National Comprehensive Cancer Network

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NCCN Equity White Paper Published

Jessica DeMartino, PhD, Manager, Health Policy Programs

On October 1, as a supplement to the September 2012 issue, JNCCN — Journal of the National Comprehensive Cancer Network 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.

The quality of patient care varies based on numerous factors, such as health care setting, geographic location, access to medications, insurance coverage, and treatment protocols. Recently, much debate has surrounded the issue of whether the use of clinical pathways can reduce costs and inappropriate variability in care. As clinical treatment guidelines and pathways are increasingly deployed in oncology practice, they have a growing impact on the quality of treatment and how it is delivered. To fulfill the current need to discuss the use of pathways and clinical treatment guidelines in oncology and to address how patient care is impacted by their use, the National Comprehensive Cancer Network® (NCCN®) convened the NCCN Oncology Policy Summit – Equity in Cancer Care: Pathways, Protocols, and Guidelines in May 2012. The Summit was a forum to discuss key issues in the use and implementation of pathways, including how much flexibility pathways should allow in care, pathways' impact on public and private health insurance benefit design, the type of data used to select pathway regimens and protocols, and, ultimately, the impact pathways may have on variation in care. The use and implementation of clinical treatment guidelines in practice was also explored from a variety of perspectives.

The White Paper explores the use of guidelines and pathways in oncology and incorporates the dis­cussions and ideas that were raised at the NCCN Oncology Policy Summit. The White Paper details the practices of the major pathway companies and examines such issues as business models, uptake of pathways, incentives, transparency, and clinical integration of pathways, as well as pathways' impact on the pharmaceutical industry, patients, and payers. In addition, the White Paper highlights the limited availability of studies that evaluate pathways. The White Paper is available at