Search

Purpose: Lung cancer remains one of the most diagnosed cancers in Canada and continues to be the leading cause of cancer deaths in Canada, responsible for 25% of all cancer deaths. Prior studies consistently report poor experiences of people with lung cancers. The study purpose was to explore the reasons for consistently poorer reported experience of people with lung cancer compared to people with gastrointestinal cancers, who previously have reported positive cancer care experiences within the same context, and to better understand key differences that influence patient experience., Methods: This qualitative study used semi-structured interviews of people living with lung cancer (LC) and gastrointestinal cancers (GIC) undergoing radiotherapy at a tertiary cancer centre. Thematic content analysis was conducted to analyse interview transcripts. A person-centred care framework was used to guide the development of the interview guide and data analysis., Results: We interviewed 16 participants (10 LC and 6 GIC). Participants with LC reported poor experience leading to and at the time of their cancer diagnosis, including delays in their diagnosis and anxiety related to their diagnosis. Most participants in both groups reported severe symptoms prior to their radiotherapy. However, the symptoms of people living with LC further worsened during the radiation therapy with the addition of treatment side effects, while the symptoms of people living with GIC were better controlled during treatment. Participants living with LC noted poor communication, gaps in coordination and uncertainty. They acknowledged awareness of support services and other resources, but they reported no interest in accessing them., Conclusion: This study identified gaps in patient experience of people living with LC compared to GIC and proposed ideas for quality improvement projects, including expediting the diagnosis process, enhancing communication with patients around their lung cancer diagnosis, improved symptom management, and timing of supportive care services., Competing Interests: Declarations. Ethics approval: The Institutional Research Information Services Solution (IRISS) Health Research Ethics Board through the University of Calgary provided ethics approval: HREBA.CC-18–0588. Informed consent: Written informed consent was obtained from participants. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Despite the known importance and necessity of the standardized collection and use of patient-reported outcomes (PROs), there remain challenges to successful clinical implementation. Facilitated through a quality improvement initiative spearheaded by the Canadian Partnership for Quality Radiotherapy (CPQR), and now guided by the Canadian Association of Radiation Oncology (CARO)'s Quality and Standards Committee, patient representatives and early-adopter radiation treatment programs continue to champion the expansion of PROs initiatives across the country. The current review discusses the evolution of a pan-Canadian approach to PROs use, striving to fill in gaps between clinical practice and guideline recommendations through multi-centre and multidisciplinary collaboration.

Background: Patient-reported outcomes (pros) are essential to capture the patient's perspective and to influence care. Although pros and pro measures are known to have many important benefits, they are not consistently being used and there is there no Canadian pros oversight. The Position Statement presented here is the first step toward supporting the implementation of pros in the Canadian health care setting., Methods: The Canadian pros National Steering Committee drafted position statements, which were submitted for stakeholder feedback before, during, and after the first National Canadian Patient Reported Outcomes (canpros) scientific conference, 14-15 November 2019 in Calgary, Alberta. In addition to the stakeholder feedback cycle, a patient advocate group submitted a section to capture the patient voice., Results: The canpros Position Statement is an outcome of the 2019 canpros scientific conference, with an oncology focus. The Position Statement is categorized into 6 sections covering 4 theme areas: Patient and Families, Health Policy, Clinical Implementation, and Research. The patient voice perfectly mirrors the recommendations that the experts reached by consensus and provides an overriding impetus for the use of pros in health care., Conclusions: Although our vision of pros transforming the health care system to be more patient-centred is still aspirational, the Position Statement presented here takes a first step toward providing recommendations in key areas to align Canadian efforts. The Position Statement is directed toward a health policy audience; future iterations will target other audiences, including researchers, clinicians, and patients. Our intent is that future versions will broaden the focus to include chronic diseases beyond cancer., Competing Interests: CONFLICT OF INTEREST DISCLOSURES We have read and understood Current Oncology’s policy on disclosing conflicts of interest, and with the exceptions of the authors listed below, we declare that we have none or were unable to respond to the request for disclosures because of covid-19–related activities. LB has received an honorarium from Genentech and travel support from Elekta. AFK has received consulting fees from Allergan. RO has received grant funding from Varian Medical Systems., (2020 Multimed Inc.)

