Use of patient-reported outcomes in regional cancer centres over time: a retrospective study

Since 2007, Cancer Care Ontario has been collecting data using the Edmonton Symptom Assessment System as a patient-reported outcome measure for use in routine care. The purpose of this project was to evaluate the factors associated with Edmonton Symptom Assessment System uptake among cancer patients seen at regional cancer centres and to examine if these associations have changed over time.

This was a retrospective cohort study among cancer patients eligible to complete Edmonton Symptom Assessment System assessments who were seen at regional cancer centres in Ontario between 2007 and 2015. We used linked administrative sources of health care data. Our primary outcome for each patient was defined as the rate of ESAS assessments, which was analyzed overall and on an annual basis.

We identified 525 409 unique patients with at least 1 visit to a cancer centre during the study period. The percentage of patients with at least 1 Edmonton Symptom Assessment System assessment increased from 5% in 2007 to 67% in 2015. Analysis demonstrated that variation by region and by cancer type decreased over time: relative rates for region ranged from 0.31 to 13.3 in 2007 whereas they ranged from 0.7 to 1.56 in 2015, and relative rates for cancer type ranged from 0.03 to 1.0 in 2007 whereas they ranged from 0.55 to 1.0 in 2015. In 2015 women and people living in poorer neighbourhoods had a lower Edmonton Symptom Assessment System uptake (relative rate 0.93 and 0.91, respectively).

Ontario has implemented a patient-reported outcome program across the province; over time, uptake has improved and variation by cancer type and region has decreased. Variation persists for other patient characteristics, which suggests that there are opportunities to improve equity in the program.