Technical Information

​The percentage of cancer patients who were screened at least once per month for ESAS-r symptom severity

Figure 1

​
• By increasing patients’ involvement in their own care and identifying issues earlier, validated screening tools, such as ESAS, help identify common cancer symptoms that can be managed by the health care team.
• Patient self-reporting of symptoms is the gold standard for symptom management and patients have reported that they find it valuable for their care.
• Tracking a patient’s symptoms over time increases the clinician’s ability to enter into a conversation with patients about their symptoms while responding directly to what patients have identified as their needs.
• Before standardized symptom screening was implemented across the province, Regional Cancer Centres did not use a standardized tool to assess and managing patients’ symptoms was not monitored on a regular basis.
• Patients are telling us that they want to know and track the changes in their symptoms as much as their healthcare team does making the electronic documentation of symptom scores an essential part of high-quality care.

Source: CSQI 2014

​In a 2010 study of more than 45,000 Ontario patients, at least 57% reported that they experienced anxiety, 53% reported pain, 49% reported shortness of breath and 44% reported depression1. These results are important for the cancer system to consider in identifying gaps and opportunities for improvement. These results demonstrate that patients have multiple symptoms throughout their cancer journey.

Computerized symptom screening has been shown to result in greater focus on issues that are most relevant to the patient’s experience, and to significantly improve patient outcomes, including reduced symptom distress ^2,3.

A 2011 survey of clinical team members at one cancer centre in Ontario concluded that ESAS screening helps to improve interdisciplinary communication and enhances patient care ⁴.

References:

• Barbera, L., Seow, H., Howell, D., Sutradhar, R, Earle, C., Liu, Y, Stitt, A., Husain, A., Sussman, J., Dudgeon, D. (2010). Symptom burden and performance status in a population-based cohort of ambulatory cancer patients. Cancer. 116:5767-76.
• Berry, D., Blumenstein, B., Halpenny, B., Wolpin, S., Fann, J., Austin-Seymour, M.,
• Ruland, C., Holte, H., Roislien, J., Heaven, C., Hamilton, G., Kristiansen, J., Sandbaek, H., Kvaloy, S., Hasund, L., Ellison, M. (2010). Effects of a computer-supported interactive tailored patient assessment tool on patient care, symptom distress, and patients’ need for symptom management support: a randomized clinical trial. Journal American Medical Informatics Association. 17:403-410

(Number of Cancer Patients who were screened at least once with Edmonton Symptom Assessment System revised ​/Number of cancer patients seen by a Regional Cancer Centre in a given month) X 100

• By FY 11/12 to 15/16(5 years trending)
• Total All Cancers
• LHIN and Total Province
• Gender
• Age(19-29, 30-49, 50-64, 65-79, 80+)

Activity Level Reporting

Symptom Management Database

FY 11/12

FY 12/13

FY 13/14

FY 14/15

FY 15/16

Equity Cuts only FY 15/16

Total number of patients seen by a Regional Center Centre in a given period

• Number of Total Cases by ICP and Affiliates (Total Cases – OCSMC based on T2 metric) from Activity Level Reporting.
• Age Groups based on Activity Level Reporting data grouped into following categories 19-29, 30-49, 50-64, 65-79, 80+
• Gender based on Activity Level Reporting

Exclusions:

• Missing or invalid Patient Health Card Numbers (e.g. Value in (0,1))
• Out of Province Patient Health Card Numbers
• Patients with a non-cancer diagnosis(e.g. Non neoplastic diagnosis, Benign neoplasm, Uncertain unspecified, Unknowns)
• For Northeast Cancer Centre and Regional Cancer Centre Northwest, the number of Ontario Telemedicine Network visits are removed from the denominator (self-reported by facilities)
• For Princess Margaret Cancer Centre 17% of the total T2 metric is removed from the denominator for one time only surgical visits

Number of patients, seen at a Regional Cancer Centre who were screened at least once with Edmonton Symptom Assessment System (ESAS-r) in the same time period as the denominator cohort

Disease site information is derived by linking Patient Health Card Number in Symptom Management Database with Patient Health Card Number in Activity Level Reporting(ALR)

For reporting purposes, only one patient submission of their symptoms per month is used for calculating the indicator.

