The rapid evolution of cancer treatments is pushing major oncology networks to revolutionize their clinical pathway systems, with some institutions now conducting reviews every two weeks to keep pace with emerging therapies and FDA approvals.
"Oncology moves way too fast to have a quarterly [P&T meeting]," explains Paul Chadwick, chief value and procurement officer at Florida Cancer Specialists & Research Institute (FCS). The institution has demonstrated remarkable agility, sometimes implementing NCCN guideline updates within hours of their release.
Network-Wide Collaboration and Implementation
OneOncology has established five specialized oncology disease groups to maintain current clinical pathways through what Lisa Raff, PharmD, BCPS, BCOP, describes as "a pretty organic process." The network aims for and largely achieves an 80% pathway adherence rate across its practices, spanning from Tennessee to California.
At Dana-Farber Cancer Institute, the pathway committee has developed innovative approaches to ensure balanced input. "We use slides in meetings to democratize the discussion," says David M. Jackman, MD, medical director for Clinical Pathways and New Business Initiatives, preventing the domination of discourse by trial investigators.
Managing Drug Shortages and Treatment Access
The recent cisplatin and carboplatin shortages have created unprecedented challenges for pathway committees. Nearly 70% of NCCN institutions reported shortages of these crucial medications in 2023, with potentially greater impact on rural practices.
The American Oncology Network (AON) has responded by establishing a dedicated drug shortages subcommittee. "Imagine we have to track all the drug shortages and then take action," notes Melody Chang, RPh, MBA, BCOP, vice president of Pharmacy Operations at AON. The committee focuses particularly on supporting rural practices through strategic drug allocation and providing guidance on substitutions and dose modifications.
Bridging the Gap with Payer Pathways
A significant challenge emerges from the disconnect between rapid clinical advances and slower-moving payer pathways. While leading cancer centers update their pathways bi-weekly, payer partners typically revise their policies annually. This lag creates tensions when physicians encounter promising new data at conferences before formal FDA approval or NCCN guideline inclusion.
Cost Considerations and Future Directions
Dana-Farber has taken a proactive stance on incorporating cost considerations into pathway decisions. "Somebody's got to be thinking about cost, and if we want a seat at that table, then it's got to be us," argues Jackman, emphasizing the importance of balancing clinical efficacy with economic factors.
The integration of clinical trials also plays a crucial role in pathway development. At FCS, disease leaders in various cancer types collaborate on protocol sharing and trial decisions, ensuring that research opportunities are appropriately incorporated into treatment pathways.
As oncology care continues to advance rapidly, these dynamic pathway systems serve multiple crucial functions: keeping clinicians updated on rare disease treatments, facilitating cost-effective therapy selection, and ensuring consistent quality care across diverse practice settings.
