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[PODCAST] Ep 76: Improving Pathology Reports

February 7, 2022

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Precision medicine is increasingly critical to selecting the right treatment for patients with cancer, but pathology reporting can be lengthy, complex, and confusing—especially in this fast-paced molecular era.

According to Dr. Timothy C. Allen, one key to moving precision medicine forward lies in simplifying and standardizing pathology reports so patients can be better informed, understand their prognosis, and own the progress of their therapies. Hear how ACCC has conducted several analyses, surveys, and focus groups to pinpoint challenges as well as opportunities to improve pathology reports for both patients and providers.

Allen-TimothyTimothy Craig Allen, MD, JD, FCAP
Professor and Chair, Department of Pathology
The University of Mississippi Medical Center
Jackson, MI

“Traditionally...[pathology] reports have been built to diagnose in scientific medical terms...It behooves us as pathologists to be the physicians to our patients and to do what we can to clarify these very complex diagnoses and prognosis...It's important to try to use terms people can understand and be very standardized in that language."

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To learn more about this education program, please visit the Precision Medicine: Integration of Pathology with the Cancer Care Team webpage. This project is supported by AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly and Company, and Pfizer.


CANCER BUZZ: Welcome back to CANCER BUZZ. I'm your host, Summer Johnson. On this quick episode an ACCC project that aims to improve pathology reports for both clinicians and patients. Dr. Timothy Craig Allen is a professor and the Department Chair of Pathology at the University of Mississippi Medical Center. He also leads ACCC Advisory Committee on pathology. He says the key to moving precision medicine forward is simplifying and standardizing pathology reports.

Dr. Timothy Allen: No, my passion is my patients and my passion for me is my lung patients. And often lung cancer patients. I spent many years in my career when the diagnosis of lung cancer was the end of the road and there was little else could be done. Now we have molecular era, amazing therapies—we must get people tested. We must get them treated if they're actual markers of presence in their tumors or that the immunotherapies work, if their markers show it. But for that to occur, patients need to be better informed and own to some extent, if not, as fully as possible, the progress of their therapies and the progress of their prognosis by understanding just where they stay.

And I think frankly, all of us are afraid of the unknown, so bad things happen, but if we know what's going on, we can have a handle on that. Then people can put a game plan together, I think are able to tolerate cancers and things much better than if they're unsure that they don't know what's going on. Families don't either. Then people get angry. All that I think can be settled down a whole lot. If we just make it very clear to the patient and to families on occasion, just exactly where they stand with their tumors in a way that they can understand without having to go to medical school.

CANCER BUZZ: Dr. Allen, what are some of the challenges with the current format of pathology reports?

Dr. Timothy Allen: Well, I think that when we're putting together our pathology reports traditionally really historically these have been written for our colleagues who do the biopsies do their sections in surgeries, or are the treating physicians in oncology, for example, our hematology who are going to be treating the patient. And so, our reports are built to diagnose in scientific really medical terms and illustrate to our colleagues directions to go stages of disease, things like that, that help inform at a physician level, the diagnostic features and the prognostic and even therapeutic features.

And especially now that we've entered our new, not even that new anymore molecular era for me in lung cancer, which is my focus, but other cancers as well. We're seeing that there's a lot more material there in terms of prognostic and therapeutic biomarker studies for tumors. And these can be confusing even for our colleagues because it's such a fast-paced environment right now. So, imagine our patients are seeing these reports and they don't know what's going on, they'll call their oncologist or called her primary care physician who may not know either.

So, it behooves us as pathologists to be the physicians, to our patients, and do what we can to clarify these very complex diagnoses and prognoses in way that's not incorrect. We can't water it down so to speak. But to me, it's important to try to use, as best we can, terms that people can understand and be very standardized in that language. I also make a point not infrequently to make a note that the patient would like to see the case with me or would like to speak with me about the diagnosis.

Now I'm going to talk about treatments and prognosis and things. That's not my purview, but I'm happy to discuss the molecular features or the histologic features of a neoplasm to please call me or come by and be happy to show it to them or talk to them about it.

CANCER BUZZ: What needs to change to better utilize pathology reports in shared decision-making?

Dr. Timothy Allen: Well, I believe patients need to understand them. These can be very complicated reports, sometimes many pages long, and it can be distilled down into a diagnosis with various features, a stage of disease and some molecular diagnostic reporting on the one. To me, it's nice having one sort of summary or one box, and yes, the report can still go on for many pages, but I think that's really where the heart and soul of the report really is.

What we often have though, is a report that sort of scattered that is we have a diagnosis and then a little bit about the features perhaps in the stage. And then another page down the road in some small print, there'll be a molecular diagnostic findings. And another page over in small print, there'll be two more molecular diagnostic findings, all sort of buried in the verbiage of a report, which is like reading a contract, you know, either way. I don't think our patients often come away comfortable. They know exactly what's going on and they should know what's going on.  

So should their families appropriate because that's where decisions we made for therapy is for options. And they sometimes need to be a fairly quickly, and this is always done at a time of stress because by definition, everyone is stressed and rightly so. So these be as helpful as possible. I think that there are opportunities for us to engage in standardizing worrying and engage in tightening up on reports in a way that the patients can actually get something more from them than just sort of a confusion and fear as a dollar, the telephone to talk to their physicians.

CANCER BUZZ: So when you started this effort with ACCC, you really had the multidisciplinary team in mind.

Dr. Timothy Allen: Sometimes we can feel alone in life. And so I'm thinking these things and considering them and the folks at ACCR are exactly similarly placed. And so to be around colleagues of physician, non-physician, it doesn't matter. All of them I've worked with have been dedicated to the betterment of our patient care and to be around people for whom they see it that way and want to support—that really is heartwarming to me because, you know, we're all human beings. It's easy because we're all busy and hardworking.

It's easy to sit and do one's day's work and say, boy, I wish that was a little more reasonable for the patient, but then we get busy with something else and no one can act upon it. We're too busy as human nature. So find people who are dedicated to working and building a team to help streamline this so that all of us can be a little bit better. Educators and informers of our patients is a nice thing to have to be part of. For instance, really privileged to work with

CANCER BUZZ: For a deeper dive on what was discussed today. ACCC has published two white papers on the case for streamlining pathology reports. You can download those on the ACCC website or through the link in the show notes. Thank you for listening to CANCER BUZZ. Make sure to follow us on your favorite podcast app to get the next episode, as soon as it's published until then for the entire CANCER BUZZ team. This is Summer Johnson.

CANCER BUZZ is a resource of the Association of Community Cancer Centers (ACCC).


The views and opinions expressed herein are those of the author(s)/faculty member(s) and do not reflect the official policy or position of their employer(s) or the Association of Community Cancer Centers.