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Cancer Care Coordination: a Systematic Review and Meta-Analysis of Over 30 Years of Empirical Studies

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

According to a landmark study by the Institute of Medicine, patients with cancer often receive poorly coordinated care in multiple settings from many providers. Lack of coordination is associated with poor symptom control, medical errors, and higher costs.

Purpose

The aims of this systematic review and meta-analysis were to (1) synthesize the findings of studies addressing cancer care coordination, (2) describe study outcomes across the cancer continuum, and (3) obtain a quantitative estimate of the effect of interventions in cancer care coordination on service system processes and patient health outcomes.

Methods

Of 1241 abstracts identified through MEDLINE, EMBASE, CINAHL, and the Cochrane Library, 52 studies met the inclusion criteria. Each study had US or Canadian participants, comparison or control groups, measures, times, samples, and/or interventions. Two researchers independently applied a standardized search strategy, coding scheme, and online coding program to each study. Eleven studies met the additional criteria for the meta-analysis; a random effects estimation model was used for data analysis.

Results

Cancer care coordination approaches led to improvements in 81 % of outcomes, including screening, measures of patient experience with care, and quality of end-of-life care. Across the continuum of cancer care, patient navigation was the most frequent care coordination intervention, followed by home telehealth; nurse case management was third in frequency. The meta-analysis of a subset of the reviewed studies showed that the odds of appropriate health care utilization in cancer care coordination interventions were almost twice (OR = 1.9, 95 % CI = 1.5–3.5) that of comparison interventions.

Conclusions

This review offers promising findings on the impact of cancer care coordination on increasing value and reducing healthcare costs in the USA.

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Acknowledgements

The authors would like to acknowledge the assistance of National Institutes of Health Library staff members Josh Duberman, Verma Walker, Brigit Sullivan, and Betty Murgolo, who retrieved papers for the study team; Eboneé Butler, University of North Carolina, Chapel Hill, who created the study databases; Dr. Nancy Payte, Westat, who adjudicated some conflicting studies and provided an initial tabular summary of the findings; Erica Evans, VA Medical Center, and Howard Wong, New York University, VA Medical Center, who assisted with the references; and Anne Rodgers, for her careful text editing. The authors thank Dr. Sara J Knight, Health Services Research and Development Programs, Birmingham and Tuscaloosa Department of Veterans Affairs Medical Centers, Division of Preventive Medicine, School of Medicine, The University of Alabama at Birmingham, whose writing enriched the behavioral medicine description. Dr. Sheinfeld Gorin received funding as PI from NCI, SAIC/Leidos Subcontract no. 13XS087.

Notes: The study was performed by a work group under the aegis of the National Cancer Institute (NCI) Quality of Cancer Care Committee Care Coordination Initiative (QCCC_CCI), a 14-federal agency partnership network whose aim is to systematically evaluate coordination of cancer care measures for implementation in diverse healthcare systems. The partners include the Veterans Health Administration (VHA), Health Resources and Services Administration (HRSA), Agency for Healthcare Research and Quality (AHRQ), CMS, and Indian Health Service (IHS), with administrative linkage to the then–National Community Cancer Centers Program (NCCCP).

Earlier versions of this paper were presented to the American Society of Clinical Oncology (ASCO), June 2013, to ASCO’s Quality Care Symposium, November 2013, to the Society of Behavioral Medicine, 2013, and to CA-PRI, May, 2015.

Author information

Authors and Affiliations

  1. National Cancer Institute (NCI; Leidos Biomedical Research, Inc.), Bethesda, MD, USA

    Sherri Sheinfeld Gorin PhD

  2. New York Physicians Against Cancer (NYPAC), New York, NY, USA

    Sherri Sheinfeld Gorin PhD

  3. VA HSR&D Center for Health Information and Communication, Regenstrief Institute, Inc., Indiana University School of Medicine, Indianapolis, USA

    David Haggstrom MD, MAS

  4. Maine Medical Center Research Institute, Scarborough, ME, USA

    Paul K. J. Han MD, MA, MPH & Kathleen M. Fairfield MD

  5. VA Medical Center, New York University, New York, NY, USA

    Paul Krebs PhD

  6. Patient-Centered Outcomes Research Institute (PCORI), Washington, DC, USA

    Steven B. Clauser PhD

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  1. Sherri Sheinfeld Gorin PhD
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  2. David Haggstrom MD, MAS
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  4. Kathleen M. Fairfield MD
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  6. Steven B. Clauser PhD
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Corresponding author

Correspondence to Sherri Sheinfeld Gorin PhD.

Ethics declarations

None of the co-authors of the manuscript, Drs. Sheinfeld Gorin, Haggstrom, Han, Fairfield, Krebs, or Clauser, have any conflicts of interest with consultancies, employment, honoraria, stock ownership, expert testimony, grants, patents, or royalties. During the study period, Dr. Sheinfeld Gorin was employed by Leidos Biomedical Research, Inc. as a senior scientific consultant to the National Cancer Institute. Both the systematic review and meta-analysis adhere to the PRISMA guidelines. The meta-analysis is based upon patient-level data. All authors have agreed to abide by the relevant ethical standards.

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Gorin, S.S., Haggstrom, D., Han, P.K.J. et al. Cancer Care Coordination: a Systematic Review and Meta-Analysis of Over 30 Years of Empirical Studies. ann. behav. med. 51, 532–546 (2017). https://doi.org/10.1007/s12160-017-9876-2

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