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

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.

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.

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.

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.