Edward Arrowsmith, MD, Tennesse Oncology, spoke with the Journal of Clinical Pathways about his role at OneOncology and what goes into their development of clinical pathways. He also shared what he is most anticipating at this year’s Community Oncology Conference.

Transcript:

Edward Arrowsmith, MD: I'm Dr Ted Arrowsmith, and I'm a medical oncologist with Tennessee Oncology practicing in Chattanooga. With Tennessee Oncology, I’m the executive vice president for therapuetics and the chair of the P&T committee. I'm also the medical director of pathways for OneOncology.

Can you briefly describe your role at OneOncology?

Dr Arrowsmith: So at OneOncology, I'm the medical director for pathways, which means I work very closely with the clinical team there with Dr Davey Daniel, the CMO, Lisa Raff, our head of pharmacy, and other pharmacists. And what kind of our mission is, is to help the providers throughout the OneOncology network give the right therapy to the right patient at the right time.

Can you provide an overview of the clinical pathways at OneOncology? What goes into creating them?

Dr Arrowsmith: At OneOncology we really see our pathways program as being part of an integrated whole to help our  physicians make the best decisions. So there's, I would say sort of two parts of the process. So one is creating the pathways and the main way that our pathways are created is through our disease groups.

So for all the common cancers we have a disease group made up of physicians at the practices in OneOncology. So, these are for instance, doctors with a special interest in lung cancer who get together quarterly or on an as-needed basis to review changes in the management of lung cancer. During those formal quarterly meetings, we have a structured process, so we review FDA approvals,  changes to NCCN guidelines, and data presented either at key meetings like ASCO or ESMO or published in the main oncology journals like the New England Journal of Medicine or the JCO. So we review all those updates and make changes to the pathways as appropriate based on the new data.

The other thing that I think is really great is that we occasionally make, usually not wholesale changes, but sometimes tweaks to the pathways in response to how things work kind of in the real world of our practices, where certain therapies in a sort of all comers real-world data set are more toxic than they are maybe in a small pilot clinical trial, and we're able to reflect that information in our pathways.

The other key thing of our pathway process is that we really consider the creation of the pathway PDF as just the beginning, kind of the first step in the pathways process. So based on the changes, we like to drive out education to providers. And then we have work with our OneOncology EMR vendor, Flatiron, on their tool, Flatiron Assist, to have sort of a customized instant of that point of care clinical decision support tool to get information to our providers when they're ordering treatment for cancer to guide them into pathway adherence, again, kind of right at the point of care.

How do you think this year's sessions at COA might impact the development of clinical pathways?

Dr Arrowsmith: Yeah, so I'm super excited for COA this year, and there are a number of great sessions coming up. I think the way that the sessions are most likely to change our pathways is one of the things we're really looking at for sort of our next generation of our pathways program, is incorporating things other than sort of strict kind of cancer clinical decisions into the pathway. So an example would be, there's what looks to be a really great session on genomics and one on minimal residual disease, and those type of molecular diagnostics is something that we're considering including in the pathways. The pathways, of course, already largely are based on results of molecular testing, particularly for first-line therapy of non–small cell lung cancer, but we're thinking of adding kind of some more guidance on when to do testing and how to do that testing and then are actively working on ways to give feedback to providers again kind of in the electronic chart on how to interpret those results.

So that's an example of where I'm looking forward to hearing those sessions and thinking about how we can integrate that into our program to help clinicians with the ever-increasing complexity of care.

What are you most looking forward to at the conference?

Dr Arrowsmith: Yeah, so again, I love attending CoA and think it's really, really one of the highlights of the year. I will say there's kind of a special session that I'm really looking forward to this year, which is that COA has started a relatively new program to reach out to oncology fellows around the country. So trainees who are learning about medical oncology and will either later this year or in the summer of 2025 become full-fledged practicing medical oncologists. And there are a couple sessions we have to talk to those young oncologists and to them advice and help them with decision-making.

So that's sort of separate from my roles in pathways. That's something I'm really looking forward to. There's an ever-increasing need for oncologists as the population ages and fortunately, as our treatments get better and patients live longer. So it's really important for us to talk to those young oncologists and help them plan for their future.