​Only select centres use electronic reporting formats (e.g., kiosks) for patients to report Edmonton Symptom Assessment System revised (ESAS-r) screening. Other centres rely on paper screens. Paper formats require data entry and may not be as accurate as the direct, electronic reporting of Edmonton Symptom Assessment System revised (ESAS-r) use and ESAS-r results.​

​Symptom severity for patients with all types of cancer, all reporting regional cancer centres, FY2015/16

Figure 2

• By increasing patients’ involvement in their own care and identifying issues earlier, validated screening tools, such as ESAS, help identify common cancer symptoms that can be managed by the health care team.
• Patient self-reporting of symptoms is the gold standard for symptom management and patients have reported that they find it valuable for their care.
• Tracking a patient’s symptoms over time increases the clinician’s ability to enter into a conversation with patients about their symptoms while responding directly to what patients have identified as their needs.
• Before standardized symptom screening was implemented across the province, Regional Cancer Centres did not use a standardized tool to assess and managing patients’ symptoms was not monitored on a regular basis.
• Patients are telling us that they want to know and track the changes in their symptoms as much as their healthcare team does making the electronic documentation of symptom scores an essential part of high-quality care.

Source: CSQI 2014

In a 2010 study of more than 45,000 Ontario patients, at least 57% reported that they experienced anxiety, 53% reported pain, 49% reported shortness of breath and 44% reported depression¹. These results are important for the cancer system to consider in identifying gaps and opportunities for improvement. These results demonstrate that patients have multiple symptoms throughout their cancer journey.

Computerized symptom screening has been shown to result in greater focus on issues that are most relevant to the patient’s experience, and to significantly improve patient outcomes, including reduced symptom distress ^2,3 .

A 2011 survey of clinical team members at one cancer centre in Ontario concluded that ESAS screening helps to improve interdisciplinary communication and enhances patient care ⁴.

References:

1. Barbera, L., Seow, H., Howell, D., Sutradhar, R, Earle, C., Liu, Y, Stitt, A., Husain, A., Sussman, J., Dudgeon, D. (2010). Symptom burden and performance status in a population-based cohort of ambulatory cancer patients. Cancer. 116:5767-76.
2. Berry, D., Blumenstein, B., Halpenny, B., Wolpin, S., Fann, J., Austin-Seymour, M.,
3. Bush, N., Karras, B., Lober, W., McCorkle, R. (2011). Enhancing Patient-Provider Communication With the Electronic Self-Report Assessment for Cancer: A Randomized Trial. Journal of Clinical Oncology. 29:1029-1035.
4. Ruland, C., Holte, H., Roislien, J., Heaven, C., Hamilton, G., Kristiansen, J., Sandbaek, H., Kvaloy, S., Hasund, L., Ellison, M. (2010). Effects of a computer-supported interactive tailored patient assessment tool on patient care, symptom distress, and patients’ need for symptom management support: a randomized clinical trial. Journal American Medical Informatics Association. 17:403-410

​(Number of ESAS patient screens by Symptom by Low severity, Moderate Severity and High Severity / Number of ESAS patient screens by Symptom) x 100

• ​By FY 2015/2016
• Total All Cancers
• by Total Province
• by Symptom (Anxiety, Depression, Drowsiness, Lack of Appetite, Nausea, Pain, Shortness of Breath, Tiredness, Wellbeing)
• by Severity( Low, Moderate, High)

Activity Level Reporting

Symptom Management Database

​FY 15/16 (Apr 2015 to Mar 2016)

Number of ESAS patient screens by Symptom( Anxiety, Depression, Drowsiness, Lack of Appetite, Nausea, Pain, Shortness of Breath, Tiredness, Wellbeing)

Exclusions:

• Missing or invalid Patient Health Card Numbers (e.g. Value in (0,1)
• Out of Province Patient Health Card Numbers
• Patients with a non-cancer diagnosis(e.g. Non neoplastic diagnosis, Benign neoplasm, Uncertain unspecified, Unknowns)

​Number of ESAS patient screens by Symptom(Anxiety, Depression, Drowsiness, Lack of Appetite, Nausea, Pain, Shortness of Breath, Tiredness, Wellbeing) by Low severity, Moderate Severity and High Severity

Disease site information is derived by linking Patient Health Card Number in Symptom Management Database with Patient Health Card Number in Activity Level Reporting(ALR)

Exclusions:

• Missing or invalid Patient Health Card Numbers (e.g. Value in (0,1)
• Out of Province Patient Health Card Numbers
• Patients with a non-cancer diagnosis(e.g. Non neoplastic diagnosis, Benign neoplasm, Uncertain unspecified, Unknowns)

