The American Society of Clinical Oncology (ASCO) is redefining its role in cancer care. In a pair of presentations made at the Association of VA Hematology/Oncology (AVAHO) annual meeting, ASCO President Daniel F. Hayes, MD, FASCO, FACP, and Robin Zon, MD, FACP, FASCO, who chairs ASCO’s Pathways Task Force, each outlined key initiatives that promise to push the organization of more than 40,000 oncology care providers into new areas of research and care.
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Pathways
Responding to the burgeoning of clinical pathways for cancer care, ASCO stepped in to develop best practices and a better process for determining appropriate pathways. Concern over the lack of consensus on quality, efficiency, and transparency in developing pathways also spurred ASCO to action.
According to Dr. Zon, clinical pathways aims to improve efficient patient care based on evidence-based practices, optimize outcomes, and reduce variations and costs. “Pathways can promote high quality care,” Dr. Zon explained, “but they must be implemented responsibly. They are here to stay.”
The ASCO task force developed 9 recommendations for clinical pathways:
- A collaborative, national approach is necessary to remove administrative burdens.
- The process should be transparent and consistent, including its methodology.
- Pathways should address the full spectrum of cancer care from diagnosis to end of life.
- Pathways should promote the best evidence based care and be updated continuously.
- Patient variability and autonomy should be recognized.
- Pathways should increase efficiency and remove preauthorizations.
- Education, research, and access to clinical trials should be encouraged.
- A robust certification process is essential.
- Pathways developers should support research that examines how pathways impact patients.
Although the pathways currently have a more significant impact in private care settings, it is likely that truly evidence-based pathways can provide an important tool for oncology providers in the federal system.
TAPUR
The Targeted Agent and Profiling Utilization Registry (TAPUR) study is one of ASCO’s first forays into clinical trials and seeks to evaluate multiple the efficacy of precision medicine. Targeted therapies “should be more likely to help the patient,” asks Dr. Hayes, “but do they?” The trial is evaluating multiple molecularly guided therapies in a single master protocol with a common entry point for patients. TAPUR will include commercially available targeted drugs, but in different cancer types, ie, off label. The trial is supported by a number of pharmaceutical companies. For the trial, each tumor type-genomic variant-drug is a group with 19 patients per group. If 3 or fewer patients respond the group is stopped, but if at least 4 patients have a good overall response rate, 14 additional patients will be enrolled, with the prospect of growing further.
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Dr. Hayes also highlighted other key ASCO initiatives. The group is developing a value framework, which will provide an objective means for both patients and providers to assess the relative value for a specific patient of an intended therapy. Different patients may wish to differently weigh endpoints (overall survival [OS], progression-free survival, or response rate). The framework scores a drug based on its clinical benefits, toxicity, and cost among other factors. ASCO also is developing Cancer-LinQ, a data collection and storage system for oncology practices that consolidates data from electronic health records in a central database that can be