Stephen Edge, MD, FACS, FASCO

Decisions to Stray From Clinical Oncology Pathways Are Often Justified, Roswell Park Analysis Shows

Financial incentives for adhering strictly to pathways could be detrimental, ASCO 2020 study suggests

  • Team reviewed nearly 3,000 decisions regarding treatment of cancer patients
  • In 84% of instances, care decisions accorded with pathway-recommended plan
  • Reasons for going off pathway include drug toxicity, conflicting prior therapy 

BUFFALO, N.Y. — Clinical oncology pathways are an important tool, helping cancer care providers and their patients to zero in on the most appropriate care plan. But a treating professional’s decision to depart from the recommendations of these decision-support resources may be well-founded and in the patient’s best interests, research being presented at the American Society of Clinical Oncology (ASCO) 2020 virtual meeting shows. 

The new review from Roswell Park Comprehensive Cancer Center of nearly 3,000 care decisions made in the course of caring for more than 2,300 patients is one of the first analyses of the appropriateness of off-pathway cancer care.

“Clinical pathways are intended to standardize care where it’s appropriate to standardize it,” says surgical oncologist Stephen Edge, MD, FACS, FASCO, Vice President for Healthcare Outcomes and Policy at Roswell Park and lead author on this research.

“They serve a tremendously valuable function in that they distill vast amounts of relevant information into evidence-based recommendations. This can help doctors keep up with the latest advances and help patients understand their treatments, comfortable in the assurance that they are receiving the best care,” he notes. “But pathways are not a cookbook, not a recipe to follow, and incentivizing strict adherence to pathways could lead to worse care.”

In their analysis of 2,997 treatment decisions for 2,389 patients, the Roswell Park team determined that the vast majority of care — 84% — did accord with pathway recommendations. The reviewers note that the on-pathways rate was higher in cases involving adjuvant/neoadjuvant therapy than in care of patients with metastatic cancer — 87% vs. 78% — reflecting the nuances of caring for patients with advanced cancer.

Some of the most common reasons practitioners recommended a course of action that departed from the pathway were known drug toxicity, co-morbidity limiting therapy, prior therapy that precluded the pathway-recommended option and new drug indications.

Collaborators included Mishellene McKinney-Bost, RN, James Thompson, MD, Grace Dy, MD, and Boris Kuvshinoff, MD, MBA, all of Roswell Park.

The study, Abstract 7014, will be displayed on board 286 in the Health Services Research and Quality Improvement virtual poster session and discussed in a poster discussion session today, May 29.

Additionally, two Roswell Park faculty leaders were invited to serve as discussants for sessions during the meeting:

  • Grace Dy , MD, Chief of Thoracic Oncology, will be the discussant for “New Antibodies, New Targets: Are We Making Progress” within the Lung Cancer—Non-Small Cell Metastatic oral abstract session. Registered, logged-in attendees can access the presentation here.
  • Philip McCarthy, MD, Director of the Transplant & Cellular Therapy Center, will be the discussant for the session “New Kids on the Block (NKOTB): Novel Therapies in Multiple Myeloma” within the Hematologic Malignancies/Plasma Cell Dyscrasia oral abstract session. Registered, logged-in attendees can access the presentation here


Roswell Park Comprehensive Cancer Center is a community united by the drive to eliminate cancer’s grip on humanity by unlocking its secrets through personalized approaches and unleashing the healing power of hope. Founded by Dr. Roswell Park in 1898, it is the only National Cancer Institute-designated comprehensive cancer center in Upstate New York. Learn more at, or contact us at 1-800-ROSWELL (1-800-767-9355) or

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