Improving Recovery after Major Cancer Surgery using Patient-Reported Outcomes

项目总结/文摘

PROJECT SUMMARY/ABSTRACT Increasing utilization of patient-reported outcomes (PROs) in clinical practice may lead to better postop- erative outcomes, with pain assessment and management as an excellent example. Although PROs are widely accepted in clinical research in medical and radiation oncology and are endorsed by the US Food & Drug Ad- ministration, the introduction of subjective outcomes is relatively novel in perioperative care practice― despite the fact that PROs are the best resource for defining and measuring the patient’s perspective of symp- tomatic and functional recovery after major cancer surgery and that the information they provide could poten- tially guide care during recovery. A major knowledge gap is that, although validated PRO tools exist, there are no established, user-friendly clinical methods for understanding and responding to symptom and function- al-status reports from patients after complex major surgery. The goal of our study is to establish a framework for clinical adoption of PROs, to define methods needed to interpret PRO data from the MD Anderson Symp- tom Inventory (MDASI), and to examine the MDASI’s clinical utility and patient and professional perspectives on using it in future practice. If we are successful, PROs could be added to well-defined, traditional metrics in perioperative care, such as decreased 30-day mortality, fewer complications, shortened hospital stays, and few- er hospital readmissions. The increasing inclusion of PRO portals in electronic medical record systems (such as EPIC) that can longitudinally track patient report away from the hospital make this approach feasible. Given EPIC’s decision to include the MDASI nationwide (also at MD Anderson Cancer Center), we believe we have a timely opportunity to provide the first evidence-based package to support implementation of the MDASI in perioperative care. At MD Anderson, perioperative recovery is being further improved by incorporation of an Enhanced Recovery Program (ERP) that challenges traditional surgical practices. The need to effectively com- pare ERP and traditional surgery outcomes exemplifies the urgency of this project. We propose a longitudinal clinical study, plus a survey of professionals to identify/address barriers to the use of PROs. We have assem- bled a strong multidisciplinary team from symptom research, surgical nursing, surgery, and anesthesiology to study patients undergoing surgery for gastrointestinal, gynecologic, or genitourinary cancer. Aim 1: Establish PRO-based methods to determine clinically meaningful postoperative symptom burden. Gap addressed: lack of quantitatively defined, procedure-specific symptom profiles and severity thresholds for managing moderate to severe symptoms, especially postdischarge. Aim 2: Establish PRO-based methods to evaluate postoperative functional recovery. Gap addressed: lack of empirical data on self-reported functional recovery to indicate readiness to resume planned oncology care or return to normal activities. Aim 3: Examine the utility of PROs as a postoperative outcome measure through a PRO study in patients and a “probe” observational study of cli- nicians. Gap addressed: lack of evidence about how the availability of PROs might alter clinical practice.