​ESAS Severity classification as follows:

• No Symptom, score=0
• Low Severity, score between 1 and 3(>=1 and <=3)
• Moderate Severity, score between 4 and 6(>=4 and <=6)
• High Severity, score= 7 to 10(>=7)

​Only select centres use electronic reporting formats (e.g., kiosks) for patients to report Edmonton Symptom Assessment System revised (ESAS-r) screening. Other centres rely on paper screens. Paper formats require data entry and may not be as accurate as the direct, electronic reporting of Edmonton Symptom Assessment System revised (ESAS-r) use and ESAS-r results.

​Percentage of patients who report that their healthcare team talked to them about symptoms on their YSM-General that concern them

Figures 3 and 4

• Person-centred care has been identified as one of CCO’s five areas of strategic focus. Computerized symptom screening tools, such as YSM-general, give patients a ‘voice’ – they serve as tools for patients to identify their symptom management needs to their health care team. Without clinician acknowledgement of patient reported symptoms, patient needs may not be addressed, thus increasing the risk of patient distress and a possible need for greater symptom management support downstream.
• This indicator serves as a critical starting point for the identification of possible gaps in the system and areas for improvement related to both provider access to patient reported symptom information, and around provider response to patient reported symptom information.
• Selection of this indicator for public reporting was confirmed by consensus of regional stakeholders, (including clinicians, administrators, and patient and family advisors). It is also similar to indicator from previous years.

• Ruland, C., Holte, H., Roislien, J., Heaven, C., Hamilton, G., Kristiansen, J., Sandbaek, H., Kvaloy, S., Hasund, L., Ellison, M. (2010). Effects of a computer-supported interactive tailored patient assessment tool on patient care, symptom distress, and patients’ need for symptom management support: a randomized clinical trial. Journal American Medical Informatics Association. 17:403-410
• Seow, H, Sussman, J, Martelli-Reid, L, Pond, G, Bainbridge, D. (2012). Do High Symptom Scores Trigger Clinical Actions? An Audit After Implementing Electronic Symptom Screening. Journal of Oncology Practice. 8(6): e142-e148.
• Pereira , J. L. Chasen, M.R., Molloy, S., Amernic, H., Brundage, M.D., Green, E., Tabing, R. et al. (2015). Cancer Care Professionals’ Attitudes Toward Systematic Symptom Assessment and the Edmonton Symptom Assessment System (ESAS) Following Large-Scale Population-Based Implementation in Ontario, Canada. Journal of pain and symptom management.

per 100

​Symptom Management Patient Experience Survey

​September 2016-January 2017

Total number of responses to question

Exclusions:

• Number of responses to response option ‘I have never filled in a symptom assessment form’
• Number of responses to response option ‘I usually do not have concerning symptoms to report’

​Number of patients who responded ‘always’ or ‘sometimes’ that their health care providers talk to them about their most concerning symptoms.

Percentage of patients who report that their healthcare team treats/manages their physical symptoms.​

Figures 5 and 6

• ​Cancer patients experience a high burden of physical symptoms, particularly pain, shortness of breath, and fatigue. Provider response to physical symptoms is important for reducing patient physical distress, improving quality of life, and potentially their need for greater symptom management support downstream. There are concerns that patients do not receive adequate symptom control. These results are important for the cancer system to consider in identifying gaps and opportunities for improvement.
• Selection of this indicator for public reporting was confirmed by consensus of regional stakeholders, (including clinicians, administrators, and patient and family advisors). It is also similar to indicator from previous years.

Barbera, L., Seow, H., Howell, D., Sutradhar, R, Earle, C., Liu, Y, Stitt, A., Husain, A., Sussman, J., Dudgeon, D. (2010). Symptom burden and performance status in a population-based cohort of ambulatory cancer patients. Cancer. 116:5767-76.

​(Number of patients who responded 'always' or 'sometimes' that their healthcare teamt treats/manages the physical symptoms of concern to them)/(Total number of resposnes - Number of responses to "I usually do not have any physical symptoms") * 100

per 100

​Symptom Management Patient Experience Survey

September 2016 -January 2017

Regional cancer centre

Total number of responses to question

Exclusions: Number of responses to response option ‘I usually do not have any physical symptoms’

Number of patients who responded ‘always’ or ‘sometimes’ that their physical symptoms were treated/managed.

