Evaluation of Health Care Professional Response To Patient-Reported Distress In Gynecologic Oncology Clinics At An Academic Cancer Centre

Objective: To evaluate health care professional (HCP) documentation of elevated patient-reported symptoms and subsequent intervention in gynecologic oncology clinics. Methods: This was a retrospective chart review of gynecologic oncology patients within a single institution. Prior to their clinical encounter, patients complete the validated Edmonton Symptom Assessment System revised (ESAS-r) questionnaire. Patients with any ESAS-r symptom score ≥4 (moderate-severe) were eligible for analysis. A stratified sampling method was used: 100 patients were randomly selected with 20 patients per year from 2012 to 2016. Patient, tumor and treatment characteristics were extracted from medical records. Health care provider (HCP) documentation of elevated symptoms and subsequent intervention were evaluated. Descriptive statistics were used to report symptom prevalence, HCP documentation and intervention. Fisher’s exact test evaluated documentation and intervention rates according to symptom severity and total ESAS-r score. Results: Between January 2012 and December 2016, 5849 patients completed the ESAS-r. Symptoms scores were ≥ 4 in 3216 patients (55%). In our sample of 100, ovarian (42%) and endometrial (34%) malignancies were most common. Median age was 55 years (range 47-63). Median ESAS-r score was 24 (range: 5-84), with tiredness being the most prevalent symptom reported by patients. HCP documented at least one elevated symptom in 50 patients (50%), most commonly for pain (71%) and least commonly for nausea (4%). Subsequent interventions were offered to only 32 patients (32%), most commonly for pain (56%). Higher median total ESAS-r score was associated with higher rate of documentation (p=0.004) and higher rate of intervention (p<0.001). Conclusions: A significant proportion of gynecologic oncology patients report symptom that should prompt an intervention. However, HCPs documented symptoms in only half of patients and reported interventions in only one third. These results highlight gaps and opportunities for improving symptom screening and response in the “real-world” setting.