Equity in Cancer Care: Pathways, Protocols, and Guidelines

Abstract

The quality of patient care varies based on numerous factors, such as health care setting, geographic location, access to medications, insurance coverage, and treatment protocols. Recently, the issue of whether use of clinical pathways can reduce costs and inappropriate variability in care has been the subject of much debate. As clinical treatment guidelines and pathways are increasingly deployed in oncology practice, they have a growing impact on the quality of treatment and how it is delivered. To fulfill the current need to discuss the use of pathways and clinical treatment guidelines in oncology and to address how patient care is impacted by their use, the National Comprehensive Cancer Network convened the NCCN Oncology Policy Summit: Equity in Cancer Care-Pathways, Protocols, and Guidelines. The summit was a forum to discuss the use and implementation of pathways, including how much flexibility pathways should allow in care, pathways' impact on public and private health insurance benefit design, what data is used to select pathway regimens and protocols, and ultimately what impact pathways may have on variation in care. The use and implementation of clinical treatment guidelines in practice was also explored from a variety of perspectives.

Efficacy of a clinical pathway for patients with thyroid cancer

“…19,20 In 2016, the Italian Association of Endocrine Surgery Units published a healthcare management protocol that included therapeutic pathways regarding preparation for surgery, surgical treatment, postoperative management, and hospital discharge. Increases in the incidence of thyroid cancer have heightened the need for standardized care protocols that reduce costs without compromising patient outcomes.…”

Postoperative hyperphosphatemia significantly associates with adverse survival in colorectal cancer patients

“…The mechanisms of these observations are unknown. Although colon and rectal cancers generally have similar path of oncogenic development and receive similar treatment modalities, there are minor differences in their treatment plans on surgery and cytotoxic therapies, due to the differences in tumor locations and other factors, according to the treatment guidelines of the National Comprehensive Cancer Network . It may be possible that some complications associated with high phosphate level are more prevalent in colon cancer patients or mitigated by the use of chemotherapy.…”

Specialty Pharmaceuticals: Policy Initiatives To Improve Assessment, Pricing, Prescription, And Use

“…Pathways combine criteria for drug selection, patient education and support, incentives to use community-based settings, and coordination with palliative and hospice care. 13 Insurers are expanding use of clinical pathways from oncology to rheumatology and immunology.…”