Background: Few measures exist to assess the quality of care received by home care clients, especially at the end of life. Objective: This project examined the rates across a set of quality indicators (QIs) for seriously ill home care clients. Design: This was a cross-sectional descriptive analysis of secondary data collected using a standardized assessment tool, the Resident Assessment Instrument for Home Care (RAI-HC). Setting/Subjects: The sample included RAI-HC data for 66,787 unique clients collected between January 2006 and March 2018 in six provinces. Individuals were defined as being seriously ill if they experienced a high level of health instability, had a prognosis of less than six months, and/or had palliative care as a goal of care. Measurements: We compared individuals with cancer ( n  = 21,119) with those without cancer ( n  = 47,668) on demographic characteristics, health-related outcomes, and on 11 QIs. Results: Regardless of diagnosis, home care clients experienced high rates (i.e., poor performance) on several QIs, namely the prevalence of falls (cancer = 42.4%; noncancer = 55%), daily pain (cancer = 48.3%; noncancer = 43.2%), and hospital admissions (cancer = 48%; noncancer = 46.6%). The QI rates were significantly lower (i.e., better performance) for the cancer group for three out of the 11 QIs: falls (absolute standardized difference [SD] = 0.25), caregiver distress (SD = 0.28), and delirium (SD = 0.23). Conclusions: On several potential QIs, seriously ill home care clients experience high rates, pointing to potential areas for quality improvement across Canada.

Background: A significant share of the cost of cancer care is concentrated in the end-of-life period. Although quality measures of aggressive treatment may guide optimal care during this timeframe, little is known about whether these metrics affect costs of care., Methods: This study used population data to identify a cohort of patients who died of cancer in Ontario, Canada (2005-2009). Individuals were categorized as having received or having not received aggressive end-of-life care according to quality measures related to acute institutional care or chemotherapy administration in the end-of-life period. Costs (2009 Canadian dollars) were collected over the last month of life through the linkage of health system administrative databases. Multivariate quantile regression was used to identify predictors of increased costs., Results: Among 107,253 patients, the mean per-patient cost over the final month was $18,131 for patients receiving aggressive care and $12,678 for patients receiving nonaggressive care (P < .0001). Patients who received chemotherapy in the last 2 weeks of life also sustained higher costs than those who did not (P < .0001). For individuals receiving end-of-life care in the highest cost quintile, early and repeated palliative care consultation was associated with reduced mean per-patient costs. In a multivariate analysis, chemotherapy in the 2 weeks of life remained predictive of increased costs (median increase, $536; P < .0001), whereas access to palliation remained predictive for lower costs (median decrease, $418; P < .0001)., Conclusions: Cancer patients who receive aggressive end-of-life care incur 43% higher costs than those managed nonaggressively. Palliative consultation may partially offset these costs and offer resultant savings., (© 2015 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.)

Purpose: To develop data-driven and achievable benchmark rates for end-of-life quality indicators using administrative data from four provinces in Canada., Methods: Indicators of end-of-life care were defined and measured using linked administrative data for 33 health regions across British Columbia, Alberta, Ontario, and Nova Scotia. These were emergency department use, intensive care unit admission, physician house calls and home care visits before death, and death in hospital. An empiric benchmark was defined using indicator rates from the top-ranked regions to include the top decile of patients overall. Funnel plots were used to graph each region's age- and sex-adjusted indicator rates along with the overall rate and 95% confidence limits., Results: Rates varied approximately two- to four-fold across the regions, with physician house calls showing the greatest variation. Benchmark rates based on the top decile performers were emergency department use, 34%; intensive care unit admission, 2%; physician house calls, 34%; home care visits, 63%; and death in hospital, 38%. With the exception of intensive care unit admission, funnel plots demonstrated that overall indicator rates and their confidence limits were uniformly worse than benchmarks even after adjusting for age and sex. Few regions met the benchmark rates., Conclusion: There is significant variation in end-of-life quality indicators across regions in four provinces in Canada. Using this study's methods-deriving empiric benchmarks and funnel plots-regions can determine their relative performance with greater context that facilitates priority setting and resource deployment. Applying this study's methods can support quality improvement by decreasing variation and striving for a target., (Copyright © 2015 by American Society of Clinical Oncology.)

