Improving management of comorbidity in patients with colorectal cancer using comprehensive medical assessment: a pilot study
Abstract Background Screening for and active management of comorbidity soon after cancer diagnosis shows promise in altering cancer treatment and outcomes for comorbid patients. Prior to a large multi-centre study, piloting of the intervention (comprehensive medical assessment) was undertaken to inv...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2020-01-01
|
| Series: | BMC Cancer |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12885-020-6526-z |
| _version_ | 1818382672029810688 |
|---|---|
| author | Virginia Signal Christopher Jackson Louise Signal Claire Hardie Kirsten Holst Marie McLaughlin Courtney Steele Diana Sarfati |
| author_facet | Virginia Signal Christopher Jackson Louise Signal Claire Hardie Kirsten Holst Marie McLaughlin Courtney Steele Diana Sarfati |
| author_sort | Virginia Signal |
| collection | DOAJ |
| description | Abstract Background Screening for and active management of comorbidity soon after cancer diagnosis shows promise in altering cancer treatment and outcomes for comorbid patients. Prior to a large multi-centre study, piloting of the intervention (comprehensive medical assessment) was undertaken to investigate the feasibility of the comorbidity screening tools and proposed outcome measures, and the feasibility, acceptability and potential effect of the intervention. Methods In this pilot intervention study, 72 patients of all ages (36 observation/36 intervention) with newly diagnosed or recently relapsed colorectal adenocarcinoma were enrolled and underwent comorbidity screening and risk stratification. Intervention patients meeting pre-specified comorbidity criteria were referred for intervention, a comprehensive medical assessment carried out by geriatricians. Each intervention was individually tailored but included assessment and management of comorbidity, polypharmacy, mental health particularly depression, functional status and psychosocial issues. Recruitment and referral to intervention were tracked, verbal and written feedback were gathered from staff, and semi-structured telephone interviews were conducted with 13 patients to assess screening tool and intervention feasibility and acceptability. Interviews were transcribed and analysed thematically. Patients were followed for 6–12 months after recruitment to assess feasibility of proposed outcome measures (chemotherapy uptake and completion rates, grade 3–5 treatment toxicity, attendance at hospital emergency clinic, and unplanned hospitalisations) and descriptive data on outcomes collated. Results Of the 29 intervention patients eligible for the intervention, 21 received it with feedback indicating that the intervention was acceptable. Those in the intervention group were less likely to be on 3+ medications, to have been admitted to hospital in previous 12 months, or to have limitations in daily activities. Collection of data to measure proposed outcomes was feasible with 55% (6/11) of intervention patients completing chemotherapy as planned compared to none (of 14) of the control group. No differences were seen in other outcome measures. Overall the study was feasible with modification, but the intervention was difficult to integrate into clinical pathways. Conclusions This study generated valuable results that will be used to guide modification of the study and its approaches prior to progressing to a larger-scale study. Trial registration Retrospective, 26 August 2019, ACTRN12619001192178. |
| first_indexed | 2024-12-14T02:54:11Z |
| format | Article |
| id | doaj.art-eb57d888e56c45c6b39adf17520a8a9c |
| institution | Directory Open Access Journal |
| issn | 1471-2407 |
| language | English |
| last_indexed | 2024-12-14T02:54:11Z |
| publishDate | 2020-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cancer |
| spelling | doaj.art-eb57d888e56c45c6b39adf17520a8a9c2022-12-21T23:19:41ZengBMCBMC Cancer1471-24072020-01-0120111010.1186/s12885-020-6526-zImproving management of comorbidity in patients with colorectal cancer using comprehensive medical assessment: a pilot studyVirginia Signal0Christopher Jackson1Louise Signal2Claire Hardie3Kirsten Holst4Marie McLaughlin5Courtney Steele6Diana Sarfati7Department of Public Health, University of OtagoDepartment of Medicine, University of Otago, Dunedin: Southern Blood and Cancer Service, Southern District Health BoardDepartment of Public Health, University of OtagoSchool of Medicine and Health Sciences at Palmerston North, University of Otago, Wellington: Cancer Screening Treatment and Support, MidCentral District Health BoardElder Health, MidCentral District Health BoardDepartment of Medicine, University of Otago, Dunedin: Older Persons Health, Southern District Health BoardDepartment of Public Health, University of OtagoDepartment of Public Health, University of OtagoAbstract Background Screening for and active management of comorbidity soon after cancer diagnosis shows promise