Lower Patient Ratings of Physician Communication Are Associated with Greater Unmet Need for Symptom Management in Lung and Colorectal Cancer Patients (FR435-C)

153 Background: Symptoms are prevalent among cancer patients, but little is known about how often patients’ needs for symptom management are met or what factors are associated with unmet needs. Methods: Patients with lung and colorectal cancer from the diverse nationally-representative Cancer Care Outcomes Research and Surveillance cohort completed a survey approximately 4-6 months following diagnosis (n=5,422). We estimated the prevalence of unmet needs for symptom management during the 4 weeks prior to the survey, with unmet needs defined as patients reporting that they wanted but did not receive help for at least one symptom (pain, fatigue, depression, nausea/vomiting, cough, dyspnea, diarrhea). Using a pre-specified conceptual model, we identified patient factors associated with unmet need using multivariable logistic regression with random effects (fixed slopes model with random intercepts for each Primary Data Collection Research site). We also tested whether clinical visits before the interview were associated with unmet need. Results: Overall, 15% (791/5,422) of patients had at least one unmet need for symptom management. Adjusting for patient sociodemographic and clinical factors, African American race, being uninsured or poor, having lung cancer versus colorectal cancer, early- vs. late-stage disease, and the presence of moderate to severe symptoms were associated with greater unmet need (all p<.05). Patients who rated their physicians communication score below 80 (on 1-100 scale) had adjusted rates of unmet need that were more than twice those of patients who rated their physicians with a perfect communication score (23.0% v. 10.0%, OR=3.05, p<0.001). Neither visits with specialty physicians (medical oncology, radiation oncology, surgery, or primary care) nor the total number of outpatient visits in the 28 days before the interview were associated with unmet need (all p>.05). Conclusions: A significant percentage of newly diagnosed lung and colorectal cancer patients report unmet needs for symptom management. Interventions to improve symptom management should consider the importance of physician communication to the experience of disease.

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Unmet Need for Symptom Management in a Newly Diagnosed Population of Lung and Colorectal Cancer Patients (412-C)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2011.12.107 ◽

2012 ◽

Vol 43 (2) ◽

pp. 377-378

Author(s):

Anne Walling ◽

Jane Weeks ◽

Katherine Kahn ◽

Diana Tisnado ◽

Nancy Keating ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Patients ◽

Symptom Management ◽

Unmet Need ◽

Newly Diagnosed ◽

Colorectal Cancer Patients

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Lower Patient Ratings of Physician Communication Are Associated With Unmet Need for Symptom Management in Patients With Lung and Colorectal Cancer

Journal of Oncology Practice ◽

10.1200/jop.2015.005538 ◽

2016 ◽

Vol 12 (6) ◽

pp. e654-e669 ◽

Cited By ~ 16

Author(s):

Anne M. Walling ◽

Nancy L. Keating ◽

Katherine L. Kahn ◽

Sydney Dy ◽

Jennifer W. Mack ◽

...

Keyword(s):

Colorectal Cancer ◽

Symptom Management ◽

Unmet Needs ◽

Early Stage ◽

Unmet Need ◽

Physician Communication ◽

Common Symptom ◽

Factors Associated ◽

Management Interventions ◽

Communication Score

Purpose: Little is known about factors associated with unmet needs for symptom management in patients with cancer. Methods: Patients with a new diagnosis of lung and colorectal cancer from the diverse nationally representative Cancer Care Outcomes Research and Surveillance cohort completed a survey approximately 5 months after diagnosis (N = 5,422). We estimated the prevalence of unmet need for symptom management, defined as patients who report that they wanted help for at least one common symptom (pain, fatigue, depression, nausea/vomiting, cough, dyspnea, diarrhea) during the 4 weeks before the survey but did not receive it. We identified patient factors associated with unmet need by using logistic regression with random effects to account for clustering within study sites. Results: Overall, 15% (791 of 5,422) of patients had at least one unmet need for symptom management. Adjusting for sociodemographic and clinical factors, African American race, being uninsured or poor, having early-stage lung cancer, and the presence of moderate to severe symptoms were associated with unmet need (all P < .05). Furthermore, patients who rated their physician’s communication score < 80 (on a 0 to 100 scale) had adjusted rates of an unmet need for symptom management that were more than twice as high as patients who rated their physicians with a perfect communication score (23.1% v 10.0%; P < .001). Conclusion: A significant minority of patients with newly diagnosed lung and colorectal cancer report unmet needs for symptom management. Interventions to improve symptom management should consider the importance of physician communication to the patient’s experience of disease.

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Results of a cluster randomized trial to evaluate a nursing lead supportive care intervention in newly diagnosed breast and colorectal cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.6035 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 6035-6035 ◽

Cited By ~ 2

Author(s):

Jonathan Sussman ◽

Doris Howell ◽

Daryl Bainbridge ◽

Kevin Brazil ◽

Susan Schiff ◽

...

Keyword(s):

Colorectal Cancer ◽

Supportive Care ◽

Cancer Patients ◽

Unmet Need ◽

Nursing Intervention ◽

Coordination Of Care ◽

Newly Diagnosed ◽

Cluster Randomized ◽

Colorectal Cancer Patients

6035 Background: Patient transitions during the early phases of cancer care from initial diagnosis through oncology consultation are often poorly coordinated resulting in unmet need, poor continuity, and resultant distress. It has been proposed that better coordination of care during this period would improve the care experience from the patient’s perspective. We designed a randomized trial to test a community based nursing lead coordination of care intervention in newly diagnosed breast and colorectal cancer patients. Methods: Cluster randomized control trial in 193 newly diagnosed breast and colorectal cancer patients enrolled through surgical practices within 7 days of cancer surgery in Toronto, Canada. Surgical practices were randomized between a standardized nursing intervention and a control group involving usual care practices. The intervention consisted of a standardized in person supportive care assessment with ongoing supportive care by telephone or in person that included linkage to community services using protocol specified guidelines according to identified needs. The primary outcomes measured at 8 weeks were validated patient reported outcomes (PROs) of 1) unmet need (SCNS) and 2) continuity of care (CCCQI). Secondary outcomes included 1) quality of life (EORTC QLQ-C30), 2) health resource utilization, and 3) level of uncertainty with care trajectory (MUIS) at 8 weeks. Results: 121 breast and 72 colorectal patients were randomized through 28 surgical practices. The intervention group had a median of 6 nursing contacts over the study period. There were no differences between groups on PROs of unmet need, continuity of care, quality of life, or uncertainty. Health service utilization did not differ between groups. Conclusions: A specialized oncology nursing intervention early in the care trajectory did not result in improved supportive care outcomes for patients. [Table: see text]

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