Clinical pathways in cancer care

The number of cancer survivors in the United States continues to increase. Concurrently, the focus of the U.S. health care system is shifting towards the value of care patients receive. To us in the cancer community, this means focusing on improving the quality of cancer care while also reining in the cost of care.

This issue is taking on increased significance. The National Cancer Institute estimates that medical costs for cancer were $125 billion in 2010, and that costs are projected to increase 39% by 2020, to a total of $173 billion per year. As a society we need to contend with the rising cost of care and make sure all cancer survivors will have access to the high quality cancer care they need.

As a result, new strategies are changing the way cancer care is delivered and paid for by Medicare and private health insurance plans. These strategies are generally well intentioned and aim to manage cost, but often lack transparency about how they are developed, what quality outcomes will be measured and what incentives they create for health care providers.

One example of a cancer payment system is “clinical pathways.” A clinical pathway is a plan of care the health care team is encouraged to follow when making treatment recommendations. Most clinical pathways are based on the results of clinical research and are therefore evidence-based treatment recommendations.

Government programs like Medicare and Medicaid as well as commercial insurance plans are increasingly looking to clinical pathways in an attempt to standardize cancer care in order to reduce costs and improve the quality of that care.

The Cancer Support Community has published a position paper on the use of cost-containment measures which includes clinical pathways. In terms of clinical pathways in particular, we feel that:

  1. Clinical pathways should be based on evidence.
  2. Clinical pathways should not interfere with the ability of the health care team to provide personalized medicine.
  3. Data used for determining clinical pathways should be transparent, to both the health care team and patients.
  4. Patients should be informed of all options available and the risks and benefits associated with each, including medical, psychosocial and financial side effects.
  5. Patients should be informed of financial or other incentives to the health care team for following clinical pathways.
  6. Social and emotional support, including distress screening and care planning should be a fundamental part of all comprehensive, quality cancer care regardless of the clinical pathway and especially when the health care team is receiving reimbursement for care management.

If you or a loved one has cancer, it is important to be educated and empowered when having discussions with your care team about treatment decisions. In addition to the points above, keep in mind these key points during your conversations:

  • Specifically ask to discuss multiple treatment options if they are available – options that are both on and off pathways.
  • For each treatment option ask:
    • What is the evidence supporting the treatment?
    • Does the treatment option meet my goals of therapy for medical effectiveness, side effects and quality of life?
    • What is the overall cost of each treatment option to both me and my insurance provider?
    • What is the financial incentive for the provider to follow a particular treatment plan?
    • Request a cancer care plan that includes social and emotional support, including distress screening and follow up care, if needed, as part of your care expectations.

Again, it is critical that people with cancer are empowered to be partners in treatment decision making. For more information about tools to help with these discussions, the Cancer Support Community has created Open to Options, a treatment decision counseling program designed to help you create a personalized list of questions to discuss with your health care team. For more information about Open to Options, please visit www.cancersupportcommunity.org/open2options or call 1-888-793-9355.


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