Pathology in Precision Medicine: Collaborative Approaches to Optimize Care

The complexity of cancer care—diagnosing, staging, and treating a disease that is in flux over months or years at a time—demands an active multidisciplinary team who are not only experts in their respective fields, but are expert collaborators as well. Effective communication and coordination are part and parcel of multidisciplinary cancer care. As academic and community cancer programs and practices navigate new therapies, genetic variations, and complex workflows, new trends are emerging that can improve collaboration across care teams. One such trend is greater integration of pathologists into the multidisciplinary team and pathology’s evolving role in precision medicine.

On April 25, 2024, the Association of Cancer Care Centers (ACCC) hosted a LinkedIn Live event to spotlight pathologists as part of the multidisciplinary team. Pathology in Precision Medicine: Collaborative Approaches to Optimize Care—a broadcast produced as part of ACCC’s growing portfolio of comprehensive resources for Cancer Diagnostics—brought together a panel of experts for a lively discussion on how working jointly with pathology through each stage of the cancer care continuum can help guide treatments with greater precision and optimize collaboration and care coordination.

The panel included expert pathologists Carolyn Compton, MD, PhD, professor of Life Sciences at Arizona State University (ASU), medical director of ASU’s Biodesign Institute’s Clinical Testing Laboratory, and professor of Laboratory Medicine and Pathology at the Mayo Clinic College of Medicine and Science, and Lija Joseph, MD, chief of Pathology and medical director of Pathology and Laboratory Medicine at Lowell General Hospital. The session was moderated by Molly Kisiel, MSN, FNP-BC, director of Clinical Content at ACCC.

The Role of Pathology in the Multidisciplinary Team

While pathologists rarely interact or communicate directly with patients, they are one of the most critical members of the patient’s multidisciplinary care team. During the panel, Dr. Compton stressed the importance of understanding that pathologists play a dual role in a patient’s cancer care—communicating and consulting with the physician team on data derived from patient specimens as well as communicating with patients through the pathology report, sharing the importance and impact of this data analysis on the patient’s care.

“We are key to everything that happens in cancer care. They [patients] don’t see us, but we are in fact their physicians and are available to them at all times just as we are to our colleagues on the multidisciplinary team,” Dr. Compton said. According to Dr. Compton, the role of the pathologist is to accurately establish the diagnosis for the patient and in cancer care, this diagnostic assessment determines all downstream patient management. “It is absolutely critical that we get it right and that we communicate effectively with all members of the multidisciplinary team,” she said.

Optimizing Communication with Pathologists

According to Dr. Joseph, at Lowell General Hospital in Lowell, Massachusetts, pathologists have optimized their role on the multidisciplinary team by meeting directly with patients to understand their pathology report and cancer diagnosis. Established 5 years ago, this innovative program ensures that all pathology reports include a statement introducing pathologists as medical doctors on their team and inviting patients to contact the Pathology Department directly for questions or to learn more. The program also features a weekly pathology clinic offering patients the opportunity to view their tumor and learn about their diagnosis. Through this model, pathologists are brought into conversations with patients early, are better integrated in the multidisciplinary team, and can play a greater role in guiding treatment.

“Pathologists are the keepers of the tissue—and tissue is the issue,” Dr. Joseph said. “We are the ones who look through the microscope and decide if this is cancer or not, and if it is cancer, how can we help guide the treatment with all of the tools that are available for precision medicine.”

This level of pathology involvement can be particularly helpful in community care settings, where care teams may face numerous barriers. Because patients may not always receive care in a single location or hospital, access to a patient’s medical history or previous medical records may be unavailable. At Lowell General Hospital, where there is a large immigrant and refugee population, many patients do not have a primary care physician or health insurance coverage. This has occasionally resulted in incidental findings, making the pathologist’s role on the care team even more critical.

To Collaborate is to Communicate

Streamlined communication and collaboration can be easier to achieve at larger academic medical centers than community care settings. Pathologists and multidisciplinary physicians often practice at the same center and multidisciplinary tumor boards offer regular opportunities to collaborate on specific case studies. For example, Dr. Compton described how radiation and surgical oncologists often visit the Pathology Department to sit at the microscope with pathologists to understand the tumor better and exchange information. She also discussed how pathologists may be called to the operating room to give interoperative consultation in real time.

However, with the advent of precision medicine, the complexities of communicating results and collaborating on treatment plans has become tremendously challenging.

“The [precision medicine] tools are extraordinarily powerful; we can get information down to the molecular or even to the anatomic level, and we are working under a tsunami of data. Our challenge as pathologists is to analyze this data, to understand it not only in the context of the disease we are analyzing, but to understand it in the context of the patient, the patient’s genomic background, and the patient’s biology,” Dr. Compton explained. “So, this kind of integrative analysis cannot happen in a vacuum; we need our fellow clinicians, we need conversation and exchange of information and data to come to the very best management decisions.”

While the urgency of starting therapy can sometimes preclude effective communication, understanding that collaboration with pathologists can ensure greater treatment options for patients is critical. Beyond initial analysis of samples, pathologists can often identify additional opportunities for testing by evaluating how much tissue is available, can determine whether liquid biopsy can be conducted on peripheral blood samples, and collaborate with the clinical care team to coordinate care. This interdisciplinary collaboration can ensure that patient care is consistently informed by the most accurate and comprehensive data and contribute to improved outcomes for patients.

Click to view the full webinar Pathology in Precision Medicine: Collaborative Approaches to Optimize Care on LinkedIn and for more information on the Cancer Diagnostics education program, please visit the ACCC website.

The ACCC education program Cancer Diagnostics is supported by AstraZeneca, Amgen, Bristol Myers Squibb, Exact Sciences, Lilly Oncology, and Merck.