Driving Evidence-Based Standardization of Care within a Framework of Personalized Medicine

Cancer care in the United States faces a number of key challenges today that are causing payers, referring physicians, and patients alike to question the value of the care, in terms of both outcomes and costs. New technologies in the form of pharmaceuticals and biologics, prognostic tests, and new radiation therapy tools and techniques offer the promise of improved outcomes, but their cost-effectiveness is often unclear. Oncologists themselves are caught in the middle, as they are the prescribers of such technologies and the entity billing for such services but have only limited ability to influence the pricing models for these services. Finally, as oncology care becomes more complex because of increased understanding of the pathogenesis of the many subtypes of cancer, the community-based oncologist who cares for patients with all cancer subtypes is confronted with maintaining an up-to-date knowledge base that is expanding rapidly. Although no single solution for these issues exists in oncology today, the experience at the University of Pittsburgh Medical Center has demonstrated that a clinical pathways program can reduce unwarranted variability in both treatment and outcomes, drive adherence to evidence-based medicine, and, in the process, reduce the growth rate in the total costs of cancer care.