In a single-institution study reported in JCO Oncology Practice, Nadler et al describe the development of an intervention at Princess Margaret Cancer Centre, Toronto, that succeeded in increasing referrals of patients with gastrointestinal cancer to a cancer rehabilitation program.

As stated by the investigators, “People with cancer are at risk for initial, late, and long-term effects of cancer and its treatments. Cancer rehabilitation focuses on prevention/treatment of these sequelae and optimization of physical, social, and vocational functioning. Our center has a multidisciplinary impairment-driven outpatient cancer rehabilitation program, but referrals of patients with gastrointestinal cancer were low.”

Study Details

A rapid cycle improvement approach was used to improve referrals of patients with gastrointestinal cancer to the cancer rehabilitation program. Barriers to cancer rehabilitation referral, identified through literature review and interviews of clinicians specializing in gastrointestinal cancer, included knowledge of cancer rehabilitation program existence, awareness of the referral process, time, and lack of cancer rehabilitation program exposure. The initiative to address barriers included Plan-Do-Study-Act (PDSA) cycles carried out every 2 months from January to December 2019. The PDSA cycles included cancer rehabilitation program advertisement, a presentation to gastrointestinal cancer–focused staff, nurse-led patient identification, patient-facing posters, and clinician thank-you emails from the investigators. Rates of referrals during the intervention in 2019 were compared with those during 2018.

Key Findings

Analysis of results using a p-chart with the total number of gastrointestinal outpatient visits per month as the denominator and cancer rehabilitation referrals as the numerator showed a 100% relative increase in referral rate from 0.002 in 2018 to 0.004 in 2019.

The proportion of referrals made by oncologists, rather than supportive care clinicians, increased from 51% in 2018 to 75% in 2019.

The absolute percentage of referrals for patients with gastrointestinal cancer among total patient referrals increased from 4% (51 of 1,199 referrals) in 2018 to 6% (81 of 1,334 referrals) in 2019.

No marked change in number of inappropriate referrals (2 in 2018 and 3 in 2019) and no marked change in cancer rehabilitation program no-shows/cancellations (9% in 2018 and 7% in 2019) were observed.

The investigators concluded, “Through PDSA cycles, we improved the total number of patients with gastrointestinal cancer and percentage referred by an oncologist to a cancer rehabilitation program. Future work will assess sustainability.”

Michelle B. Nadler, MD, of Princess Margaret Cancer Centre, Toronto, is the corresponding author for the JCO Oncology Practice article.

Disclosure: For full disclosures of the study authors, visit ascopubs.org.