Background: The relationship between performance status and death among cancer patients has been of increasing interest over the past years. However, few studies have implemented statistical models that adequately capture the longitudinal nature of performance status assessments collected under intermittent observation., Aim: The main research aims were to examine the association between performance status and death and to determine the probability of deterioration in performance status over time., Design: This was a population-based longitudinal study among adult outpatients diagnosed with cancer. Throughout their observation period, all patients were repeatedly assessed for performance status using an 11-point scale with a score of 100 being the best, 10 being the worst and 0 representing death. A Markov multistate model accounting for intermittent observation was implemented in which each score represented a distinct state in the model., Results: The cohort consisted of 27,739 patients with over 157,000 assessments. The rate of transition to death increases with a quadratic trend as performance status declines. The 1-month and 3-month probability of deterioration also increases with a quadratic trend as performance status declines. The relative rate of transition to death decreases as we compare lower scores (relative rate = 2.20 for comparing scores 90 vs 100 and relative rate = 1.23 for comparing scores 10 vs 20)., Conclusion: There is a significant relationship between performance status and rate of transition to death. The Markov multistate model provides a comprehensive understanding of the shape of this relationship, which facilitates the interpretation of performance status and provides strength in its use as a prognostic tool in a clinical setting.

Background: A number of palliative care delivery models have been proposed to address the structural and process gaps in this care. However, the specific elements required to form competent systems are often vaguely described., Aim: The purpose of this study was to explore whether a set of modifiable health system factors could be identified that are associated with population palliative care outcomes, including less acute care use and more home deaths., Design: A comparative case study evaluation was conducted of 'palliative care' in four health regions in Ontario, Canada. Regions were selected as exemplars of high and low acute care utilization patterns, representing both urban and rural settings. A theory-based approach to data collection was taken using the System Competency Model, comprised of structural features known to be essential indicators of palliative care system performance. Key informants in each region completed study instruments. Data were summarized using qualitative techniques and an exploratory factor pattern analysis was completed., Results: 43 participants (10+ from each region) were recruited, representing clinical and administrative perspectives. Pattern analysis revealed six factors that discriminated between regions: overall palliative care planning and needs assessment; a common chart; standardized patient assessments; 24/7 palliative care team access; advanced practice nursing presence; and designated roles for the provision of palliative care services., Conclusions: The four palliative care regional 'systems' examined using our model were found to be in different stages of development. This research further informs health system planners on important features to incorporate into evolving palliative care systems.

Background: Both the United States and Canada offer government-financed health insurance for the elderly, but few studies have compared care at the end of life for cancer patients between the two systems., Methods: We identified care for non-small cell lung cancer (NSCLC) patients who died of cancer at age 65 years and older during 1999-2003. Patients were identified from US Surveillance, Epidemiology, and End Results (SEER)-Medicare data (N = 13,533) and the Ontario Cancer Registry (N = 8100). Health claims during the last 5 months of life identified chemotherapy and emergency room use, hospitalizations, and supportive care. We estimated rates per person-months (PM) for short-term survivors (died <6 months after diagnosis) and longer-term survivors (died ≥6 months after diagnosis), adjusting for demographic differences. To test whether monthly rates in Ontario were statistically significantly different from the United States, standardized differences were computed, and a 99% confidence interval (CI) was constructed to account for the multiple tests performed. All statistical tests were two-sided., Results: Rates of chemotherapy use were statistically significantly higher for SEER-Medicare patients than Ontario patients in every month before death (short-term survivors at 5 months before death: SEER-Medicare, 33.2 patients per 100 PM vs Ontario, 9.5 per 100 PM, rate difference = 23.7 per 100 PM, 99% CI = 18.3 to 29.1 per 100 PM, P < .001; longer-term survivors at 5 months before death: SEER-Medicare, 24.4 patients per 100 PM vs Ontario, 14.5 per 100 PM, rate difference = 9.9 per 100 PM, 99% CI = 7.7 to 12.1 per 100 PM, P <. 001). During the last 30 days of life, fewer SEER-Medicare than Ontario patients were hospitalized (short-term survivors, 49.9 vs 78.6 patients per 100 PM, rate difference = 28.6 per 100 PM, 95% CI = 22.9 to 34.4 per 100 PM, P <. 001; longer-term survivors, 44.1 vs 67.1 patients per 100 PM, rate difference = 23.0 per 100 PM, 95% CI = 18.5 to 27.5 per 100 PM, P < .001)., Conclusions: NSCLC patients in both Ontario and the United States used extensive end-of-life care. Limited availability of hospice care in Ontario and differing attitudes between the United States and Ontario regarding end-of-life care may explain the differences in practice patterns.