A review of patient self-reported symptom data with a focus on pain.

Abstract

79 Background: Cancer Treatment Centers of America, Inc (CTCA) is a national network of five hospitals that specialize in the treatment of patients fighting complex or advanced-stage cancer. The Symptom Inventory Tool (SIT) is an assessment tool that captures the patients’ perceived symptom burden. It includes the scientifically validated M. D. Anderson Symptom Inventory core items and is supplemented by CTCA clinician interested ‘custom 8’ (constipation, swelling, mouth soreness, bleeding, sexual interest, family, hope and Quality of Life). Methods: A baseline assessment is administered to new patients. Follow ups are assessed every 21 days or greater. The patients’ answers range from 0 to 10 and a score of 8 or higher was considered a severe symptom. A change of 2 points from baseline to 2nd follow up assessment is considered a clinically significant. Patients who had a severe pain score on a baseline assessment between April 2013 and March 2014 were closely followed. Results: There were 6,836 baseline assessments and 2,961 2nd follow up assessments between April 2013 and March 2014. Fatigue and sleep were the most reported symptoms while bleeding, mouth sores and vomiting were the least reported. Most of the patients had a decrease or stayed unchanged in their symptom scores. The patients who had a significant increase in symptoms at follow up ranged from 6% for bleeding to 28% for fatigue. There were 462 patients who reported severe pain on baseline assessment. Of the 462 patients, 295 patients (63.8%) had improvement in severity by the follow up assessment. After chart review, 447 patients (96.7%) had either improvement by follow up assessment (63.8%) or documented pain intervention (32.9%). Interventions included change to pain medication, addition of a Medtronic pain pump, physical therapy, palliative radiation therapy, cold laser therapy, and integrative therapies such as acupuncture, chiropractic care and massage therapy Conclusions: The SIT was successful in identifying symptom burden and interference with life issues in oncology patients. It has become an integral part of patient care at CTCA in providing exceptional pain and symptom management through the disease process creating visibility and focus.