On Friday, May 11, 2012, the National Comprehensive Cancer Network (NCCN) convened the NCCN Oncology Policy Summit - Equity in Cancer Care: Pathways, Protocols, and Guidelines in Washington, DC at the Washington Plaza Hotel. This invite-only Policy Summit was attended by patient advocates, providers (e.g., oncologists, oncology nurses, etc.), payors, pathways developers, and industry representatives within the oncology community. These key stakeholders gathered for a day-long session to discuss current issues surrounding the use and implementation of standardized treatment protocols, also known as pathways, including but not limited to, how much flexibility pathways should allow in care, how pathways impact public and private health insurance benefit design, what impact pathways may have on variation in care, and how data is used to determine pathways.
The quality of care received by patients often differs based on numerous factors, such as, treatment protocols that are being used in practice, health care setting, geographic location, access to medications, and insurance coverage. Recently, the issue of whether pathways can reduce costs without reducing the quality of care has been the subject of much debate, as has been their ability to reduce variance of care. As pathways are increasingly deployed in practice, they have a growing impact on how treatment is delivered and ultimately on health outcomes for patients. Identifying the benefits and limitations of clinical treatment guidelines and pathways to improve care for all patients was a major focus of the Summit.
The Summit featured two expert roundtable discussions covering the clinical, administrative, patient, payor, and pathway developer perspectives regarding the use and implementation of both guidelines and pathways, moderated by Clifford Goodman, PhD, of the Lewin Group, a Question & Answer session addressing the development of pathways, moderated by Lyn Fitzgerald, MJ, of NCCN, as well as several presentations to set the stage for the summit. The discussion from the Summit will culminate in the publication of a white paper on the use and implementation of pathways in oncology later this year.
Al Benson, III, MD, FACP, Professor of Medicine and Associate Director for Clinical Investigations at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, provided an overview regarding guidelines and pathways, including a description of the NCCN Clinical Guidelines in Oncology (NCCN Guidelines) development process and how guidelines and pathways are currently being used in practice. Dr. Benson highlighted the time-intensive nature and complexity of guideline development in the rapidly evolving oncology space.
J. Russell Hoverman, MD, PhD, Vice President of Quality Programs for Texas Oncology and Medical Director of Managed Care for US Oncology, and John Sprandio, MD, FACP, Chief of Medical Oncology and Hematology at Delaware County Memorial Hospital, both presented about their experiences implementing and using guidelines and pathways in the clinical setting. Issues related to value and quality of cancer care in the context of guidelines and pathways were highlighted.
The first expert roundtable panel addressed clinician, patient, and administrative issues related to the use and implementation of guidelines and pathways. Panelists representing these areas discussed how pathways are currently being used in oncology practice and the need for more data and education regarding their use for both patients and providers.
The second panel followed the Question & Answer session with pathways developers and explored variability in the design and implementation of pathways, including a discussion of incentives and barriers to their use in practice. The panel, moderator, and audience members discussed transparency of pathways development, their utility in clinical decision-making, and their future role in oncology.
Stakeholder engagement and dialogue through the course of the Summit validated the increasing role of guidelines and pathways in improving value and quality of care. It is important that the oncology community continue to work collaboratively to identify mechanisms for increasing the quality of care for people with cancer. On October 1, as a supplement to the September 2012 issue, JNCCN published the White Paper: "Equity in Cancer Care: Pathways, Protocols, and Guidelines" which examines the challenges faced by health care providers and other key stakeholders regarding the use of clinical pathways and guidelines in oncology practice in the United States.