Segment 3: Considerations for Developing a Clinical Pathway

What do pathway developers consider as they formulate cancer clinical pathways? AIM Specialty Health and Via Oncology have somewhat distinct approaches to their pathway development process, in terms of the evidence used.

Michael Fisch, MD, MPH, said that AIM uses “published clinical data, which are rigorously curated and summarized,” and these summaries are updated in a quarterly fashion. The specific evidence that is used depends on the clinical scenario, driven by the specific cancer type, and the outcome being evaluated (progression-free survival, overall survival, response rate, etc), which may vary, Fisch said. He added that safety and quality-of-life outcomes are also curated in the pathway development process, along with costs.

Kathy Lokay said that their committee defragments individual case presentations to identify the subpopulations of patients for which a specific treatment can be defined. Then, this is corroborated with published literature and included as a pathway recommendation, Lokay said. Their committee also considers alternate scenarios for patients that might warrant a different approach, although she agreed with Fisch in that efficacy, toxicity, and cost are considered, in that order, when comparing treatments. “So for us, really if we look across all the end branches, the primary end branches of our medical oncology pathways at least, the cost decision really only comes into account about 5% of the time.”