Improving the Quality of Lung Cancer Care in Ontario: The Lung Cancer Disease Pathway Initiative

PURPOSE: Effective care coordination (CC) is a hallmark of a high-quality cancer care. However, efforts to improve cancer care delivery are limited by the lack of a clinically useful tool to assess CC. In this study, we examined patients’ perceptions of cancer CC using a novel tool, the Care Coordination Instrument (CCI), and evaluated the quality of the CCI. METHODS: The CCI is a 29-item patient questionnaire that assesses CC across varied practice settings and patient populations overall and for three critical domains of CC: communication, navigation, and operational. We conducted univariable and multivariable regression analyses to identify patient clinical and practice characteristics associated with optimal versus suboptimal CC. RESULTS: Two hundred patients with cancer completed the CCI questionnaire between October 2018 and January 2019, of whom 189 were used for the analysis. The presence of a family caregiver and a diagnosis of a blood cancer were correlated with overall positive reports of CC ( P < .001 and P < .05, respectively). Poorer perceptions of CC were associated with having a head and neck cancer and the absence of family caregiver support. The effects of cancer disease stage and having access to a patient navigator on CC were not statistically significant. CONCLUSION: Integrating a patient-centered tool to assess cancer CC can be a strategy to optimize cancer care delivery. Understanding factors associated with effective and ineffective CC can help inform efforts to improve overall quality of care and care delivery.

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Does a quality-of-care problem exist? Cancer Care Ontario practice pattern data and the recommendations of two lung cancer practice guidelines.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.34_suppl.190 ◽

2012 ◽

Vol 30 (34_suppl) ◽

pp. 190-190

Author(s):

Melissa C. Brouwers ◽

Julie Makarski

Keyword(s):

Lung Cancer ◽

Quality Of Care ◽

Practice Guidelines ◽

Cancer Care ◽

Practice Patterns ◽

Practice Pattern ◽

Theory Approach ◽

System Quality ◽

Depth Analysis

190 Background: Practice-pattern data, evidence-based knowledge and transfer, and performance management strategies define Cancer Care Ontario’s quality improvement strategy. Knowledge products, such as practice guidelines, are intended to provide recommendations for practice, based on best available evidence, to improve quality of care and reduce variation in practice. Review of 2010-2011 Cancer System Quality Index (CSQI) data revealed complex practice patterns in treatment of non-small cell lung cancer patients with stages II and IIIa resected and stages IIIa and IIIb non-resected disease in Ontario. A multi-method study was initiated to understand the patterns, to identify if a quality of care problem exists and to propose improvements moving forward. Methods: Surgeons, medical oncologists and radiation oncologists from Ontario were invited to participate in a survey consisting of 6 areas of inquiry. A grounded theory approach was used to guide key informant interviews of purposively sampled clinicians and administrators. A more in-depth analysis of the CSQI data was planned. Results: Clinicians responding to survey provided positive assessments of PG recommendations and evidentiary base; perceptions of practice patterns were less problematic than hypothesized; estimates of benchmarks were highly variable; and assessments of barriers to recommendation implementation included slow referral process, lack of organization support and patients seen in practice not reflected in the evidence. From the interviews, 5 themes emerged: unique patient, unique physician, family, clinical team, and clinical evidence. Further analysis of CSQI data was not possible given limitations related to data collection. Conclusions: A perceived quality of care problem initiated this study. Concerns centred on significant proportion of patients receiving no treatment; modest percentage of patients receiving treatment that aligned with PG recommendations; and regional variation within each of the clinical care options. Our data show that defining a quality of care problem is significantly more complex than consideration of practice patterns alone.

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Lung cancer quality of care in Uruguay: First experience in a public hospital.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.8_suppl.231 ◽

2017 ◽

Vol 35 (8_suppl) ◽

pp. 231-231

Author(s):

Maria Clara Rodriguez Palleiro ◽

Virginia Rodriguez ◽

Viviana Dominguez ◽

Siul Salisbury ◽

Alonzo Rodriguez ◽

...

