Improving the quality of care and decreasing the morbidity of patients with lung cancer through routine symptom screening

Abstract

9621 Background: The morbidity of patients with cancer would be significantly reduced if they received optimal symptom management. This requires early identification of the symptoms, comprehensive assessment and monitoring over time. Cancer Care Ontario implemented a quality improvement project for all lung cancer patients seen in 12 regional cancer centers (RCC). Aims of the project included: 90% of all lung cancer patients screened for symptom intensity; a comprehensive assessment done if scores ≥ 4/10 for pain and dyspnea or ≥ 5/10 for depression; and pain and dyspnea severity ≤ 6/10 within 72 hours of finding “severe” scores (≥ 7/10). Methods: All lung cancer patients seen in the 12 RCCs and community were asked to complete an Edmonton Symptom Assessment System (ESAS) on each visit. Data was collected and reported monthly to measure progress including: use of ESAS and whether pain and dyspnea severity were ≤ 6 within 72 hours. Monthly chart audits were completed to assess whether a comprehensive assessment was completed for scores ≥ 4 for pain and dyspnea and ≥ 5 for depression. Results: Over 10 months there was an increase in the number of ESASs completed per month (10,354). Provincially the percentage of lung cancer patients in RCCs screened at least once per month with ESAS increased from 3.5% to 47% over 10 months, with 2 regions reaching the aim of 90% of patients screened. The percentage with moderate severity (4–6) was 20.6% (pain), 16.0% (dyspnea), 16.4% (depression) and severe (7–10) was 11.7%, 9.9%, and 6.5%. The percentage of no evidence of comprehensive assessment was 27% (pain), 39% (dyspnea) and 50% (depression). Analysis of 4,466 ESASs showed that when a subsequent ESAS assessment was completed within 72 hours of a result of ≥ 7 for pain or dyspnea (170 pain and 124 dyspnea assessments), 69% of pain and 31% of dyspnea assessments decreased to ≤ 6. Conclusions: Uncontrolled symptoms continue to cause significant morbidity for cancer patients. Routine symptom screening is possible and provides the opportunity for improved patient care and aggregate data for performance indicators to make process and human resource improvements at a regional level. No significant financial relationships to disclose.