Measuring Patient-Reported Outcomes to Improve Cancer Care in Canada: An Analysis of Provincial Survey Data

Abstract

Patient-reported outcomes measures (proms) are an important component of the shift from disease-centred to person-centred care. In oncology, proms describe the effects of cancer and its treatment from the patient perspective and ideally enable patients to communicate to their providers the physical symptoms and psychosocial concerns that are most relevant to them. The Edmonton Symptom Assessment System-revised (esas-r) is a commonly used and validated tool in Canada to assess symptoms related to cancer. Here, we describe the extent to which patient-reported outcome programs have been implemented in Canada and the severity of symptoms causing distress for patients with cancer. As of April 2017, 8 of 10 provinces had implemented the esas-r to assess patient-reported outcomes. Data capture methods, the proportion of cancer treatment sites that have implemented the esas-r, and the time and frequency of screening vary from province to province. From October 2016 to March 2017 in the 8 reporting provinces, 88.0% of cancer patients were screened for symptoms. Of patients who reported having symptoms, 44.3% reported depression, with 15.5% reporting moderate-to-high levels; 50.0% reported pain, with 18.6% reporting moderate-to-high levels; 56.2% reported anxiety, with 20.4% reporting moderate-to-high levels; and 75.1% reported fatigue, with 34.4% reporting moderate-to-high levels. There are some notable areas in which the implementation of proms could be improved in Canada. Findings point to a need to increase the number of cancer treatment sites that screen all patients for symptoms; to standardize when and how frequently patients are screened across the country; to screen patients for symptoms during all phases of their cancer journey, not just during treatment; and to assess whether giving cancer care providers real-time patient-reported outcomes data has led to appropriate interventions that reduce the symptom burden and improve patient outcomes. Continued measurement and reporting at the system level will allow for a better understanding of progress in proms activity over time and of the areas in which targeted quality improvement efforts could ensure that patient symptoms and concerns are being addressed.

Patient-reported outcome measures obtained via E-Health tools ease the assessment burden and encourage patient participation in cancer care (PaCC Study)

“…This approach can improve efficiency, making it easier to integrate required screening and assessments into the clinical routine. Furthermore, E-health tools potentiate early identification and provide a more dynamic approach to patient-centered care by enabling and encouraging active patient participation [2,3]. In fact, Chrischiles et al found that among the general population, high-frequency users had higher odds of recognizing symptoms and adverse effects among users ≥ 65 years of age [4].…”

A Prospective Outcomes Pilot Evaluation of Inspire Now: A Program for People with Lung Cancer

“…The benefit of PROMs is well-established 20 - 22 as they allow patients to better communicate their physical and psychosocial symptoms, and promote a shift from disease-centered care to person-centered care. 23 FACT-L is commonly used in research studies and provides a rigorous description of overall quality of life (QoL) across several domains that mirrors problems commonly experienced by people with lung cancer. 24 The MYCaW was developed for use in people with cancer and is most often used in integrative care centres.…”

Implementing Practice Guides to Improve Cancer Symptom Management in Homecare: A Comparative Case Study

“…23 Current in-person practice in oncology programs using the Edmonton Symptom Assessment Scale (ESAS) and related practice guidelines including COSTaRS is to target clients scoring 4 or higher out of 10 as an indicator of further assessment required. 25,26 Therefore, we used this as the trigger for conducting a COSTaRS symptom assessment. If there were multiple symptoms, nurses started with the highest score or used their judgment as described earlier.…”