Keyword(s):

Lung Cancer ◽

Quality Of Care ◽

Cancer Care ◽

Medical Records ◽

Adherence Rate ◽

Pathology Report ◽

Histologic Subtype ◽

Starting Point ◽

The Impact

231 Background: Improvement in quality of cancer care is a strategic health objective for the Ministry of Health in Uruguay. Lung cancer is the first cancer in mortality in men and the third in women in our country, there are few reports from Latino America about quality of cancer care, in our knowledge this is the first in lung cancer. Methods: We audit a public reference center in oncology that receive about 8 percent of new cases in the country, our objective was to perform a first study in quality of cancer care in non-small cell lung cancer. We reviewed the compliance with a group of 14 indicators (six general and eight NSCLC specific) selected from literature and used in different quality programs. We performed a retrospective analysis of medical records from 408 new patients seen between January 2011 and July 2016. Results: The median age was 62 years, 72,8% were male and 27,2% females, 76,6% were stage III-IV and 23,6% were stage I-II. The median adherence rate to core indicators were 84,2 (69% to 100%). PS was recorded in 76% of cases. Pathology report was present in 71,8% and stage in 97% of medical records. NSCLC indicators had a lower adherence rate 29,8% (5% to 56,3%). 60% receive adjuvant therapy based in platins but only in 5% of patients receive cisplatin. Histologic subtype was informed in 42% of pathology samples and EGFR mutation test were performed in 56% of patient with non-squamous lung cancer. Patients were treated with chemotherapy or radiotherapy as first treatment in 65,4%, stage IV patients receive as first line platin based chemotherapy in 42,7% of cases . Time between diagnosis and first treatment initiation was 28 days and the time to symptoms initiation to diagnosis was 3 months. Conclusions: This auditory identify a high rate of compliance in general indicators, compliance with lung cancer specific quality indicators is heterogeneous. Time to diagnosis need special attention. This study identify a room to improve in lung cancer quality of care and establish a starting point to evaluate the impact of future improvement efforts.

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Faster and better: Improving the diagnostic phase of lung cancer at a system level.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.8_suppl.115 ◽

2017 ◽

Vol 35 (8_suppl) ◽

pp. 115-115

Author(s):

Melissa Kaan ◽

Claire Holloway ◽

Julie Gilbert ◽

Vicky Simanovski ◽

Garth Matheson

Keyword(s):

Lung Cancer ◽

Primary Care ◽

Patient Experience ◽

Cancer Care ◽

Primary Care Providers ◽

Diagnostic Process ◽

Care Providers ◽

The Past ◽

Rule Out

115 Background: For many patients going through diagnostic testing for cancer, the time from suspicion to diagnosis or rule-out, can be a confusing and anxious time. In 2007, Cancer Care Ontario began investing in the implementation of diagnostic assessment programs (DAPs) across Ontario, Canada to improve the quality of care during the diagnostic phase of lung cancer. DAPs consist of multidisciplinary healthcare teams that manage and coordinate a patient’s diagnostic care from testing to a definitive diagnosis. The objectives of the DAPs are to: 1) decrease time from suspicion to diagnosis or resolution; 2) optimize the patient’s experience during the diagnostic process; 3) optimize satisfaction and experience among primary care providers and specialists; and 4) provide a sustainable solution by offering good value for money. Today over 35,000 patients have been diagnosed in one of the 18 lung DAPs that exist across the province. Methods: The implementation of DAPs featured the introduction of a patient navigator to act as the primary point of contact for patients, improve the patient experience and ensure their patients were progressing through any required diagnostic imaging and consultations in a timely manner. Cancer Care Ontario also engaged with primary care providers to refer patients with findings suspicious for lung cancer to DAPs as early as possible to ensure they benefited from organized assessment. Cancer Care Ontario has collected patient level data to measure wait times and implemented a patient survey to assess patient experience. Results: In the past five years, the median wait time from referral to a lung DAP to diagnosis or rule out has decreased by 19% to 24 days and the 90th %tile has decreased by 28% to 51 days. The large majority of patients have had a positive experience with their DAPs, with 95% of patients scoring their experience in the diagnostic process as “good” or “excellent”. Conclusions: The implementation of DAPs across the province is seen as a valuable component of quality of care by improving the diagnostic phase of cancer. The sustainability of the DAP model is demonstrated by the continued improvements in access and maintained patient experience in spite of growing volumes (91% increase in the past five years).

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Patients' Experiences With Care for Lung Cancer and Colorectal Cancer: Findings From the Cancer Care Outcomes Research and Surveillance Consortium

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.3268 ◽

2010 ◽

Vol 28 (27) ◽

pp. 4154-4161 ◽

Cited By ~ 74

Author(s):

John Z. Ayanian ◽

Alan M. Zaslavsky ◽

Neeraj K. Arora ◽

Katherine L. Kahn ◽

Jennifer L. Malin ◽

...

