​Our quality of life results

Assessment methodology

Cancer Treatment Centers of America® (CTCA) was among the first U.S. cancer hospitals to use quality of life metrics as part of its routine assessment of patient well-being and quality of care. Research demonstrates Patient Self-Reported Outcome (PSRO) data are a valuable part of a patient’s treatment plan. Several studies validate the potential of routine assessment data in improving both the precision and degree of patient centered care – making sure the right care is delivered to the right patients at the right time. The benefits of PSRO data not only include better health-related quality of life and fewer emergency room visits, but also improvements in health service outcomes and survival.®1,2,3

For patients with severe baseline scores (7 or greater on a 0 to 10 scale with 0 being “non-existent” and 10 being “as bad as one can imagine/greatly interfered”), a two-point change in score is clinically relevant and significant, with respect to the symptom getting better, remaining constant or getting worse. The data reflect more than 8,692 patients completing a second return assessment from baseline between July 1, 2017 and June 30, 2019, with 2,272 deemed severe.

CTCA® patients self-report their symptoms and quality of life concerns as part of our patient evaluation process. This process includes a symptom assessment, called the Symptom Inventory Tool (SIT), that patients complete in correspondence with their treatment cycle, not more frequently than every 21 days. Upon arrival, patients complete the electronically administered SIT using a tablet computer. CTCA team members utilize these results as part of their patient assessment and evaluation process. These two complementary processes (patient self-assessment and reflection, and analyzing the data as a starting point for discussion) help CTCA care teams readily identify when patients may benefit from referral and/or more directed intervention to help them cope with their symptoms, side effects and quality of life concerns. The data also exist real-time within the electronic health record. More than 94 percent of patients voluntarily participate in the SIT assessments.

The SIT includes 27 items: 13 core symptom questions (box 1) and six questions related to issues that interfere with patients’ everyday functioning (box 2). These 19 questions mirror the MD Anderson Symptom Inventory (MDASI) tool used by many U.S. hospitals. MDASI, which assesses both the severity and impact of patients’ symptoms and quality of life issues, has been psychometrically validated and tested. It is also endorsed by the National Cancer Institute. CTCA has added eight (8) questions to the patient assessment process that our medical and care teams consider clinically relevant (box 3).

Box 1: Core Symptoms Box 2: Interference Issues Box 3: Additional Areas of Focus
• Pain
• Fatigue (tiredness)
• Nausea
• Disturbed sleep
• Distressed (upset)
• Shortness of breath
• Remembering things (memory)
• Lack of appetite
• Drowsy (sleepy)
• Dry mouth
• Feeling sad
• Vomiting
• Numbness or tingling
• General activity
• Mood
• Working (including around the house)
• Relations with others
• Walking
• Enjoyment of life
• Constipation/diarrhea
• Swelling (fluid retention)
• Mouth soreness
• Problems with bleeding
• Sexual interest
• Family response
• Sense of hope
• Overall quality of life

1 Basch E, Deal AM, Kris MG, et al: Symptom monitoring with patient-reported outcomes during routine cancer treatment: A randomized controlled trial. J Clin Oncol 10.1200/JCO.2015.63.0830.

2 Jensen R, Snyder CF: PRO-cision Medicine: Personalizing Patient Care Using Patient-Reported Outcomes. J Clin Oncol 10.1200/JCO.2015.63.0830.

3 Snyder CF, Herman JM, White SM, et al: When using patient-reported outcomes in clinical practice, the measure matters: A randomized controlled trial. J Oncol Pract 10:e299-e306, 2014.