Oncology Pathways Research: Challenges, Adoption, and Future Trends

In an exclusive interview with the Journal of Clinical Pathways, Cindy Chen, Head of Research at HMP Market Access Insights, shares insights into the challenges, adoption, and future trends of oncology pathways research. Her discussion draws on crucial points from her Clinica Pathways Congress + Cancer Care Business Exchange session with Lee Blansett, Vice President of HMP Market Access Insights. The following is an edited excerpt from the video interview for clarity and brevity.

What would best support pathway adoption amongst oncologists?

Cindy Chen: Pathways and pathway adoption have been a hot topic over the last few days [of CPC+CBEx]. As we launched our inaugural research and are planning for our second year of research. What we set out to do, which is the first part, is to understand how oncologists engage with pathways. So, how do they perceive pathways, what do they use, and how does that fit into their daily lives. Regarding the factors that would drive adoption or encourage the use of pathways, we learned a couple of key drivers in our research.

The first driver is that oncologists need to understand how recommendations are selected for the pathway, [eg,] transparency of the type of clinical data, the selection process, and the selection criteria.

For the oncologist to understand that process, it creates or improves that credibility with them. They can see the oncology pathway as a clinical decision tool. If they view it as a clinical decision tool, then oncologists are more likely to use it. But equally important, this is interesting; the second point that the oncologists want us to understand is that it's great to have a good decision tool, but it must be easy to access. Oncologists are busy; they want to spend most of their time treating patients, so they must integrate the treatment pathway into their daily workflow well.

Integrating the pathways into their electronic medical record (EMR) is a good start. When we discuss this topic with the oncologists, some refer to this as the clickability factor. So, the fewer clicks they need to get to with that viable set of recommendations, the more likely they will use that pathway.

What general trends have you noticed in oncology pathways through your research?

Chen: Although this is only our second year of research, we’ve been looking into oncology pathways for a while. Although this is only our second year of research, we've been looking into oncology pathways for a while. We've been looking at pathways through our specific integrated delivery network (IDN) research, community oncology research, and payer research. One of the things I want to bring up is the trends that we see. Although oncology pathways are useful in terms of helping clinicians make clinical decisions, they are also complicated to implement and, once implemented, require constant maintenance.

It is an undertaking, and because it is an undertaking, we primarily see oncology pathways and what we consider to be sophisticated and well-resourced networks, [eg,] large IDNs or community practices which are often affiliated with a network like the US Oncology Network or the OneOncology network. But we also saw this year, particularly in our IDN research, that once these institutions have implemented the pathway in their first or second site, we are now seeing a more consistent rollout of pathway programs across all of their sites.

It's no longer that only the academic medical center is using pathways, or a particular site is adopting pathways. We now see more consistent usage across all sites in a particular network.

What is one key takeaway from your session that you would like to emphasize around payer and provider pathways?

Chen: As part of our research, we really wanted to understand the impact of pathways on oncologist treatment selection decisions. So, in our session, we shared quite a bit of data on that impact, and in particular, we did make some comparisons between what we consider to be the provider-led pathways: the US Oncology pathways, OneOncology pathways vs the payer pathways, [like] the Optum Pathway or Evolent.

One key takeaway is that although our research found measurable levels of impact across both sets of pathways, we measured a higher level of impact in those provider-led pathways.

There are many reasons for a higher impact on provider pathways, and we saw some differences across tumor types. But what I want to emphasize here is that across all of the different pathways, we notice that certain pathways are more impactful in influencing oncologists' treatment decisions than some others.

What key learnings from CPC do you plan to take into your research?

Chen: First of all, I've enjoyed all the sessions I have attended thus far. And I think one of the main reasons for that is that each of the sessions has brought this very well-balanced panel where we can see across the board the different viewpoints between the providers, payers, IDNs, the community, and the platforms of how everyone is really trying to solve some of these key challenges we face in oncology.

That being said, in terms of how I think about our research, I think the biggest value for me personally is to be at this particular conference and to interact with all of the different stakeholders involved in clinical pathways. I want to speak to the physicians using the pathways, the pathway developers, and the National Comprehensive Cancer Network (NCCN) representatives. It really helps us round out our viewpoint as well.

That enables us to hone in on the questions we want to address and make sure that we are reflecting on what is going on in the landscape to generate better research and better understanding for all participants and our clients.