A clinical pathways project to promote evidence-based medicine in a large community oncology practice

Abstract

6597 Background: Medical oncology therapy tends to vary widely due to a large number of drug choices and a wide array of reference sources for decision-making. It is assumed that this high variability reduces quality and efficient delivery of cancer care. We developed clinical pathways for common cancers in which we, after extensive review of seminal literature, distilled a succinct list of evidence- based regimens. We then instructed all physicians at KCCC (26 medical oncologists) to adhere to these pathways or write an exception to the pathway. Exceptions were reviewed by a practice peer-review committee before treatment was initiated. Methods: Included in this analysis is KCCC practice data on treatment choices for ALL patients who were started on treatment or had a change in treatment for breast cancer, non-small cell lung cancer, or colon cancer. All treatments required entry of patient information and staging information on a web-based pathway tool followed by selection of a pathway choice. If a physician preferred “off-pathway” treatment for his/her patient, then an exception sheet with an explanation for off-pathway therapy was submitted and reviewed before treatment. Data was collected from January 1, 2006 through October 31, 2006. The study endpoints were pathway adherence, pathway exception rate, and frequency of accrual to clinical trials. Results: Over a 10 month time period, there were 764, 624, and 326 patients treated for breast, non-small cell lung, and colon cancer, respectively. On-pathway treatment rates were 92.5%, 93.4% and 88.3%. Conversely, exceptions were utilized 7.5%, 6.6% and 11.7% of the time. Rate of accrual to clinical trials was 6.8%, 13.0% and 7.7% for breast, non-small cell lung and colon cancer. Conclusions: Strategies to support and enforce evidence-based medicine in a community based oncology practice can be successful in standardizing care, improving efficiencies, promoting clinical trial enrollment, and developing a practice profile. This pathway project is now being implemented throughout most of the US Oncology network. No significant financial relationships to disclose.