Can We Fill in the Gaps? Authoring Custom Oncology Pathways vs Surfacing NCCN Preferred Recommendations Alone

The use of clinical decision support (CDS) tools may help to optimize the delivery of value-based cancer care and reduce variations in treatment. Flat­iron Assist (FA) is an electronic health record (EHR)-embedded CDS tool that is locally customizable and designed to aid medical oncologists in selecting and documenting National Comprehensive Cancer Network (NCCN) Guideline–con­cordant, NCCN Preferred, and/or customized treatment regimens. The study aimed to compare the availability of NCCN Preferred recommendations to cus­tom preferred pathways in FA, and to assess provider concordance with the pre­ferred suggestions. This retrospective, observational, real-world study analyzed 16,722 orders for breast, non-small cell lung, and colon cancers over 11 months, placed at 12 US-based sites of care by 522 clinicians in hospital and community-based cancer clinics. Of the 13,140 orders placed at sites where NCCN Preferred was available, an NCCN Preferred option existed for 7,680 orders, resulting in 58.5% relative coverage for the clinical scenarios in scope. Of the 3,261 orders placed where a custom preferred pathway was available, a custom preferred op­tion existed for 2,320 orders, resulting in 71.1% relative coverage for the clinical scenarios in scope (rate ratio 1.22, 95% confidence interval 1.19-1.25; P < .001 fa­voring custom preferred pathways). When a preferred option was available, pro­viders’ selection rates were similar. The study highlights the opportunity for cus­tom preferred pathways to guide oncologists and provide clearer guidance in cases where NCCN Preferred is not available. FA’s design, with the ability to pro­vide a local preference, and the option to highlight treatment regimens based on efficacy, safety, and affordability, makes it a valuable tool for oncologists to navigate the complex treatment landscape. The study emphasizes the need for accessible and accurate information to ensure high-quality cancer care delivery.