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Excellent Care for All

The Ontario Cancer Symptom Management Collaborative (OCSMC)

Health Care Challenge

Cancer patients face many challenges as they battle the disease. They often experience a range of physical and emotional symptoms associated with coping with their illness and treatment, including pain, fatigue, depression and shortness of breath.

Supporting health care providers to better monitor and effectively manage the symptoms of cancer patients can improve their quality of life and well being. But research shows that clinicians can fail to recognize 50 to 80 per cent of cancer patient concerns during consultations. This can result in inadequate and inconsistent symptom management for patients.

Real Change In Action

Cancer Care Ontario (CCO) launched an initiative to promote a set of accessible and standardized symptom assessment and management tools that put patients at the forefront. “Patient self-reporting of symptoms is the ‘gold standard’. The person experiencing the symptoms is better at describing the symptom and what impact that has,” said Esther Green, provincial head, nursing and psychosocial oncology at CCO.

“The symptom assessment tool represents a starting point for dialogue between patients and clinicians. It provides them with a common language” added Susan King, provincial improvement co-ordinator, OCSMC.

Edmonton Symptom Assessment System (ESAS)

ESAS is a validated, patient-reported assessment tool that screens for nine common symptoms experienced by cancer patients. Using ESAS, patients respond to a short questionnaire that rates the severity of their current symptoms. “It allows clinicians to better focus the discussion and drill down on the concerns that are a priority to the patient,’ King said.  Early identification and communication of symptoms improve care planning and symptom management, she explained.

CCO’s aim is that seventy per cent of all cancer patients visiting regional cancer centres in Ontario will be screened using ESAS in 2011-12.

A CCO survey of 2,921 patients from 14 Regional Cancer Centres in 2010 found the following :


Green noted that clinicians do not report that using ESAS has negatively impacted on the length of their consultations with patients; in fact, clinicians report that this helps them to focus on the symptoms that distress the patients.

Interactive Symptom Assessment and Collection (ISAAC)

ISAAC is an easy-to-use e-tool developed and hosted by CCO.  It puts patients in control of their own symptom assessment using ESAS, while allowing clinicians to track their symptoms over time and across care settings.

Touch screen kiosks using ISAAC were set up at Regional Cancer Centres across Ontario starting in 2007. As of March 2011, 53 per cent of cancer patients were being screened monthly – representing 337,000 assessments in the past year. A cancer patient completes the 3 minute assessment at the kiosk at the start of their appointment and retrieves a printout with their responses to share with their health care providers. The results are also automatically sent to the hospital’s electronic health record, where they exist.

The computerized screening has been found to be more accurate than in-person interviews in gathering sensitive information. “Patients may respond more candidly to a faceless computer about feelings such as depression, than if asked directly by a health care provider,” King pointed out.

Use of ISAAC by patients to screen their symptoms from their home computer or telephone is also being explored by a number of hospitals and Community Care Access Centres.

Symptom Management Guides

CCO developed Symptom Management Guides linked to ESAS in 2010. The guides act as a resource to support health care providers in assessing and appropriately responding to cancer-related symptoms.

The guides focus on a range of individual symptoms – from pain to anxiety – and are posted on the CCO website. They are available in a range of formats to best suit the needs of the provider, including a condensed pocket-sized guide and an app for mobile devices.

There were more than 13,500 downloads of the guides from the CCO website in the first eight months they became available. While the mobile app received over 1,500 downloads between February and June 2011. “Having a decision-making support tool in an electronic format makes it very accessible for health care providers at the point of care,” Green said.

Better Quality, Sustainable Care

Appropriately monitoring symptoms of patients over time and across care settings will improve overall patient care. Information generated by CCO’s symptom management database will inform future planning and impact on system outcomes.

CCO’s symptom management tools have the capacity to empower both patients and health care providers alike. “It comes down to improving the quality of life for patients physically and emotionally,” Green said. “When a cancer patient’s symptoms are appropriately addressed it gives them a better quality of life and may also help them to live longer.”

Learn more about the Ontario Cancer Symptom Management Collaborative (OCSMC) for the improvement of patient journeys.

Contact person :
Susan King
Provincial Improvement Coordinator
Ontario Cancer Symptom Management Collaborative (OCSMC)
Cancer Care Ontario
Email: Susan.King@cancercare.on.ca

For More Information

Call ServiceOntario, Infoline at 1-866-532-3161
In Toronto, 416-314-5518
TTY 1-800-387-5559
In Toronto, TTY 416-327-4282
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