Closer Coordination, Better Outcomes
How the pathology-oncology care team can work together more closely to leverage the true power of precision therapies
Mark Kruzel | | 6 min read | Opinion
The first visit between a recently diagnosed cancer patient and their oncologist can be fraught with uncertainty. The patient has received life-altering news and may be scared and unsure about what happens next. That anxiety is only likely to worsen if the treating physician is not prepared with the information needed to recommend the most effective course of treatment.
This scenario is not uncommon for cancer patients and their oncologists. At the root are breakdowns in communication between the pathologist and the oncology care team, which can result in suboptimal use of targeted precision therapies – and potentially worse patient outcomes. Nearly 40 percent of men and women will be diagnosed with cancer at some point during their lifetimes, so large segments of the population may be affected by these issues (1) – issues that are likely to worsen because of delays in care that persist following the COVID-19 pandemic. A recently released health trends study conducted in the United States shows that, more than two years after the pandemic began, diagnoses of breast and prostate cancer – two of the leading causes of death by cancer in the US – continue to lag behind pre-pandemic levels. More people are living with undiagnosed cancers (2).
Bringing an accurate treatment plan to a patient’s first visit with their medical oncologist is vital in fighting the disease. If a physician is not fully armed with complete information and prepared to begin treatment, a patient can embark on a less effective care pathway with potentially negative health effects and wasted dollars on expensive but ineffectual therapies. In fact, patients whose cancer treatment is delayed by even one month have as much as a 13 percent higher risk of dying – a risk that rises the longer their treatment is stalled (3). And that’s why it is critical for the treating physician to have a full picture of patient information before the first visit begins. Yet, with so much going on behind the scenes in diagnostics and pathology – and with health systems under more pressure than ever before – how can each piece of a patient’s care pathway fall into place to make this possible?
The power of precision therapies
Closer pathology-oncology care team coordination is vital to share information, address issues, and fully benefit from the value of precision therapies. One of the tools clinicians have at their disposal to inform a patient’s care is the companion diagnostic, which helps match a patient to a specific therapy, by identifying if a patient’s tumor has a specific gene change or biomarker that can be targeted by a certain treatment. Often, a companion diagnostic can supplement a biopsy.
Teams like mine work alongside the hospital’s medical oncologist, treating physician, and diagnosing pathologist to develop care pathways that leverage precision therapies and help close the gap in time between cancer diagnosis and initiation of targeted treatment. This requires dedication and to be both timely and comprehensive. To repeat: a full picture of complete information must be available at the earliest possible time to help ensure the physician and patient make the right decisions along the care continuum.
In one instance, we created a pathway for a hospital customer who routinely ordered testing for diagnosing non-small cell lung cancer (NSCLC), and who was fielding testing to different providers. The hospital was taking as long as 3–4 weeks to get results back to oncology teams because of logistical issues, coordination, and miscommunications. When the results did arrive, they were in multiple reports that were organized differently and made the oncologist’s job more difficult.
We worked with the hospital to cut the time from the period between diagnosis and receiving results, so the treatment team could initiate therapy quicker. Previously, this health system would often start patients on general chemotherapy treatment while waiting for a full suite of results – an approach many hospitals and physicians use. Though treating cancer as soon as possible is ideal with the right treatment, embarking on the wrong treatment can worsen the patient’s outcome or care, bringing adverse effects to their health, and possibly wasting a hospital’s time and increasing costs. It is crucial to consider a targeted therapy and that means having the right insights.
The appropriate care pathway can facilitate coordination between oncologists, pathologists, and hospital staff to ensure the patient’s treatment plan is agreed upon at the time of diagnosis, reducing time to treatment with the goal of better outcomes. Despite this being a critical need in cancer care, many health systems struggle to meet that need.
The medical professionals involved must make a dedicated effort to prepare, review pain points together, and get the entire treatment team on the same page. Everyone – from pathologists to oncologists to lab coordinators – needs to talk to and work with one another, so that small steps, such as expediting testing and getting results compiled into one report, happen seamlessly.
Patient care can vastly improve by reviewing expectations, the patient’s chart, and the details of their case and treatment plan from the day the case is initiated. A simple discussion with the lab director and their team can change a patient’s entire course of care.
Ultimately, a health system relies on good communication – without it, negative consequences downstream are more likely. Beyond worse patient outcomes, there are also other matters, such as cost containment and reimbursement pressures, to consider. And with the costs of treating cancer in the US already high, we cannot afford to make mistakes.
It is hard to overstate the role of the pathologist in a cancer patient’s care. With precision medicine taking more of the spotlight as new cancer therapies and innovations debut, using enhanced diagnostics to uncover and grade cancer sooner will only grow in importance. Likewise, identifying targeted therapies can generate favorable outcomes for patients. But the pathologist can’t do it alone. Collaboration with the oncologist and other care team members is essential – and strong communication remains at the crux of it all.
In 2018, the Association of Community Cancer Centers surveyed over 600 physicians, administrators and laboratory staff members on the integration of pathology specialists with a treating cancer care team. While 78 percent of respondents reported that pathologists attend the majority of their organization’s tumor boards, only 14 percent stated that pathologists have one-on-one conversations with medical oncologists to discuss treatment recommendations (4).
Pathologists must collaborate with physicians on testing decisions, including exploring additional uncommon biomarkers. If health systems can help connect oncologists with local specialists to recommend treatments or refer patients for clinical trials, physicians can expect to see much improved outcomes. By implementing care pathways that cut the time between diagnosis and treatment, pathologists and other members of the care team will reduce waste and, most important of all, accelerate the initiation of the therapy most likely to be effective for the patient.
- National Cancer Institute, “Cancer Statistics” (2020). Available at https://www.cancer.gov/about-cancer/understanding/statistics
- Quest Diagnostics, “Breast and Prostate Cancer Diagnoses Still Lagging During Second Full Year of COVID-19 Pandemic, Quest Diagnostics Health Trends® Study Finds” (2022). Available at https://bit.ly/3npeSg8
- British Medical Journal, “Every month delayed in cancer treatment can raise risk of death by around 10%”. Available at https://bit.ly/40YrkBh
- Association of Community Cancer Centers, “Integration of Pathology in Oncology Care; Leadership Summit Proceedings” (2018). Available at https://bit.ly/3NxZJUl