Reflecting on Growth and Impact: Clinical Pathways in Cancer Care and Beyond
As 2023 comes to a close, I took the opportunity to reflect on the past years since our inception in 2015. Looking back at where we started, and seeing where we are today, we have seen tremendous growth and uptake of clinical pathways. What was once a mere sequencing of medical oncology treatment regimens is now becoming one of many tools needed to successfully navigate the complexity and challenges of value-based cancer care. It’s clear that since 2015, clinical pathways have become a topic of interest to a broader audience: the Journal reaches over 50 000 health care providers, but we know there are not 50 000 oncologists in the US. It is encouraging to see the growth in this area.
In this issue, one of our featured articles touches on the topic of social determinants of health (SDOH) in cancer care. The impact of SDOH has become a focus of cancer research, especially in advanced, metastatic disease. Specifically in metastatic prostate cancer (mPC), the authors point out that the impact of race has been extensively investigated; however, little is known regarding the impact of non-race SDOH factors on outcomes. The authors conducted a systematic literature review to evaluate the current evidence relating to SDOH and survival in mPC. Relatively few studies were found, with most studies reporting significant differences in survival by income, socioeconomic status, marital status, treatment facility type, insurance status, and location. Most studies reported no association between survival and education level. The authors concluded that disparities in mPC survival by SDOH beyond race remain, and further research is needed to better understand the reasons for these associations to improve survival for all patients with mPC.
Our next featured article comes from our broader audience in the UK. The NationalHealth Service provides comprehensive health care services to all individuals living in theUK. Primary care providers (PCPs) are the gatekeepers for nonemergent conditions, and they manage patients’ access to investigations and hospital specialists based on a patient’s clinical condition. To support this role, guidance and clinical pathways are available from national bodies such as the National Institute for Health and Care Excellence and the Medical Royal Colleges, but their interpretation and implementation is varied across the different health boards and regions within the UK. To ensure the application of the principle of prudent health care among PCPs, HealthPathways, a clinical information portal providing locally agreed management and referral advice on musculoskeletal radiological procedures at a single institution, was implemented in 2019. The goal was to improve the quality of care by reducing harm, waste, and variation. Results show a substantial reduction in the number of procedures, resulting in a savings of more than $470 000 USD per year, just from there duction in referrals from PCPs. Reductions in magnetic resonance imaging lumbar spine procedures were also reported from orthopedic consultants. The more appropriate utilization of scans by PCP and orthopedic consultants reduced wait times for patients with other medical conditions requiring scans, as the number of scans was reduced without a change in the overall capacity. There is no evidence that the reduced number of scans had any detrimental effect on patient outcomes. The authors concluded that the overall guidance and support to the PCP appears to be an effective way of improving the clinical management of patients based on clinical need.
Finally, the Journal of Clinical Pathways is always open to receiving your submissions highlighting your work and research throughout the year at jcponline.com. Have a safe holiday season, and we’ll see you next year.