​Percentage of patients who report that their health care team responds to their worries, concerns or feelings of sadness.

Figures 7 and 8

• Cancer patients experience a high burden of psychosocial symptoms such as depression. Provider response to these symptoms is important for reducing patient emotional distress, improving quality of life, and potentially their need for greater symptom management support downstream.
• Effective communication, including active listening, expressions of empathy and sensitivity to the experience of the person affected by cancer, has been shown to improve psychological adjustment, adherence to treatment plans and satisfaction with care.
• The provision of whole person care as reflected in the Cancer Care Ontario guideline ‘Psychosocial Health Care for Cancer Patients’ is essential. Whole person care includes not only cancer treatment and physical care but also identification of the individual’s psychosocial health needs and available resources to support them in managing the emotional, practical, social and spiritual elements of their experience.
• There are concerns that providers do not adequately respond to patient’s psychosocial symptom needs. These results are important for the cancer system to consider in identifying gaps and opportunities for improvement.
• Selection of this indicator for public reporting was confirmed by consensus of regional stakeholders, (including clinicians, administrators, and patient and family advisors). It is also similar to indicator from previous years.

• Adler NE, Page EK, editors. Cancer care for the whole patient: Meeting psychosocial health needs. Washington, D.C.: The National Academies Press, 2008.
• Epstein RM, Street RL. Patient-centered communication in cancer care: Promoting healing and reducing suffering. NIH Publication No. 07-6225. Bethesda, MD: National Cancer Institute, 2007.
• Hack TF, Degner LF, Parker PA. The communication goals and needs of cancer patients: A review. Psycho-Oncology. 2005; 14:831-845.
• Adamson et al. Understanding the Patients’ Perspective of Emotional Support. Healthcare Quarterly, 2012; 15(4): 63-69

​(Number of patients who reported that their healthcare team 'always' or 'sometimes' responded to their worries, concerns or feelings of sadness)/(Total number of responses - Number of responses to "I usually do not have worries, concerns or feelings of sadness') * 100

​Per 100

​Symptom Management Patient Experience Survey

​September 2016 - January 2017

​Regional cancer centre

Total number of responses for question

Exclusions: Number of responses to response option “I usually do not have worries, concerns of feelings of sadness”

​Number of patients who reported that their care team ‘always’ or ‘sometimes’ responds to their worries, concerns or feelings of sadness.

Percentage of patients who report that their health care team includes them in decisions about how to treat/manage their symptoms.

Figures 9 and 10

• Person-centred care is one of CCO’s five areas of strategic focus, with ‘respect for patients’ preferences’ identified as a key dimension of person-centred care. Evidence suggests that there is sometimes a mismatch between patients’ preferred and actual roles during decision making.
• As Stewart et al. (2003) suggest, “being patient-centred means taking into account the patients’ desire for information and for sharing decision-making and responding appropriately” (p. 13).
• When patients who prefer to participate are included in care decisions, there is some evidence to suggest that they are more likely to adhere to treatments.
• Selection of this indicator for public reporting was confirmed by consensus of regional stakeholders, (including clinicians, administrators, and patient and family advisors).

• Coulter A. (2003). Patient Information and Shared Decision-Making in Cancer Care. British Journal of Cancer. 89(Suppl. 1):515-516.
• Stewart, M, Belle Brown, J, Weston, WW, McWhinney IR, McWilliam CL, Freeman TR. (2003). Patient-Centred Medicine: Transforming the Clinical Method. (2nd ed.). Abingdon, UK: Radcliffe Medical Press Ltd.
• Tariman, J.D. et al. Preferred and actual participation roles during health care decision making in persons with cancer: a systematic review. Annals of Oncology, 2010; 21: 1145-1151.

​(Number of patients who reported that their healthcare team 'always' or 'sometimes' included them in decisions about how to treat/manage their symptoms)/[Total number of responses - (Number of responses to preferences for healthcare team to make decisions + Number of responses to not having symptoms)] * 100

​Per 100

Symptom Management Patient Experience Survey

​September 2016 - January 2017

Regional cancer centre

Total number of responses to question

Exclusions:

• Number of responses to response option ‘I prefer that my health care team always makes the decisions about how to treat/manage my symptoms’
• Number of responses to response option ‘I usually do not have any symptoms’

​Number of patients who reported that their health care team always or sometimes includes them in decisions about how to treat/manage their symptoms.