Coordination of Care Improves Patient-Reported Quality of Supportive Care Among Patients With Colorectal Cancer


Key Points

  • High proportions of patients were not asked about symptoms and were not offered instructions on how to deal with symptoms.
  • Coordination of care was associated with significantly increased likelihood of receiving wanted help for specific problems.

In a study reported in the Journal of Clinical Oncology, van Ryn et al assessed patient-reported quality of care among patients with colorectal cancer in the Veterans Affairs health-care system. The investigators found significant gaps in patient-centered quality of supportive care, but also found that coordination of care predicted receipt of wanted help for all symptoms independent of patient demographics or clinical characteristics.

Study Details

The study involved use of a patient-centered quality of colorectal cancer care questionnaire (PCQ) in patients with new diagnosis of colorectal cancer at any Veterans Health Administration medical center in 2008. The questionnaire asked whether patients have been asked by a doctor or nurse whether they have been having problems with bowel, fatigue, or pain problems; whether they talked with a doctor or nurse about such problems, problems with other symptoms, depression irrespective of who brought the topic up; whether they received instructions about what to do if bowel, fatigue, or pain problems started, got worse, or returned; and whether any doctor or nurse provided the help the patient wanted for specific problems. Of 1,749 eligible patients, 1,109 (63%) returned the questionnaire. 

Coordination of overall cancer care was assessed using a four-item instrument measuring how often a health-care provider was familiar with a patient’s medical history, was aware of changes in treatment that other providers recommended, and had all the information needed to make decisions about treatment, as well as how often the patient knew who to ask about health problems.

Gaps in Addressing Patient Problems

Overall, 73%, 69%, and 53% of patients reported being asked about bowel, pain, and fatigue problems, respectively, and 51% and 33% reported talking about other physical symptoms and depression, respectively, regardless of who brought up the topic. Only 54%, 46%, and 28% of patients reported receiving instructions regarding what to do if bowel, pain, and fatigue problems, respectively, started up, got worse, or recurred.

In analysis limited to patients who reported wanting or needing help with specific problems, receipt of wanted help from a doctor or nurse within the prior 6 months was reported by 71% of patients with bowel problems, 66% with pain, 41% with fatigue, 54% with other problems (eg, nausea, sore tongue), and 38% with depression (mood or emotions).

Factors Predicting Receipt of Wanted Help

A logistic regression analysis, including age, race/ethnicity, disease stage, surgery or chemotherapy within the prior year, and coordination of care was used to identify predictors of receipt of wanted help among patients who reported wanting or needing help with specific problems (P < .05 for all significant factors shown). In this analysis, both age 65 to 79 years (odds ratio [OR] = 0.64) and age ≥ 80 years (OR = 0.50) were associated with significantly reduced likelihood of receiving wanted help for depression compared with age < 65 years. Non-Hispanic white patients were significantly less likely than patients of other race/ethnicity to receive help for fatigue (OR = 0.47), with borderline reduced likelihood for bowel problems (OR = 0.62, P < .06) and depression (OR = 0.67, P < .06).

Compared with stage IV disease, likelihood of receiving wanted help was significantly reduced for bowel problems (OR = 0.43), pain (OR = 0. 31), fatigue (OR = 0.29), depression (OR = 0.54), and other symptoms (OR = 0.42) in patients with stage I disease; pain (OR = 0.56), fatigue (OR = 0.48), and other symptoms (OR  =  0.42) in those with stage II disease; and pain (OR  = 0.44), fatigue (OR = 0.41), and other symptoms (OR = 0.44) in those with stage III disease.

Having surgery within the prior year was associated with reduced likelihood of help with pain (OR = 0.55), fatigue (OR = 0.57), and other symptoms (OR = 0.61), whereas having chemotherapy within the last year was associated with significantly increased likelihood of help for bowel problems (OR = 2.93), pain (OR = 2.32), and other physical symptoms (OR = 2.11).

Coordination of care was associated with significantly greater likelihood of wanted help for bowel problems (OR = 1.71), pain (OR = 1.79), fatigue (OR = 1.55), and other symptoms (OR = 1.29).

The investigators concluded, “This study revealed substantial gaps in patient-centered quality of care [that would be] difficult to characterize through quality measurement relying on medical record review alone. It established the feasibility of collecting patient-reported quality measures. Improving quality measurement of supportive care and implementing patient-reported outcomes in quality-measurement systems are high priorities for improving the processes and outcomes of care for patients with cancer.”

Michelle van Ryn, PhD, MPH, of the Mayo Clinic, is the corresponding author for the Journal of Clinical Oncology article.

The study was supported by the Interagency Quality of Cancer Care Committee, Applied Research Branch, and National Cancer Institute, through an interagency agreement with the Veterans Health Administration.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.