ASCO’s Clinical Pathways Recommendations and Remaining Challenges

The American Society of Clinical Oncology (ASCO) today released its “policy statement on clinical pathways in oncology,” which acknowledges the challenges in developing these pathways and offers recommendations for improvement. We were pleased to see that many of their recommendations address concerns that we had raised in public presentations during the last year, as well as in a study that is currently in-press in The American Journal of Managed Care.

Clinical pathways, also known as care pathways or integrated care pathways, are typically characterized as a method for managing patient care based on clinical evidence, with the main goals of improving quality of care, reducing variation in clinical practice and increasing the efficient use of health care resources. The use of clinical pathways has increased in recent years as more payers and providers, particularly in oncology, are attempting to meet those goals.

One of the concerns that we’ve raised about clinical pathways is that, in contrast to clinical practice guidelines, formal standards or best practices are lacking for care pathway development, implementation and evaluation. According to its statement, ASCO would remedy this concern through the development of national criteria to certify pathways.

Transparency, however, is not fully addressed in ASCO’s statement, particularly when it comes to patients. Patients often do not know that their doctor has financial incentives to follow a pathway. We believe that patients should receive information about the development and impact of pathways, know whether treatment plans follow a care pathway and whether the clinical practice in which care is being delivered is subject to pathway-related incentives.

ASCO also raises the need to examine the impact of pathways. We agree. Little is known about the true impact of pathways on patient outcomes and quality of care, or medical care resource use and cost of treatment. We also were pleased that ASCO recognizes heterogeneity, or the differences in patient responses to a treatment, and the need for flexibility.

As ASCO notes, “oncology pathways must be developed and used appropriately and efficiently to guide care recommendations and coverage policies.” That’s a key point—above all, patients should receive the treatment that is best for them.

Interested in learning more about clinical pathways? Check out these additional resources:

• AJMC video interview on barriers to pathway adoption.
• AJMC video interview on expectations for pathway adoption.
• NPC’s interview with Anthem’s Dr. Jennifer Malin on their care pathway implementation.