Abstract
BackgroundPathways are frequently used to improve care for cancer patients. However, there is little evidence about the effects of pathways used in oncological care. Therefore, we performed a systematic review and meta-analysis aiming to identify and synthesize existing literature on the effects of pathways in oncological care.MethodsAll patients diagnosed with cancer in primary and secondary/tertiary care whose treatment can be characterized as the strategy “care pathways” are included in this review. A systematic search in seven databases was conducted to gather evidence. Studies were screened by two independent reviewers. Study outcomes regarding patients, professionals, and system level were extracted from each study.ResultsOut of 13,847 search results, we selected 158 articles eligible for full text assessment. One hundred fifty studies were excluded and the remaining eight studies represented 4786 patients. Most studies were conducted in secondary/tertiary care. Length of stay (LOS) was the most common used indicator, and was reported in five studies. Meta-analysis based on subgroups showed an overall shorter LOS regarding gastric cancer (weighted mean difference (WMD)): − 2.75, CI: − 4.67 to − 0.83) and gynecological cancer (WMD: − 1.58, CI: − 2.10 to − 1.05). Costs were reported in six studies and most studies reported lower costs for pathway groups.ConclusionsDespite the differences between the included studies, we were able to present an evidence base for cancer care pathways performed in secondary/tertiary care regarding the positive effects of LOS in favor of cancer care pathways.Systematic review registrationPROSPERO CRD42017057592.
Highlights
Pathways are frequently used to improve care for cancer patients
By conducting this systematic review and meta-analysis, we aimed to present the available high evidence in a substantiated and concise way, in order to improve the current evidence base regarding the effects of oncological care pathways
Due to the different terminology used for cancer care pathway, we applied the definition of clinical pathways based on four operational pathway criteria: (1) multidisciplinary, (2) protocol or algorithm based, (3) evidence based or based on practice guidelines, and (4) aiming to standardize cancer care [12]
Summary
Pathways are frequently used to improve care for cancer patients. There is little evidence about the effects of pathways used in oncological care. We performed a systematic review and metaanalysis aiming to identify and synthesize existing literature on the effects of pathways in oncological care. Pathways aim to improve communication between clinicians and patients as well as patient satisfaction [3]. Care pathways are described to have a positive impact on quality of care, efficiency, and teamwork [4, 5]. Care pathways are frequently applied in cancer care, the evidence of its effects is often limited. A systematic review of the effects of pathways in cancer care is not available [7]
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