Patient-Reported Quality of Supportive Care Among Patients With Colorectal Cancer in the Veterans Affairs Health Care System

1. Michelle van Ryn⇑,
2. Sean M. Phelan,
3. Neeraj K. Arora,
4. David A. Haggstrom,
5. George L. Jackson,
6. S. Yousuf Zafar,
7. Joan M. Griffin,
8. Leah L. Zullig,
9. Dawn Provenzale,
10. Mark W. Yeazel,
11. Rahul M. Jindal and
12. Steven B. Clauser

+ Author Affiliations

1. Michelle van Ryn and Sean M. Phelan, Mayo Clinic, Rochester; Joan M. Griffin, Veterans Affairs Medical Center; Mark W. Yeazel, University of Minnesota, Minneapolis, MN; Neeraj K. Arora and Steven B. Clauser, National Cancer Institute, Bethesda, MD; David A. Haggstrom, Roudebush Veterans Affairs Medical Center and Indiana University School of Medicine, Indianapolis, IN; George L. Jackson, Leah L. Zullig, and Dawn Provenzale, Durham Veterans Affairs Medical Center; George L. Jackson, S. Yousuf Zafar, and Dawn Provenzale, Duke University Medical Center, Durham; Leah L. Zullig, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Rahul M. Jindal, Walter Reed Army Medical Center, Washington, DC.

1. Corresponding author: Michelle van Ryn, PhD, MPH, Division of Health Care Policy and Research, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: vanryn.michelle@mayo.edu.

Abstract

Purpose High-quality supportive care is an essential component of comprehensive cancer care. We implemented a patient-centered quality of cancer care survey to examine and identify predictors of quality of supportive care for bowel problems, pain, fatigue, depression, and other symptoms among 1,109 patients with colorectal cancer. 

Patients and Methods Patients with new diagnosis of colorectal cancer at any Veterans Health Administration medical center nationwide in 2008 were ascertained through the Veterans Affairs Central Cancer Registry and sent questionnaires assessing a variety of aspects of patient-centered cancer care. We received questionnaires from 63% of eligible patients (N = 1,109). Descriptive analyses characterizing patient experiences with supportive care and binary logistic regression models were used to examine predictors of receipt of help wanted for each of the five symptom categories. 

Results There were significant gaps in patient-centered quality of supportive care, beginning with symptom assessment. In multivariable modeling, the impact of clinical factors and patient race on odds of receiving wanted help varied by symptom. Coordination of care quality predicted receipt of wanted help for all symptoms, independent of patient demographic or clinical characteristics. 

Conclusion This study revealed substantial gaps in patient-centered quality of care, difficult to characterize through quality measurement relying on medical record review alone. It established the feasibility of collecting patient-reported quality measures. Improving quality measurement of supportive care and implementing patient-reported outcomes in quality-measurement systems are high priorities for improving the processes and outcomes of care for patients with cancer.

Footnotes

• Supported by the Interagency Quality of Cancer Care Committee, Applied Research Branch, National Cancer Institute (NCI), through an interagency agreement with the Veterans Health Administration and by NCI Grant No. 5R25CA116339 (L.L.Z.).
• Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.
   © 2014 by American Society of Clinical Oncology