The detection and treatment of cancer-related functional problems in an outpatient setting

Goals of work: Cancer causes functional problems that are often neither detected nor treated in the outpatient setting. Patient-physician communication regarding functional issues may contribute. This study was conducted to quantify the degree of concordance between patient-identified functional problems and their documentation in the oncology-generated medical record. Materials and methods: We administered a 27-item questionnaire addressing cancer-related symptoms, signs, and functional problems to a consecutive sample of 244 patients undergoing outpatient cancer treatment. Oncology clinician-generated notation in the electronic medical record (EMR) was systematically reviewed for documentation of the instrument items. EMR review began the day of instrument completion and extended retrospectively for 6 months. Main results: Eighty-three percent (202) completed the survey with at least one cancer-related symptom, sign, or functional problem identified by 71.8%, 33.2% and 65.8% of patients, respectively. Difficulty with ambulation (23.9%) and balance (19.4%) were the most frequent functional problems. Clinician notes referred to 49% of patients' symptoms, but only 37% of their signs and 6% of their functional problems. Pain, weight loss, and nausea (ORs>4.9, p<0.004) were most likely to be documented while functional problems (OR 0.2, p<0.0001) were the least likely to be noted. Two rehabilitation physician referrals were generated for pain and limb swelling, but no functional problems were formally addressed. Conclusion: Functional problems are prevalent among outpatients with cancer and are rarely documented by oncology clinicians. A more aggressive search for, and treatment of, these problems may be beneficial for outpatients with cancer.