This pilot study evaluated an electronic health record (EHR)-supported, guidelines-based care pathway designed to improve broad panel genetic testing among patients with metastatic prostate cancer (mPC) in a community urology practice. The intervention combined systematic identification of living patients with mPC diagnosed within the previous 12 months and workflow enhancements to facilitate ordering of germline and tumor-based next-generation sequencing. Over the 3-month pilot period, broad panel testing rates increased from 33.5% at baseline to 47.0%, 51.2%, and 49.0% at months 1, 2, and 3, respectively, representing statistically significant improvements relative to baseline. Despite growth in the overall mPC population, the gap between eligible and tested patients narrowed during the study period. Germline testing accounted for most testing orders. Feedback from study personnel indicated that analytics-supported patient identification and standardized workflows were feasible, practical, and helpful for integrating testing into routine care. Participants also noted that integration of clinical decision support tools within the EHR would be valuable for sustaining long-term use. Overall, the findings suggest that an EHR-supported, guideline-based care pathway can feasibly increase broad panel testing rates in community urology settings and may help improve adherence to testing recommendations for patients with mPC.
Within the US Department of Veterans Affairs (VA), prostate cancer is the most commonly diagnosed noncutaneous malignancy. The Prostate Cancer Clinical Pathways (PCCP) were established to equip providers with the expertise needed to treat all veterans with prostate cancer at a subject matter expert level. Since the launch of the PCCP in February 2021, there has been variability in provider documentation of PCCP use across the VA health care system. To increase the use of PCCP, a collaboration was formed between the National Surgery Office and the National Oncology Program to develop a Urology Prostate Cancer Note (UPCN). The UPCN serves as a standardized clinical note for urologists who incorporate PCCP. At the initial visit, PCCP are used to document the cancer diagnosis, staging, and treatment plan. They are subsequently documented only when the staging or treatment plan changes, or both. Since the UPCN deployment, 8570 notes have been written; however, the PCCP were documented in only 6671 of these notes. The UPCN accounted for approximately 16% of the total prostate cancer pathway documentation, including 17% on-pathway PCCP documentation and 9% off-pathway PCCP documentation. Combined use by oncology and urology staff showed that 14% of treatments were off-pathway and 86% were onpathway. Therefore, on-pathway treatment exceeding the goal of 80% compliance with the prostate cancer treatments outlined in the PCCP.
Cancer treatment decisions should be made by patients and their oncology care teams, informed uniquely by tumor biology, disease stage, prior therapy, comorbidities, and patient preferences—not constrained by coverage rules. Utilization-management approaches, traditionally associated with other therapeutic areas, are increasingly applied to medical-benefit oncology, leading to treatment delays, added administrative burden, and barriers to evidence-based care. This report describes how payer management in oncology is evolving, why the current environment is worsening, the impact to patients and practices, and the policy changes needed to protect timely access and physician-led decision making in cancer care.
Teclistamab and talquetamab are bispecific antibody (BsAb) therapies approved for relapsed/refractory multiple myeloma (RRMM). It is important to understand how practices evolve BsAb step-up dosing (SUD) in outpatient care models that improve patient access while ensuring safety. A qualitative interview was conducted with hematologists at Atrium Health Wake Forest Baptist Comprehensive Cancer Center to understand their processes and experiences with administering teclistamab/talquetamab SUD in an outpatient setting. Atrium Health hematologists used Hospital-at-Home (HAH) programs to administer outpatient SUD, thereby reducing health care burden and increasing access to these therapies. Patient eligibility for outpatient SUD was determined by presence of caregiver support, proximity to Atrium Health’s main campus, and clinical characteristics. Hematologists and HAH staff jointly work to monitor vitals, and HAH paramedics conduct home visits between step-up doses. Atrium Health hematologists developed adverse event management processes, including guidance for at-home medications, nurse triage, and emergency department protocols. These findings showed that outpatient SUD for teclistamab/talquetamab is feasible and can be safely implemented for selected patients with RRMM. This care model may serve as an example to inform the development of outpatient SUD programs at other centers.
Racial disparities in uterine cancer stem from biological, clinical, and socioeconomic factors, yet the impact of clinical pathways in mitigating these factors remains largely unexamined. Using Surveillance, Epidemiology, and End Results (SEER) data and propensity score matching, we analyzed uterine cancer cases to assess disparities between non-Hispanic (NH) Black and White patients in hysterectomy rates and overall survival (OS). In Cohort 1 (N = 133 839), 10 952 NH Black patients were matched 1:1 with 10 952 NH White patients; NH Black patients had lower hysterectomy rates and shorter median OS (114 vs 170 months, P < .001). In Cohort 2 (N = 59 516), 9314 NH Black patients were matched 1:1 with 9314 NH White patients. Similar disparities persisted, with NH Black patients showing lower hysterectomy rates, higher mortality (30.67% vs 23.15%, P < .001), and higher risk of death (HR, 1.41; 95% CI, 1.34-1.49). Moreover, NH White patients lived a median of 4.5 years longer than NH Black patients, who also had higher mortality risk. These findings suggest that equity-focused clinical pathways that standardize hysterectomy recommendations and address social determinants, along with real-time monitoring, may help reduce racial disparities in uterine cancer and improve care of NH Black patients.
