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Using Clinical Pathways to Treat NSCLC


Edward Arrowsmith, MD, describes the value of using clinical pathways in NSCLC therapy and how they are used at his institution, including their multiple sites of care.

Edward Arrowsmith, MD: We think of 2 areas where pathways can improve the overall patient experience. One is quality, and the other is the creation of value. When it comes to quality, there are 2 different but related things that I think of. One is selecting the best drug for the patient. A clinician can follow the pathways, particularly in the increasingly complex landscape of a disease like non-small cell lung cancer, and choose the optimal therapy for the patient. The other, though, is standardization. In a lot of pathways, there are sometimes several therapies that appear clinically equivalent based on either head-to-head comparisons or the trials that look similar. Standardizing 1 of those regimens, particularly for intravenous therapy, can lead to improvement in quality, as the whole treatment team has experience with 1 way of treating a patient. Everyone's on board with the logistics, with the adverse events and patients properly educated and cared for. The second is value. If there are treatments that appear to have the same efficacy and adverse event profile, sometimes one of those will create more value for the patient or the health care system. Often, 1 has a lower cost of care or lower out-of-pocket expenses for patients. By having pathways, that's the type of thing that the OneOncology system, or other systems, can look into. It's unlikely that an individual clinician seeing a busy schedule of patients is going to have [that] top of mind. Those are the 2 key things for us with pathways for non-small cell lung cancer, improving quality and increasing value.

The pathways program at OneOncology is relatively new, and it's something that we're trying to improve all the time. Our basic idea, what we come back to again and again, is that we're trying to pool the clinical wisdom of the physicians across our practices. We come together, make decisions, and then try to push that knowledge back out to our physicians across the country. How that works is Lisa Raff, a pharmacist who leads our pathways in clinical teams, helps get together our key physicians from across the practices. We're broken down into disease-related groups. We have a lung cancer program that has representatives from all 13 practices of OneOncology. We discuss new data, existing data, and make decisions about pathways. [We] then try to get that information out to clinicians, both at the point of care and through educational programs.

The key stakeholders in OneOncology are the physicians in our practices. They're the main drivers of our pathway program. We're fortunate that we have a robust clinical team at OneOncology who are tracking both new approvals of drugs for non-small cell lung cancer and clinical trials for non-small cell lung cancer. We're following compounds or studies anticipating those results [months or years in advance], as well as data presented at our big conferences or published in peer review journals.

We have sites of care in diverse locations: urban, suburban, and rural, across the nation. We're seeing all types of patients and have all types of providers—some who have practices, almost exclusively lung cancer, and others who are seeing all types of hematology and oncology, eg, in a rural site where they may be the only oncologist within miles. We want to focus on providing optimal resources for all those physicians and patients. The scientific background is the same for everyone, but there are tweaks in how we want to present the data. It's different from someone who sees all lung cancer [patients] to someone who's seeing everything that comes in the door. How we try to educate and assist those people is a little different. The other is that a goal with the pathway program is not to have 100% of the patients following a pathway. We know that some patients, particularly those with a lot of comorbidities, may need some customization of their care.

This transcript has been edited for clarity.

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