Author(s)
Stover A1, Urick B1, Deal A2, Jansen J2, Henson S2, Miller R3, Smith T4, Scholle S5, Chiang A6, Cleeland C7, Deutsch Y8, Zylla D9, Pitzen C10, Snyder C11, McNiff K12, Krzyzanowska M13, Spears P14, Smith ML15, Geoghegan C16, Basch EM1
1University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 2UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA, 3American Society for Clinical Oncology, Alexandria, VA, USA, 4American Cancer Society, Atlanta, GA, USA, 5National Committee for Quality Assurance, Washington, DC, USA, 6Yale University, New Haven, CT, USA, 7University of Texas MD Anderson Cancer Center, Houston, TX, USA, 8Memorial Healthcare System, Pembroke Pines, FL, USA, 9Frauenshuh Cancer Center, St. Louis Park, MN, USA, 10MN Community Measurement, Minneapolis, MN, USA, 11Johns Hopkins School of Medicine, Baltimore, MD, USA, 12KM Healthcare Consulting, Boston, MA, USA, 13Princess Margaret Cancer Centre, Toronto, ON, Canada, 14UNC-Chapel Hill, Chapel Hill, NC, USA, 15Research Advocacy Network, Naperville, IL, USA, 16Patients and Partners LLC, New Haven, CT, USA
OBJECTIVES. Symptom management is a cornerstone of quality oncology practice. The American Society for Clinical Oncology (ASCO) established a Working Group to develop patient-reported outcome performance measures (PRO-PMs) for assessing symptom management during chemotherapy. We describe multicenter testing funded by PCORI. METHODS. Multi-stakeholder consensus and literature review identified 12 symptoms to test as potential PRO-PMs: gastrointestinal (nausea, vomiting, diarrhea, constipation, eating and drinking decreases), pain, insomnia, fatigue, dyspnea, neuropathy, depression, and anxiety. For these symptoms, questions from PRO-CTCAE were administered at 6 US academic and community oncology practices. Patients across cancer types completed questions electronically on days 5-15 of chemotherapy cycles. PRO-CTCAE scores were dichotomized to delineate clinically meaningful thresholds (0-1 vs >=2), and rates were tabulated between practices. Symptoms were selected for model testing if they were clinically actionable and had a prevalence ≥20%; between-practice variation was evaluated using χ2. Twelve candidate sociodemographic and clinical risk adjustment variables were evaluated via Akaike information criterion testing. Risk-adjusted PRO-PM rates were calculated using observed:expected ratios via generalized linear mixed modeling. RESULTS: Among 653 enrolled patients, 607 (93%) completed questionnaires. Four of 12 symptoms met criteria for PRO-PM development: nausea, constipation, insomnia, pain. Unadjusted scores across practices ranged from 13-30% for uncontrolled nausea (χ2 p = 0.06), 19-37% for uncontrolled constipation (χ2 p = 0.12), 31-54% for uncontrolled insomnia (χ2 p = 0.04), and 36-50% for uncontrolled pain (χ2 p = 0.30). Four risk adjustment variables met inclusion criteria: age, gender, cancer type, insurance type. Risk-adjustment yielded a modest impact on practice scores, with changes around 1-4%. CONCLUSIONS: Oncology PRO-PMs have been developed to quantify the burden of actionable symptoms at the practice level. Collecting PROs from patients at home on days 5-15 of chemotherapy cycles is feasible. Further refinement and validation is underway prior to submission for endorsement by the U.S. National Quality Forum.
Conference/Value in Health Info
2019-11, ISPOR Europe 2019, Copenhagen, Denmark
Acceptance Code
ON5
Topic
Clinical Outcomes, Health Service Delivery & Process of Care, Methodological & Statistical Research, Patient-Centered Research
Topic Subcategory
Patient-reported Outcomes & Quality of Life Outcomes, Performance-based Outcomes, PRO & Related Methods, Quality of Care Measurement
Disease
Oncology
