Outcome Measures in Cancer Rehabilitation: Pain, Function, and Symptom Assessment

Assessment of cancer rehabilitation outcome measures is integral for patient assessment, symptom screening, and advancing scientific research. In the broad field of cancer rehabilitation, outcome measures can cross-cut across many different branches of oncologic care including clinician-reported, patient-reported, and objective measures. Specific outcome measures that apply to cancer rehabilitation include those pertinent to pain, function, quality of life, fatigue, and cognition. These outcome measures, when used in cancer rehabilitation, can be utilized to evaluate the effectiveness of an intervention and to triage to the appropriate supportive care service. This review article summarizes some of the commonly used outcome measures that can be applied in the cancer rehabilitation setting to support scholarly work and patient care.

Development of an integrated palliative and supportive care service within an academic cancer center.

99 Background: Timely incorporation of palliative services with chemotherapy treatment has become a new standard of care for oncology patients based on evidence-driven national clinical practice guidelines. However, best practices for service integration are not known, particularly for small academic centers. In our 224 bed university hospital, we hypothesized that advertisement, responsiveness to needs and service integration would result in increased utilization of palliative and supportive care. We report the process of developing our Integrated Model of Care. Methods: The program began with a 1.0 FTE APRN boarded as a FNP and certified as an advanced hospice and palliative nurse. The goal was to identify opportunities for her integration within the outpatient cancer center. A needs-assessment survey was sent to medical oncology faculty with the following items: proposed change in service name, care areas of greatest need, limitations to providing palliative care, additional growth opportunities. The Interdisciplinary Supportive Care Team was created utilizing existing staff. One year of billed consults were reviewed. The APRN attended tumor boards, team meetings, biweekly Interdisciplinary Team Meetings, communicated directly with the Inpatient Hem/Onc Team and provided educational sessions. Results: Needs assessment survey and service name change proposal sent to 14 oncology providers: 50% completed survey; seven responded YES to name change; zero providers responded NO. Of the 489 consults billed within the 1st year of service, 249 were inpatient and 240 outpatients. 168 individual patients were referred; > 72 patients were referred to palliative/hospice services; > 82 patients died. One year satisfaction survey; 17 respondents; 88.23% were satisficed and 100% would consult again. Conclusions: Medical oncology faculty at our institution responded favorably to the development of a designated “Oncology Supportive Care Service” evidenced by increased consultation and utilization of services. Optimizing clinical infrastructure, processes, education and research has led to the success of this integrated care model, lending to recruitment of additional allied health professionals and ongoing program growth.

The integrated care service: Impact of a multidisciplinary supportive care service for medical oncology patients in a NCI-designated cancer center.

134 Background: Palliative care (PC) has shown benefits to inpatient length of stay (LOS), symptom burden reduction, utilization decrease, and time on hospice. It has shown less impact on the rate of hospice referrals. We assessed the impact of an integrated care model on these outcomes. Methods: From Jan-July, 2018, the Department of Supportive Care Medicine collaborated with medical oncology (med onc), nursing and administration to create the Integrated Care Service (ICS). Multi-disciplinary rounds include med onc, supportive care (PC, social work, spiritual care, psychiatry, psychology, hospice liaison), nursing, case management, nutrition, and physical and occupational therapy. The admission criteria include: 1) Later-stage disease; 2) Non-curative intent therapy; 3) High distress burden; and 4) Poor prognosis. The ICS was designed to have geographic co-location, morning PC and med onc rounds, multidisciplinary rounds, and post-acute management. The ICS was compared with other med onc patients (non-ICS) and Mantel-Haenszel Chi-Square statistical significance (p<0.05) was calculated using Epi Info StatCalc. Results: In 6 months, 190 med onc patients (pts) were admitted to ICS versus 537 non-ICS pts. Compared with non-ICS, the ICS pts had a higher Case Mix Index (1.81 vs. 1.56) and metastatic disease incidence (95% vs. 78%, p=0.008). Discharge to hospice was higher from ICS versus non-ICS (23% vs. 7%, p=<0.001), and average time on hospice increased from 9 to 15 days. No chemotherapy was given in the last two weeks of life to any pts on ICS (0 vs. 6 non-ICS pts). Length of stay (LOS) was higher on ICS as compared to non-ICS (8.45 vs. 5.26 days) and readmission rates were similar (12% vs. 13%). Conclusions: For medical oncology pts in a comprehensive cancer center, the ICS, an integrated, multidisciplinary supportive care service, significantly improved discharge rates to hospice, increased LOS on hospice by almost a week, avoided patients receiving chemotherapy, and maintained similar readmission rates. LOS was higher for complex ICS patients as compared to non-ICS. Based on this pilot, the ICS is planning for expansion to include hematology and surgical services.

The Implementation of ISO 9001:2015 to Improve the Supportive Care Services for the Cancer Survivors

Background and context: Cancer has been the leading cause of death in Taiwan since 1982. According the most updated cancer registry published by the Ministry of Health and Welfare, a total of 105,156 new cases (302/100,000 population) were diagnosed and 46,829 people (128/100,000 population) died of cancer which accounted for 28.6% of all deaths. Currently, around 500,000 people live with cancers in Taiwan. The Formosa Cancer Foundation (FCF) operates two Cancer Survivor Supportive Care Centers in Taipei and Kaohsiung cities which provide comprehensive, professional services to cancer survivors and their families. These centers regularly offer free medical, nutritional and psychological counseling, nutrition and transportation subsidies for low-income survivor households, critical emergency relief as well as hold a regular courses of body and mind rehabilitation to help cancer survivors successfully navigate their road to optimal recovery. As the number of cancer survivors needed supportive care services are rapidly increasing, the resources allocated for the services is not proportionately increased. Therefore, how to improve both the quantity and quality for the survivors' supportive care services becomes an essential issue. Aim: To ensure service standardization as well as to improve the quantity and quality of the supportive care services for the cancer survivors. Strategy/Tactics: FCF began the process necessary to certify its Survivor Supportive Care Service Quality Management System under ISO 9001 since 2015. Program/Policy process: To certify the FCF Survivor Supportive Care Service Quality Management System under ISO 9001:2015 by (1) Clearly defining the assessment and service goals (2) Systemized management and control of service delivery procedures (3) Regular collection and utilization of client-satisfaction data and comments (4) Systemized tracking and management of documents (5) Standard method for records storage and maintenance (6) Standardized procedures for managing and maintaining service facilities; and (7) Standardized procedures for evaluating and training staff. Outcomes: After implementation of the ISO 9001:2015 quality management system, FCF's overall service capacity has increased by 18-20%. Each service now covered by a standardized procedure, high levels of service quality and teamwork have been well maintained even under reduced staffing conditions. Survivors’ satisfaction with FCF services has risen significantly from an average of 4.0 prior to implementation of the quality management system to 4.7 afterward (full score: 5). The survivor´s family members also indicate strong satisfaction with FCF services. What was learned: Implementing the ISO 9001:2015 quality management system in the cancer survivor supportive care service has assisted FCF not only to increase the quality and quantity of its service deliveries but also to enhance the effectiveness of its professional team.