Cancer Care Pathways

Mark J. Krasna, MD

Videos - Pathways

One of the tools available to oncology providers in medical radiation and surgical oncology is the use of cancer care pathways. Pathways are a method of diminishing the variance in cancer care. In the case of chemotherapy infusion or in the case of radiation therapy, it is obvious that any path that would cause significant variation can actually increase complications and worsen patient outcomes.

Cancer care pathways are intended to minimize that variation, thus providing the best possible standardization and inevitably resulting in improved outcomes. In surgery, an excellent example, cancer care pathways are the management of patients after lung cancer surgery or esophageal cancer surgery.

Patients who have been treated according to guidelines and have adhered to pathways have been shown to have better outcomes after these major surgeries than patients who are not treated on pathways. Again, the issue of standardization and variance from standard care is what leads to these negative outcomes.

Although some treating physicians find pathways to be a challenge, in fact, the more we can adhere to pathways and minimize variation and the more we can adhere to proven guidelines, such as the NCCA Guidelines, the better the patient care will be, the better the outcome will be. Ultimately, I believe this kind of care is going to be recognized as quality cancer care by payers, and there will be incentives to providing this kind of care.

One obvious way to determine the benefit of pathways and the negative impact that variance has on cancer caregivers treating not on pathways is by following costs. Again, using the obvious examples of chemotherapy infusion or radiation, if a patient is being treated on a treatment plan that is not adhering to a standardized pathway, there’s risk that many treatments will be changed during the course of the therapy.

Changes in dosing, changes in schedule may result in negative outcomes or frequent return visits, whether to get repeat testing, or even visits to the emergency room or visits to the hospital for hospitalization as a result of complications from therapy.

Likewise, in the case of surgical oncology, variations from pathways will ultimately result in either increased use of technology, such as additional tools, additional instruments, additional devices that are necessary to deal with complications. Most importantly, in the case of surgery, increased length of stay.

By decreasing length of stay, by diminishing the variance by adhering to pathways, that, in itself, can be such a significant reduction in patient costs for the surgical oncology cases as to justify this as a quality incentive by payers or cancer centers.