Disease-Specific Patient-Reported Outcome Tool in Head and Neck Cancer Patients

Abstract

Problem and Purpose: Head and neck cancers (HNC) have a five-year survival rate of 62%. The effects of treatment and the disease can be debilitating. Symptoms are subjective and frequently go undetected during clinic visits. Patient reported outcome tools (PROs) provide a quantitative measurement of symptoms and improve symptom management, communication, and patient satisfaction. The Functional Assessment of Cancer Therapy: Head and Neck Symptom Index (FACT: HNSI) is a validated and reliable PRO which can improve symptom reporting and management for HNC patients. The purpose of this project was to implement this tool among HNC patients receiving treatment. Methods: Structure changes included imbedding the PRO in the patient portal. Process changes included patients completing weekly PROs, treatment team reviewing responses during visits and integrating results in progress notes. A retrospective chart audit evaluated staff’s consistency of capturing symptoms listed in the FACT: HNSI prior to implementation. Descriptive data was used to evaluate compliance and effectiveness of implementation. Pre- and post-implementation surveys were administered to staff to evaluate perceptions of the PRO. Patient compliance was defined as percentage of patients who successfully completed the PRO compared to the number who agreed to participate each week. Staff compliance was defined as the percentage of staff who used the smartphrase in patient progress notes compared to the number of patients who completed a PRO each week. Results: The integration of the PRO into the patient portal was essential to the success of the project. Overall patient compliance was 68.2% while staff compliance was 78.8%. Staff opinions of the project improved by 0.38-1.37 points on a five-point scale between the pre- and post-implementation surveys. The chart audit revealed 46% of the symptoms listed in the FACT: HNSI were routinely captured before implementation. Conclusion: The culture of the organization supported adaptation of PROs in outpatient oncology. Staff education and development of an HNC note template will take place for future sustainability. The FACT: HNSI is a useful tool for the HNC population. Other facilities treating outpatient HNC patients should incorporate PROs to improve the detection and management of symptoms, and patient and staff communication.