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Clinical pathways in chronic lymphocytic leukemia: Challenges and solutions

January 2017

Dr. Chadi Nabhan

Vice President and Chief Medical Officer
Cardinal Health Specialty Solutions

Dr. Chadi Nabhan, MD, MBA, FACP, has more than 17 years of clinical practice experience and is board certified in Internal Medicine, Medical Oncology and Hematology. He has broad healthcare management expertise in a variety of settings, including community, hospital-based and academic centers and has significant experience in clinical research, quality metrics, benchmarking and managed care. 

Progress in prognosticating and treating patients with chronic lymphocytic leukemia (CLL) has led to deeper remissions, longer disease-free intervals and better overall patient survival.


These advances are tempered by the challenges oncologists face in a value-based care era that rewards quality and cost-effectiveness. While these advances show promise, their cost, unique side effects and the chronic nature of the disease makes building and maintaining pathways for CLL challenging.

Core principles of clinical pathway design define the “most effective” therapy as the one that is least toxic and most effective. If toxicity and efficacy are comparable, the lower cost treatment is recommended. However, in a disease where expensive therapies have led to patients living longer, the traditional model of clinical pathway development must be re-evaluated.

In this article from the American Journal of Hematology, Dr. Chadi Nabhan, Vice President and Chief Medical Officer for Cardinal Health Specialty Solutions, explains why data from clinical practice (for both toxicity and efficacy) and patient-reported outcomes must be incorporated into clinical pathway development for CLL.

Incorporating clinical pathways

Dr. Nabhan recently addressed the topic of incorporating clinical pathways into CLL and other hematologic malignancies at the American Society of Hematology (ASH) annual meeting.