Promoting Individualized Oncology Care Within Clinical Pathways
Key Takeaways
- While clinical pathways provide treatment guidelines and recommendations for oncology patients, practices should allow for deviations based on individual needs and preferences.
- Evaluating pathways through patient outcomes can show how off-pathway decisions reflect individualized care.
- Providers should consider biomarker testing, patient preferences, and affordability when developing and implementing clinical pathways.
At the Clinical Pathways Congress (CPC) 2026, panelists Edward Arrowsmith, MD, MPH, Victoria Handy, PharmD, BCOP, PMP, Alti Rahman, MHA, MBA, CSSBB, and Susan Sabo-Wagner, MSN, RN, OCN, NEA-BC, discussed how physician-led governance, patient-specific exceptions, and enhanced data integration could strengthen pathway programs.
Allowing Space for Pathway Deviation
The speakers described pathways as tools for translating evidence into usable treatment guidance. Programs aim to cover approximately 80% of commonly encountered situations while providing opportunity for cases requiring individualized decisions.
For example, pathway deviations are common among second-line therapies for diffuse large B-cell lymphoma (DLBCL). Treatments before chimeric antigen receptor T (CAR)-cell therapy may vary based on disease burden, insurance coverage, and treatment timing.
Improving Pathway Development in Oncology
The panel recommended a 6-month pilot program involving a utilization management organization with 1 payer across 8 states. Participating teams measure dose rounding and erythropoiesis-stimulating agent optimization without requiring 100% pathway adherence.
While artificial intelligence (AI) has potential applications in evidence synthesis, electronic health record integration, and outcomes assessment, the speakers emphasized the importance of clinician-led pathway governance. A partnership with companies like OpenEvidence was used as an example of how to potentially optimize utilization of network-specific pathway content and clinical trial data.
According to the panelists, biomarker data integration remains a challenge in pathway development. Rare mutations may still require molecular tumor board review, while resistance testing needs timely prompts.
In addition, real-world outcomes assessment remains in its infancy within oncology spaces. When developing and assessing pathways, meaningful outcomes should reflect patient needs and priorities.
Implications for Oncology Care
The discussion supports reviewing both adherence and the reasons for off-pathway treatment, then using those findings to refine pathways. Clinicians should consider individual factors such as biomarker testing, comorbidities, access barriers, and patient preferences when prescribing treatment.
The panelists envisioned how pathways could extend across the care continuum, from testing and treatment selection to supportive care and treatment discussions. Demonstrating patient benefit through contextualized real-world outcomes remains a central objective for future pathway development.
Reference
Arrowsmith E, Handy V, Rahman A, Sabo-Wagner S. Pathways in practice: measuring outcomes, adherence, and continuous improvement in complex systems. Presented at: Clinical Pathways Congress; November 10-11, 2026; Boston, MA.
