7014 Background: Clinical oncology pathways (COP) provide decision support and benchmarking against national standards. Some organizations provide financial incentives for using COP-recommended treatment (on pathway: OnP). Treatment (Rx) other than COP recommended Rx (off pathway: OffP) is appropriate for some cases. There are limited data on the appropriateness of OffP Rx. This study examines rates and reasons for OffP Rx in one cancer center. Methods: All systemic Rx decisions entered in the ClinicalPath COP from 10/1/18 - 9/30/19 were classified as OnP (including Rx on a clinical trial) or OffP and as adjuvant/neoadjuvant therapy (ADJ) or for metastatic cancer (MET). Oncologists must provide free text reasons for OffP Rx. Records of all OffP care were reviewed by a senior nurse-led team and physician to verify and classify OffP reasons. Cases without clear documentation were referred to the treating oncologist and/or multidisciplinary team for review. Justified OffP reasons (R1-6) were classified as: R1. Documented drug toxicity and/or treatment-limiting co-morbidity; R2. Prior treatment precluding pathway Rx; R3. New drug indication or molecular targeted therapy not in COP; R4. Continuation of Rx started prior to referral; R5. Other clearly documented and reviewed provider or multidisciplinary team rationale; and R6. Patient preference. Results: There were 2,997 COP treatment decisions for 2,389 patients. The OnP rate was higher for ADJ than for MET Rx (87% vs. 78%). Non-justified OffP care accounted for 1% of cases. 69% of OffP Rx was because of known drug toxicity, co-morbidity limiting therapy, prior therapy precluding COP choice, and new drug indications (Table). Conclusions: COPs provide decision support and practice benchmarking. Lower OnP rates for MET Rx likely reflect the nuances of Rx for advanced cancer. Most OffP care was justified and appropriate. Financial incentives that focus on the percentage of COP OnP care could paradoxically harm the quality of care, especially given the high percentage of OffP decisions for reasons of drug toxicity, co-morbidity and new drug indications. [Table: see text]
Measuring Risk Allocation of Tax Burden for Small and Micro Enterprises
