Clinical Pathways for Breast, Colon, and Rectal Cancers Improve Physician Adherence to Best Practices

Implementation of clinical pathways for breast, colon, and rectal cancers can help narrow the gap between evidence-based treatment guidelines and clinical practice, according to a new study. 

With research on newer, better methods of treatment being published so frequently, it can be difficult for institutions to ensure that physicians and other health care professionals are adhering to the most current, evidence-based methods of care. In a study published in the Journal of Cancer Research and Clinical Oncology, a team of Chinese researchers (Harbin Medical University, Heilongjiang, China) analyzed the effectiveness of using clinical pathways to improve the quality of care for patients with breast, colon, and rectal cancers.  

A total of 1768 patients were enrolled in the study: 971 with breast cancer; 394 with colon cancer; and 403 with rectal cancer. To evaluate the impact of clinical pathway implementation, patients with each type of cancer who were treated between January 1, 2012, and June 30, 2012 (before pathways were implemented into clinical practice), were compared with those treated between January 1, 2013, and June 1, 2013 (after pathways implementation). A third group of patients, comprised of those admitted and treated between January 1, 2014, and June 30, 2014, was compared with these two groups in order to evaluate the long-term effects of clinical pathway implementation.

Information about patient demographics, tumor characteristics, processes of care, and postoperative complications were obtained from  the patients’ medical records. Researchers selected evidence-based quality indicators (6 for breast cancer and 12 for colon or rectal cancer) as the basis of comparison between the groups. Measures were established independently by the research team and were intended to be dichotomous, indicting either compliance or non-compliance for each clinical technique or scenario. Baseline and endpoint analyses were conducted using various statistical models to evaluate any differences.

Results of the study showed that compliance with best practices for a number of different facets of care increased after pathways were introduced. For the care of patients with breast cancer, the uses of core biopsy, fine needle aspiration, and sentinel nodes biopsy were each improved significantly.

For the care of patients with colon cancer, use of rectal cancer diagnostic practices was significantly improved following pathway usage: preoperative evaluation of the invasion depth of tumors increased from 88.24% before pathway implementation to over 97% after pathway use. Compliance with total mesorectal excision treatment, surgical anastomosis, and lymph node resection increased significantly.

In addition to improving compliance with best-practice standards, the use of clinical pathways also significantly reduced the median length of hospital stay for patients with each disease state, indicating that adherence to evidence-based practices helped patients to recover more quickly. 

Meina Liu and coauthors concluded that implementing clinical pathways could have a positive effect on the quality of cancer care by reducing variation in clinical practice.—Sean McGuire

-----

Boa H, Yang F, Su S, et al. Evaluating the effect of clinical care pathways on quality of cancer care: analysis of breast, colon and rectal cancer pathways. [Published online ahead of print January 13, 2016]. J Cancer Res Clin Oncol. 2016. doi: 10.1007/s00432-015-2106-z.