Keyword(s):

Colorectal Cancer ◽

Lung Cancer ◽

Health Status ◽

Cancer Care ◽

Pacific Islander ◽

Asian Pacific Islander ◽

Interpersonal Care ◽

English Speaking ◽

Asian Pacific

Purpose To assess patients' experiences with cancer care, ratings of their quality of care, and correlates of these assessments. Patients and Methods For 4,093 patients with lung cancer and 3,685 patients with colorectal cancer in multiple US regions and health care delivery systems, we conducted telephone surveys of patients or their surrogates in English, Spanish, or Chinese at 4 to 7 months after diagnosis. The surveys assessed ratings of the overall quality of cancer care and experiences with three domains of interpersonal care (physician communication, nursing care, and coordination and responsiveness of care). Results English-speaking Asian/Pacific Islander patients and Chinese-speaking patients and those in worse health reported significantly worse adjusted experiences with all three domains of interpersonal care, whereas white, black, and Hispanic patients reported generally similar experiences with interpersonal care. The overall quality of cancer care was rated as excellent by 44.4% of patients with lung cancer and 53.0% of patients with colorectal cancer, and these ratings were most strongly correlated with positive experiences with coordination and responsiveness of care (Spearman rank coefficients of 0.49 and 0.42 for lung and colorectal cancer, respectively). After multivariate adjustment, excellent ratings were less common for each cancer among black patients, English-speaking Asian/Pacific Islander patients, Chinese-speaking patients, and patients reporting worse health status (all P ≤ .05). Conclusion Patients' reports and ratings of care differed significantly by race, language, and health status. Efforts to improve patients' experiences with cancer care should focus on problems affecting Asian and Pacific Islander patients and those in worse health.

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The Victorian Lung Cancer Registry Pilot: Improving the Quality of Lung Cancer Care Through the Use of a Disease Quality Registry

Lung ◽

10.1007/s00408-014-9603-8 ◽

2014 ◽

Vol 192 (5) ◽

pp. 749-758 ◽

Cited By ~ 14

Author(s):

Rob G. Stirling ◽

S. M. Evans ◽

P. McLaughlin ◽

M. Senthuren ◽

J. Millar ◽

...

Keyword(s):

Lung Cancer ◽

Cancer Registry ◽

Cancer Care ◽

Quality Registry

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A pilot study of using smartphone application versus routine follow up for patients' care in advanced non-small cell lung cancer (NSCLC).

Journal of Global Oncology ◽

10.1200/jgo.2019.5.suppl.9 ◽

2019 ◽

Vol 5 (suppl) ◽

pp. 9-9

Author(s):

Naiyarat Prasongsook ◽

Kasan Seetalarom ◽

Siriwimon Saichaemchan ◽

Kitipong Udomdamrongkul

Keyword(s):

Quality Of Life ◽

Lung Cancer ◽

Cancer Care ◽

Mobile Application ◽

Advanced Nsclc ◽

Patient Reported Outcome ◽

P Value ◽

Patient Reported

9 Background: Web-based patient reported outcome (PRO) improved quality of life (QoL), and overall survival (OS) in patients with advanced NSCLC who were treating with specific therapy. Lung Cancer Care application is a mobile application program that provides patients with individually tailored information on patient reported outcome. This study aims to invent a novel mobile application evaluating PRO for Thai NSCLC patients, and to evaluate the validity of mobile application. Methods: Our mobile application-based PRO was designed for monitoring quality of life. The validity of the application was tested following guidelines for translating, and validating a questionnaire. The quality of life score (FACT-L score). After the validated mobile application-based PRO, patients with advanced NSCLC were randomized to use mobile application-based PRO versus routine follow-up. The primary endpoint was quality of life (QoL). Secondary endpoint was OS. Results: Thirty-three patients with advanced NSCLC were enrolled. The mean of FACT-L score at baseline in mobile application-based PRO arm and routine follow up arm was similar (90.08 ± 5.66 vs 91.78 ± 5.26, p-value= 0.82). Patients with mobile application group had more FACT-L score at 3 months than patients with routine follow up arm (106 ± 5.97 vs 99.96 ± 5.74, p-value = 0.07). There was a trend towards increased in different mean of FACT-L score at baseline and 3 months in patients with mobile application compared to patients with routine follow up ( p-value = 0.05). The median follow-up time was 5.43 months, patients with mobile application had longer median OS than patients with routine follow up (4 months vs 2.9 months, p-value = 0.5). Conclusions: Lung Cancer Care application based on self-reported symptoms is a novel electronic device for real-time patient care monitoring. Our study results showed trend towards improved quality of life from using this novel mobile application. However, there was small samples for pilot testing, the relatively large sampling errors may reduce the statistical power needed to validate this tool.

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