Case management used to optimize cancer care pathways: a systematic review

Area of Science:

• Oncology
• Healthcare Management
• Evidence-Based Practice

Background:

• Cancer patient care pathways often lack adequate support and are poorly studied.
• Case management (CM) presents a potential method for cost-effective, high-quality, patient-centered cancer care.
• Randomized controlled trials (RCTs) are crucial for evaluating interventions in cancer care.

Purpose of the Study:

• To systematically review and summarize the characteristics, outcomes, results, and validity of published RCTs on CM in optimizing cancer care pathways.
• To assess the current evidence base for CM interventions in cancer patient care.

Main Methods:

• Systematic search of multiple databases (PubMed, Embase, Web of Science, CINAHL, Cochrane) up to August 2008.
• Inclusion criteria focused on RCTs of CM interventions for cancer patient care, involving multidisciplinary collaboration, care coordination, and patient-case manager meetings.
• Exclusion of studies on cancer screening or palliative care; validity assessed using CONSORT guidelines.

Main Results:

• The systematic search identified 654 unique papers, with 25 retrieved for scrutiny, and only seven ultimately included in the review.
• Significant heterogeneity was observed across the included studies regarding target groups, intervention settings, measured outcomes, and methodologies.
• Intervention characteristics, outcomes, findings, and methodological aspects were highly diverse among the seven included RCTs.

Conclusions:

• Due to the limited number of studies and significant heterogeneity, no definitive conclusions can be drawn regarding the effect of CM on cancer patient care.
• Case management's impact is often unclear ('black box'), hindering the identification of specific effective components.
• Further rigorously designed RCTs are necessary to elucidate the mechanisms and effectiveness of CM interventions in diverse cancer care settings.