in altering cancer treatment and outcomes for comorbid patients. Prior to a large multi-centre study, piloting of the intervention (comprehensive medical assessment) was undertaken to investigate the feasibility of the comorbidity screening tools and proposed outcome measures, and the feasibility, acceptability and potential effect of the intervention. Methods In this pilot intervention study, 72 patients of all ages (36 observation/36 intervention) with newly diagnosed or recently relapsed colorectal adenocarcinoma were enrolled and underwent comorbidity screening and risk stratification. Intervention patients meeting pre-specified comorbidity criteria were referred for intervention, a comprehensive medical assessment carried out by geriatricians. Each intervention was individually tailored but included assessment and management of comorbidity, polypharmacy, mental health particularly depression, functional status and psychosocial issues. Recruitment and referral to intervention were tracked, verbal and written feedback were gathered from staff, and semi-structured telephone interviews were conducted with 13 patients to assess screening tool and intervention feasibility and acceptability. Interviews were transcribed and analysed thematically. Patients were followed for 6–12 months after recruitment to assess feasibility of proposed outcome measures (chemotherapy uptake and completion rates, grade 3–5 treatment toxicity, attendance at hospital emergency clinic, and unplanned hospitalisations) and descriptive data on outcomes collated. Results Of the 29 intervention patients eligible for the intervention, 21 received it with feedback indicating that the intervention was acceptable. Those in the intervention group were less likely to be on 3+ medications, to have been admitted to hospital in previous 12 months, or to have limitations in daily activities. Collection of data to measure proposed outcomes was feasible with 55% (6/11) of intervention patients completing chemotherapy as planned compared to none (of 14) of the control group. No differences were seen in other outcome measures. Overall the study was feasible with modification, but the intervention was difficult to integrate into clinical pathways. Conclusions This study generated valuable results that will be used to guide modification of the study and its approaches prior to progressing to a larger-scale study. Trial registration Retrospective, 26 August 2019, ACTRN12619001192178.https://doi.org/10.1186/s12885-020-6526-zNeoplasmsComorbidityHealth servicesQuality improvementInterventionsChemotherapy tolerance |
| spellingShingle | Virginia Signal Christopher Jackson Louise Signal Claire Hardie Kirsten Holst Marie McLaughlin Courtney Steele Diana Sarfati Improving management of comorbidity in patients with colorectal cancer using comprehensive medical assessment: a pilot study BMC Cancer Neoplasms Comorbidity Health services Quality improvement Interventions Chemotherapy tolerance |
| title | Improving management of comorbidity in patients with colorectal cancer using comprehensive medical assessment: a pilot study |
| title_full | Improving management of comorbidity in patients with colorectal cancer using comprehensive medical assessment: a pilot study |
| title_fullStr | Improving management of comorbidity in patients with colorectal cancer using comprehensive medical assessment: a pilot study |
| title_full_unstemmed | Improving management of comorbidity in patients with colorectal cancer using comprehensive medical assessment: a pilot study |
| title_short | Improving management of comorbidity in patients with colorectal cancer using comprehensive medical assessment: a pilot study |
| title_sort | improving management of comorbidity in patients with colorectal cancer using comprehensive medical assessment a pilot study |
| topic | Neoplasms Comorbidity Health services Quality improvement Interventions Chemotherapy tolerance |
| url | https://doi.org/10.1186/s12885-020-6526-z |
| work_keys_str_mv | AT virginiasignal improvingmanagementofcomorbidityinpatientswithcolorectalcancerusingcomprehensivemedicalassessmentapilotstudy AT christopherjackson improvingmanagementofcomorbidityinpatientswithcolorectalcancerusingcomprehensivemedicalassessmentapilotstudy AT louisesignal improvingmanagementofcomorbidityinpatientswithcolorectalcancerusingcomprehensivemedicalassessmentapilotstudy AT clairehardie improvingmanagementofcomorbidityinpatientswithcolorectalcancerusingcomprehensivemedicalassessmentapilotstudy AT kirstenholst improvingmanagementofcomorbidityinpatientswithcolorectalcancerusingcomprehensivemedicalassessmentapilotstudy AT mariemclaughlin improvingmanagementofcomorbidityinpatientswithcolorectalcancerusingcomprehensivemedicalassessmentapilotstudy AT courtneysteele improvingmanagementofcomorbidityinpatientswithcolorectalcancerusingcomprehensivemedicalassessmentapilotstudy AT dianasarfati improvingmanagementofcomorbidityinpatientswithcolorectalcancerusingcomprehensivemedicalassessmentapilotstudy |