Peer review encourages physician compliance with evidence-based cancer treatment plans

September 29, 2016, University of Pittsburgh

Evidence-based treatment pathways implemented by UPMC 15 years ago to guide cancer care have become integral to ensuring that each patient receives the most up-to-date course of treatment specific to his or her cancer. That's the conclusion of a recent University of Pittsburgh Cancer Institute (UPCI) analysis showing the high physician compliance rate with the pathways—a standardization concept borrowed from the manufacturing sector.

The analysis, presented today at the American Society for Radiation Oncology (ASTRO) 2016 Annual Meeting in Boston, found that UPMC CancerCenter physicians nearly always complied with the standard, evidence-based treatment pathways or presented an acceptable alternative to a review panel of their peers.

"Research and clinical trials are continuously yielding new and better cancer treatments, but it can take time for treatment protocols to be updated, and, even then, physicians may be unfamiliar with rapid advances in treatment," said lead author Brian Gebhardt, M.D., a third-year resident in the UPCI Radiation Oncology Residency Program. "Our treatment management process—called Clinical Pathways —is updated as often as necessary to ensure that our patients receive the best care. We set treatment protocols according to national guidelines, published literature and institutional experience, and then evaluate each option based on efficacy, toxicity and cost, in that order."

UPMC CancerCenter physicians enter their treatment decisions into the online Clinical Pathways support tool that is integrated with patient electronic medical records. Sometimes for a specific cancer, there is only one type of treatment recommended, but often there is more than one evidence-backed option. If the physician wants to provide a treatment recommendation not compliant with the pathways, the tool launches a peer-review process that usually yields a ruling within two days.

Dr. Gebhardt and his colleagues evaluated 6,965 treatment decisions entered in 2015 across 22 UPMC CancerCenter sites and found that 91.3 percent followed the Clinical Pathways recommendation. In 605 decisions (the remaining 8.7 percent), the physician wanted to pursue a different treatment protocol than was recommended. Those cases were sent to peer review for evaluation. More than 99 percent were approved.

The reasons for an off-pathway treatment were: The patient was in poor health, and an aggressive approach was not warranted (53.2 percent); the patient was doing better than expected on standard treatment and wanted more aggressive treatment (17.1 percent); the financial burden of treatment was too great (1 percent); the patient refused standard treatment (13.8 percent); or the physician didn't agree with the Clinical Pathways-recommended treatment for some other reason (14.9 percent).

"Since less than 1 percent of the were ultimately rejected following peer review, we believe that we've hit upon a really positive, efficient method to widely disseminate the latest cancer treatment options throughout our UPMC CancerCenter sites," said Dr. Gebhardt. "The peer-review process is a strong way to encourage compliance and ensure consistent, high-quality care across a large network."

Explore further: Newer radiation technique has fewer side effects than traditional techniques for recurrent head and neck cancer

Related Stories

Newer radiation technique has fewer side effects than traditional techniques for recurrent head and neck cancer

September 28, 2016
When a patient's cancer comes back, he or she is often left with limited treatment options and higher odds of debilitating side effects. But a University of Pittsburgh Cancer Institute (UPCI) study presented today at the ...

Radiation therapy often underused for common type of non-Hodgkin lymphoma despite recommendations

October 21, 2015
Patients with an early-stage, indolent form of lymphoma are increasingly being given no treatment, chemotherapy or targeted drug therapies despite strong clinical evidence that shows radiation therapy can have better outcomes, ...

Targeted radiation, drug therapy combo less toxic for recurrent head, neck cancers

September 17, 2014
Patients with a recurrence of head and neck cancer who have previously received radiation treatment can be treated more quickly, safely and with fewer side effects with high doses of targeted radiation known as Stereotactic ...

A new tool helps remove the emotion around choosing the right approach for prostate cancer

July 19, 2016
Over 90 percent of prostate cancers are detected at a curable stage, with men more likely to die of other diseases than from this cancer. Although patients with localized, low-risk prostate cancer have treatment options: ...

Physician survey indicates positive experience, desire for formal guidelines to improve peer review

January 7, 2015
Peer review is a common practice in medicine to support the complementary, multidisciplinary team approach in healthcare. A 2013 survey of radiation oncologists indicates that they would like more formal recommendations and ...

Sampling method used for new breast cancer tests may lead to underestimation of risk

July 28, 2016
Not only is breast cancer more than one disease, but a single breast cancer tumor can vary within itself, a finding that University of Pittsburgh Cancer Institute (UPCI) researchers discovered has the potential to lead to ...

Recommended for you

Machine-learning algorithm used to identify specific types of brain tumors

March 15, 2018
An international team of researchers has used methylation fingerprinting data as input to a machine-learning algorithm to identify different types of brain tumors. In their paper published in the journal Nature, the team ...

Higher doses of radiation don't improve survival in prostate cancer

March 15, 2018
A new study shows that higher doses of radiation do not improve survival for many patients with prostate cancer, compared with the standard radiation treatment. The analysis, which included 104 radiation therapy oncology ...

Joint supplement speeds melanoma cell growth

March 15, 2018
Chondroitin sulfate, a dietary supplement taken to strengthen joints, can speed the growth of a type of melanoma, according to experiments conducted in cell culture and mouse models.

Improved capture of cancer cells in blood could help track disease

March 15, 2018
Tumor cells circulating throughout the body in blood vessels have long been feared as harbingers of metastasizing cancer - even though most free-floating cancer cells will not go on to establish a new tumor.

Area surrounding a tumor impacts how breast cancer cells grow

March 14, 2018
Cancer is typically thought of as a tumor that needs to be removed or an area that needs to be treated with radiation or chemotherapy. As a physicist and cancer researcher, Joe Gray, Ph.D., thinks differently.

Obesity may promote resistance to antiangiogenic therapy for breast cancer

March 14, 2018
Obesity—which is already known to reduce survival in several types of cancer—may explain the ineffectiveness of angiogenesis inhibitors in the treatment of breast cancer. A research team led by Massachusetts General Hospital ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.