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A Look Back at Clinical Pathways in 2022
Last year began with discussions and debates on the compatibility of personalized medicine and clinical pathways. The increased utilization of genomic profiling via NGS analysis and integration of patient preferences into cancer care is critical but may make it difficult to monitor treatment pattern consistency using clinical pathway programs. Therefore, throughout 2022, I suggested on my Editor’s Page that what we call a “clinical pathway” today may become a “care pathway” tomorrow. In a care pathway, the clinical pathway is a component of a system that incorporates diagnostics, social determinants of health and patient preference, patient engagement/navigation, and payer/employer interfaces.
Another big development in the past year was the return to in-person events, including our own Oncology Clinical Pathways Congress. Although the pandemic caused many shutdowns and delays, the work in the pathway arena did not stop--in fact, many would suggest that the pandemic stimulated progress. The field homed in on a broad range of topics for further evaluation, including the need to incorporate real-world data into learning analysis, predict population outcomes based upon social determinants of health and patient-reported outcomes, analyze patient response to therapy, and view patient follow-up from a triage perspective.
Throughout all of this, the Journal of Clinical Pathways played an integral role in investigating and reporting on these topics and others relevant to the pathways space. I’m happy to present the top 5 research reports the Journal published in 2022 that our audience found most compelling:
Breenish Manzoor, PhD, MPH, et al, designed this study to estimate the total cumulative costs per patient of treatment sequences for adults with chronic lymphocytic leukemia (CLL), with and without deletion 17p over 10 years. In addition, this study evaluates the budget impact of introducing sequences with venetoclax in combination with obinutuzumab as first-line therapy for CLL from a US payer perspective, based on the estimated costs of treatment sequences.
Tom Valuck, MD, JD, et al, discuss a workgroup they convened to better understand the gaps and challenges in oral oncolytic adherence performance measurement and provide recommendations to advance measurement for the management of oncology care. The workgroup identified action steps to advance the measured concepts, including evidence generation, agreement on best practices to support adherence, identification and use of patient-reported outcome measures and tools, and integration of measurement data components into existing workflows.
3. Improving Biosimilar Adoption Rates and Affordability With Oncology Pathways
Stephen Hamilton, MD, et al, describe the potentially significant impact of biosimilars on the cost of oncology care. Biosimilars have the potential to blunt the cost curve; however, utilization remains low for oncology indications compared to reference products. The authors describe a program put into place to drive biosimilar utilization for three common biologic drugs used for cancer treatment (trastuzumab, rituximab, and bevacizumab) and the resultant financial savings generated.
4. Phase II: A Value-Based Collaborative Care Model by Payers, Providers, and Pharma
Lili Brillstein, MPH, et al, detail phase 2 of the Specialty Care Medical Home model. The authors describe how a no-risk model is a thoughtful and important step that allows providers to participate and study the claims and data and identify the most effective and thoughtful use of resources, as well as identify appropriate prospective partners.
Yasmine Anouty, PharmD, et al, identify factors that are predictive of early death after chemotherapy administration within the last weeks of life. Identification of these factors is thought to assist in the creation of standardized assessments to guide clinical decision-making on whether to administer cancer-directed therapy near end of life vs palliative or comfort care.
