A study presented at the American Society of Clinical Oncology (ASCO) Annual Meeting (May 29-31, 2020) demonstrated how standardized evidence-based clinical pathways can be used successfully across a large number of providers over a wide geographic range and can help increase clinical trial entry.
Evidence-based pathways have been integrated into the Aurora Health Care medical oncology workflow since November 2014. After 3 months of integration, compliance was high for all medical oncologists in the network across 19 satellite locations – all working with a common EHR. Eighty-five percent of patients were treated on-pathway as a result of integration.
James L Weese, MD, Aurora Health Care (Milwaukee, WI), and colleagues designed a study to determine the overall cost of treatment between patients with non-small cell lung cancer (NSCLC) treated on vs off pathway. Researchers also sought to determine whether on-pathway patients had a lower rate of ED use and unplanned admissions within 30 days of chemotherapy (as required in the new CMS directives).
A total of 407 patients with newly diagnosed NSCLC treated on pathway (including in clinical trials) and 93 treated off pathway from January 2017 through December 2018 were identified from the Aurora Health tumor registry. Researchers categorized patients into groups based on early diagnosis, advanced/curative disease, and advanced/non-curative disease. All patients undergoing treatment were ECOG 0-2 performance status.
Aurora Health’s data warehouse was consulted to determine the total charges of adjuvant medical oncology treatment for the patients. Data was also extracted for the same groups to determine the patients who sought ED evaluation or hospital admission within 30 days of chemotherapy treatment.
Results of the analysis showed that the mean cost for treating the on-pathway vs off-pathway groups was $104,436 and $183,717, respectively (P = .01). Additionally, Dr Weese and colleagues found that since implementation of pathways, clinical trial entry rose from 27 patients per year to 66 patients per year.
As for patients who sought ED evaluation or hospital admission within 30 days of chemotherapy treatment, rates were lower in the on-pathway group compared with the off-pathway group (25.8% vs 29.0%, respectively).
“Standardized usage of evidence-based pathways can be used successfully across a large number of providers over wide geography,” authors of the study concluded. “Adherence to pathways results in significant cost savings for each patient and significant rise in clinical trial entry.”—Zachary Bessette
