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Care Pathway Analysis to Inform the Earliest Stages of Technology Development: Scoping Oncological Indications in
Mirre Scholte1, Jan Heidkamp2, Gerjon Hannink2
1Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Imaging, Nijmegen, The Netherlands; Maastricht University Medical Centre+, Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht, The Netherlands.
Objectives:
Identifying unmet needs for innovative solutions across disease contexts is challenging but important for directing funding and research efforts and informing early-stage decisions during the innovation process. Our aim was to study the merits of care pathway analysis to scope disease contexts and guide the development of innovative devices. We used oncologic surgery as a case study, for which many intraoperative imaging techniques are under development.
Methods:
Care pathway analysis is a mapping process, which produces graphical maps of clinical pathways using important outcomes and subsequent consequences. We performed care pathway analyses for glioblastoma, breast, bladder, prostate, renal, pancreatic, and oral cavity cancer. Differences between a "perfect" care pathway and the current care pathway in terms of percentage of inadequate margins, associated recurrences, quality of life, and 5-year overall survival were calculated to determine unmet needs. Data from The Netherlands Cancer Registry and literature were used.
Results:
Care pathway analysis showed that highest percentages of inadequate margins were found in oral cavity cancer (72.5%), glioblastoma (48.7%), and pancreatic cancer (43.9%). Inadequate margins showed the strongest increase in recurrences in cancer of oral cavity, and bladder (absolute increases of 43.5% and 41.2%, respectively). Impact on survival was largest for bladder and oral cavity cancer with positive margins.
Conclusions:
Care pathway analysis provides overviews of current clinical paths in multiple indications. Disease contexts can be compared via effectiveness gaps that show the potential need for innovative solutions. This information can be used as basis for stakeholder involvement processes to prioritize care pathways in need of innovation.
Insights
Care pathway analysis identifies critical gaps in cancer care, particularly in oral cavity, glioblastoma, and pancreatic cancers. This method highlights unmet needs for innovative surgical devices to improve patient outcomes and survival rates.
Area of Science:
- Medical Devices
- Surgical Innovation
- Oncology
Background:
- Identifying unmet needs is crucial for directing research and funding in healthcare innovation.
- Oncologic surgery faces challenges in developing innovative solutions, with many intraoperative imaging techniques under development.
Purpose of the Study:
- To evaluate the utility of care pathway analysis in defining disease contexts and guiding the development of innovative surgical devices.
- To identify unmet needs in oncologic surgery using a case study approach.
Main Methods:
- Care pathway analysis was employed, mapping clinical pathways and identifying discrepancies between ideal and current care.
- Analyses were conducted for glioblastoma, breast, bladder, prostate, renal, pancreatic, and oral cavity cancers.
- Unmet needs were quantified by comparing inadequate margins, recurrence rates, quality of life, and survival between current and ideal pathways, using data from The Netherlands Cancer Registry and literature.
Main Results:
- Oral cavity cancer exhibited the highest percentage of inadequate margins (72.5%), followed by glioblastoma (48.7%) and pancreatic cancer (43.9%).
- Inadequate margins significantly increased recurrence rates in oral cavity and bladder cancers.
- Positive margins had the most substantial negative impact on survival in bladder and oral cavity cancers.
Conclusions:
- Care pathway analysis offers a comprehensive overview of clinical pathways across various cancer types.
- Effectiveness gaps identified through this analysis highlight areas with a strong need for innovative solutions.
- The findings can inform stakeholder engagement to prioritize care pathways requiring innovation.
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