Provision of Comparative Clinical Evidence to Support Pathway Decision-Making
Introduction
In early 2019, the Pathways Task Force (PTF) created evidence tables to summarize primary literature used in evaluating therapies for inclusion in the Value Pathways powered by the National Comprehensive Cancer Network (NCCN). These tables comprehensively outlined clinical trial design, patient population, treatment arms, endpoints, and grade 3 or 4 adverse effects. Although not intended for cross-trial comparison, the tables served as reminders of previously reviewed and approved clinical data.
Beginning in early 2020, the tables were embedded at the point-of-care and published on the intranet for providers within the US Oncology Network (USON). In 2024, table content expanded to incorporate an advanced review of clinical trials, including evaluation of patient-reported outcomes and discontinuation rates, offering insights into the potential for informative censoring.
Materials and Methods
Evidence tables were embedded in iKnowMed (iKM), an electronic health record (EHR) used by more than 2700 providers at 600 care sites. The tables were also published on the USON intranet site for providers, pharmacists, and other clinical staff. Monthly access metrics tracked unique users, inter-month repeated users, and the total number of hits for each posted location. A year-over-year analysis was conducted, focusing on the most recent 18-month period.
Results
Since its implementation in 2020, 18 329 users have accessed the evidence tables—8749 via iKM and 9580 on the intranet—with a total of 65 630 hits. In 2020, use of the iKM-linked tables outpaced intranet access by a 2.17:1 ratio. As oncology treatment complexity increased, so did the demand for direct access on the intranet. By 2025, the trend reversed to the current access ratio of 0.27:1 (iKM to intranet).
Over the past 18 months, although average monthly iKM usage remained stable, the number of inter-month repeated users increased by 130%. Compared with the prior 3-year period, intranet hits increased 14.6-fold, unique users increased 6-fold, and repeated users rose by 138%.
Conclusion
Originally developed to support the PTF’s evaluation process within the Value Pathways powered by the NCCN program, the evidence tables have become a widely used resource among USON providers. Embedding the tables in both iKM and the intranet enabled broader access to comparative efficacy and toxicity data at the point of care.
As oncology care advanced in both the rate of approvals and treatment complexity, table usage also increased, especially via the intranet. The inclusion of patient-reported outcomes and expanded clinical trial assessments has further increased engagement. These findings support the continued integration of real-world evidence tools to inform decision-making and improve workflow efficiency in oncology practice.
