Last week, the American Society for Clinical Oncology (ASCO) issued a policy statement calling for improvements in clinical pathway programs. The statement responds to the growing concern that clinical pathways are being developed and implemented in a way that could impede delivery of high-quality cancer care.
ASCO offers several recommendations to improve the development and use of clinical pathways in oncology:
- 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 include 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 based 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.
These recommendations echo many of the concerns expressed by members of the patient community and underscore the need for pathways to be carefully developed to support informed choices by health care providers and their patients.