The detection and treatment of cancer-related functional problems in an outpatient setting
Goals of work
Cancer causes functional problems that are often neither detected nor treated in the outpatient setting. Patient–physician communication regarding functional issues may contribute. This study was conducted to quantify the degree of concordance between patient-identified functional problems and their documentation in the oncology-generated medical record.
Materials and methods
We administered a 27-item questionnaire addressing cancer-related symptoms, signs, and functional problems to a consecutive sample of 244 patients undergoing outpatient cancer treatment. Oncology clinician-generated notation in the electronic medical record (EMR) was systematically reviewed for documentation of the instrument items. EMR review began the day of instrument completion and extended retrospectively for 6 months.
Eighty-three percent (202) completed the survey with at least one cancer-related symptom, sign, or functional problem identified by 71.8%, 33.2% and 65.8% of patients, respectively. Difficulty with ambulation (23.9%) and balance (19.4%) were the most frequent functional problems. Clinician notes referred to 49% of patients’ symptoms, but only 37% of their signs and 6% of their functional problems. Pain, weight loss, and nausea (ORs > 4.9, p < 0.004) were most likely to be documented while functional problems (OR 0.2, p < 0.0001) were the least likely to be noted. Two rehabilitation physician referrals were generated for pain and limb swelling, but no functional problems were formally addressed.
Functional problems are prevalent among outpatients with cancer and are rarely documented by oncology clinicians. A more aggressive search for, and treatment of, these problems may be beneficial for outpatients with cancer.
KeywordsCommunication Function Rehabilitation Documentation Symptom
- 7.Cheville AL, Troxel AB, Basford JR, Kornblith AB. Prevalence and treatment patterns of physical impairments in patients with metastatic breast cancer. J Clin Oncol (in press)Google Scholar
- 11.Kraft GAA (1996) Effect of resistive exercise on physical function in multiple sclerosis. Veterans Aff Rehab Res Dev Prog 33:328–329Google Scholar
- 15.Abrams WBM, Berkow R (1995) The Merck manual of geriatrics, 2nd edn. Merck Research Laboratories, Whitehouse StationGoogle Scholar
- 24.Society AC (2007) Cancer facts & figures 2007. American Cancer Soceity, AtlantaGoogle Scholar
- 25.Surveillance E, and End Results (SEER) Program (www.seer.cancer.gov) Limited-use data (1973–2004). National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch