title: Quality of supportive care for patients with advanced cancer in a VA medical center.
abstract: OBJECTIVE
  Using the Assessing Symptoms Side Effects and Indicators of Supportive Treatment (ASSIST) quality indicators (QIs), we conducted a comprehensive evaluation of the quality of care provided in our institution to patients diagnosed with advanced cancer in 2006.
  
  
  METHODS
  Patients diagnosed with a Stage IV solid tumor were identified from the hospital's cancer registry. Using data abstracted from medical records, care was assessed using 41 explicit QIs. Mean percent adherence to QIs was calculated overall, as well as across five clinical domains: (1) Pain, (2) Depression and Psychosocial Distress, (3) Dyspnea, (4) Treatment Toxicity, (5) Other Symptoms, and (6) Information and Care Planning.
  
  
  RESULTS
  The study cohort (n = 118) was almost all male (2% female) and mean age was 65.9 years (standard deviation [SD] 9.9 years). The most common cancers were lung and head and neck cancer (23% each); 17% had prostate cancer; 13% had colorectal cancer; and the rest (24%) had breast, esophageal, stomach, genitourinary, liver/biliary, or pancreas cancer. Patients received 51% (95% confidence interval [CI] 48%-54%) of recommended care. Adherence to recommended care within domains ranged from 38% (95% CI 35%-42%) for Other Symptoms to 79% (95% CI 73%-86%) for Information and Care Planning.
  
  
  CONCLUSIONS
  This study suggests that the quality of supportive care for patients with advanced cancer can be greatly improved. Future efforts should use the ASSIST indicators to evaluate the quality of supportive care in larger and more diverse cohorts of advanced cancer patients.
authors.affiliation: VA Greater Los Angeles Healthcare System, RAND Health, David Geffen School of Medicine, University of California, Los Angeles, USA. jennifer.malin@va.gov
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Malin
authors.forename: Sean M
authors.initials: SM
authors.lastname: O'Neill
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
authors.forename: Sydney M
authors.initials: SM
authors.lastname: Dy
authors.forename: Anne M
authors.initials: AM
authors.lastname: Walling
authors.forename: Diana
authors.initials: D
authors.lastname: Tisnado
authors.forename: Anna Liza
authors.initials: AL
authors.lastname: Antonio
authors.forename: Karl A
authors.initials: KA
authors.lastname: Lorenz
mesh_terms: D000368:Aged; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms; D010166:Palliative Care / Q000592:standards*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012720:Severity of Illness Index