Effective routine electronic symptom screening and use of evidence to improve cancer symptom management in Ontario, Canada.

e20507 Background: Improving symptom management is a critical component of high quality care. Cancer Care Ontario (CCO) is working to improve through a standardized approach to symptom screening and assessment that leverages electronic tools along the cancer journey. Methods: CCO has developed a web-based application that allows patients to report their symptoms using the Edmonton Symptom Assessment System (ESAS). ESAS is a validated screening tool that asks patients to rate the severity of nine common cancer symptoms. The use of ESAS promotes a common language among patients and providers and across care settings. To support clinicians in determining follow-up to scores, CCO has developed symptom management guides. The guides represent current evidence and best practices and are available in various formats to help the care team assess and manage a patient’s cancer-related symptoms. Results: Since the program’s introduction in 2007, over 1.6 million ESAS screens have been performed across the province. In November 2012, over 53% of all Regional Cancer Centre patients were screened representing over 23,000 patients and nearly 35,000 ESAS screens. Symptom assessments collected from 45,000 cancer patients revealed that 75% of patients reported fatigue as a concern, 57% reported anxiety and 53% reported pain. Patients have indicated that they value this approach. Results from a 2012 survey of 3,320 patients show that 93% thought that indicating their symptom severity is important as it helps their health care providers know how they are feeling. Evidence from chart audit reviews demonstrates that symptom screening is linked to higher rates of documented clinical interventions but further research is needed to analyze its impact on outcomes. Conclusions: Lessons learned include the importance of leadership at all levels, clinician engagement in change, point of care decision support tools and the importance of engaging patients in the management of their symptoms. Patients are overwhelmingly in support of this approach to cancer symptom screening and their involvement is critical to its expansion across all settings of care. </jats:p

Concordance with the ASCO Provisional Clinical Opinion on the integration of palliative care into standard oncology care in Ontario.

170 Background: In 2012, ASCO released a Provisional Clinical Opinion for patients with stage IV non-small cell lung cancer (NSCLC) and the need for integration of palliative care services concurrent with standard treatment from the time of diagnosis. To understand if this recommendation is being followed in Ontario, provincial administrative data was used to explore concordance. Methods: Various aspects of concordance were considered including: whether and when in the treatment trajectory patients received palliative care, and how much care was received. For Phase 1 of the analysis, a provincial database of outpatient cancer care was used to identify services received within Ontario’s regional cancer centers (RCCs) and select partner hospitals. The Ontario Cancer Registry and Staging databases were used to identify the patient cohort. The cohort included patients diagnosed with stage IV NSCLC between January 1, 2012 and December 31, 2013. Results: Phase 1 results indicate that 41% of patients received palliative and/or psychosocial oncology care at the RCC or partner hospital after diagnosis. Those receiving palliative care first received services an average of 148 days after diagnosis. See Table below for detailed results. Conclusions: A growing body of literature has identified the benefits of concurrent palliative care. Knowing whether these services are being provided for the NSCLC population is a promising start to understanding and improving the delivery of palliative care in Ontario. Initial results suggest that there is a need for quality improvement in this area. Future phases will expand the analysis to include services received in additional settings such as hospitals and community. [Table: see text] </jats:p