evaluation through medical, surgical, and radiation treatments, and including imaging, laboratory testing, survivorship, and end of life care.
- Update pathways continuously to reflect new scientific knowledge, as well as insights gained from clinical experience and patient outcomes, to promote the best possible evidence-based care.
- Recognize patient variability and autonomy and allow for physicians to easily diverge from pathways when evidence and patient needs dictate.
- Implement oncology pathways in ways that promote administrative efficiencies for both oncology providers and payers.
- Promote education, research, and access to clinical trials in oncology clinical pathways.
- Develop robust criteria to support certification of oncology pathway programs; pathway programs should be required to qualify on these criteria, and payers should accept all oncology pathway programs that achieve certification through such a process.
- Support research to understand the impact of pathways on care and outcomes.
Ensuring Cancer Pathways Provide Value
It is important to be mindful, however, that various stakeholders define “value” differently. Patients are looking for access to state-of-the-art “personalized” treatments, diagnostics, and interventions at the time of their diagnosis while also being provided an optimal overall “experience” with the healthcare system. They are looking for easily accessible and understandable education and online tools to help them navigate through their cancer journey, as well as online access to their healthcare providers and health information. Providers and payers can see value in these clinical pathways because they can help to reduce redundancies and inefficiencies, saving time and financial resources. They can also assist in regulatory and compliance reporting as more and more healthcare systems are establishing financial penalties for not adequately following established protocols. To maximize the benefit to all stakeholders, cancer clinical pathways need to include the patient journey beyond treatment and need to be consistently and judiciously updated with the latest scientific facts and validated real-world evidence.
Challenges for Developing Cancer Pathways
One of the challenges in perpetually updating cancer clinical pathways is the antiquated ways in which working groups collaborate, exchange data, and update protocols. With busy schedules and no clear mechanism of continuous dialogue for consistent revisions, maintaining state of the art protocols remains elusive. Added to that is the lack of interoperability of electronic health records, inconsistent patient access to their health data, compliance requirements to “block” data, immense physician documentation burdens, and inconsistent EHR usability and reportability.
Impetus InSite Online Platform for Cancer Pathway Creation
At Impetus Digital, we provide a secure, compliant online platform to support the ongoing development, assessment, and revisions of cancer care pathways. Through a series of online, “digestible” touchpoint assignments, collaborators, such as oncologists, allied healthcare providers, patients, and payers, are able to annotate, discuss, and share new data and reach consensus through discussion forums and web meetings. Working committees can include the latest education protocols and clinical trials in each update or pathway revision. The entire process is project managed and programmed by the Impetus Digital team; this allows the collaborators to focus on protocol development and not logistics, which can be very laborious and time consuming. Through a Longitudinal Expert Engagement Plan (LEEP), collaborators can review new data at specific timepoints throughout the year, allowing cancer protocols to be consistently and systematically updated and disseminated.