Highlights from the 2014 Quality Care Symposium

Dec 18, 2014

The 2014 Quality Care Symposium was held October 17-18, in Boston, Massachusetts,and featured research on combating disparities, improving end-of-life care, and finding opportunities for cost reduction. Highlights have been adapted from ASCO Quality Care Symposium Daily News.

Participation in tumor boards associated with improved outcomes
A study of nearly 5,000 patients withlung or colorectal cancer and 1,600oncologists found that patients withextensive-stage small cell lung cancerand stage IV colorectal cancer had significantlylower mortality rates if treatedby physicians with frequent tumorboard participation (p = 0.05) comparedto those treated by physicians inthe less often/never group (Abstract 179). Additionally, patients whose physiciansparticipated in tumor boardsweekly were more likely to enroll in clinicaltrials compared to patients whosephysicians participated less often/never(OR 1.6, 95% CI: 1.1, 2.2).

Medicare program reduces racial disparities in adherence to hormone therapy after breast cancer surgery
A study of more than 23,299 participantssuggests that women with breastcancer who are enrolled in the MedicarePart D Extra Help program, whichprovides low-income subsidies formedications, have greater adherenceto tamoxifen or aromatase inhibitors inall racial and ethnic groups, comparedto those not enrolled (white women:71% vs. 62%; black women: 67% vs.55%; Hispanic women: 71% vs. 55%)(Abstract 2). Importantly, the studyfound that enrollment in the programalso reduces racial and ethnic disparitiesin adherence: Among women notenrolled, white women had significantlyhigher adherence rates than black andHispanic women (62% vs. 55%).

Physician and patient survey reveals gaps in symptom management
A study of 2,487 patients, four to 12months from a locoregional breastor colon cancer diagnosis, found thatoverall, 77% of the cohort reportedtalking to clinicians about pain, and70% said they received advice on painmanagement (Abstract 180). Overall,78% of patients said they discussedfatigue symptoms, but only 61% saidthey received advice about managingit. Rates of discussion and advice aboutemotional distress were lower: Overall,59% of patients reported discussingthe symptom and 55% said they weregiven advice by professionals. Thestudy also found a gap between thenumber of patients who were botheredby these symptoms and those whoreceived help: A total of 61%, 74%,and 46% of patients were bothered bypain, fatigue, and emotional distress,respectively, but only 58%, 40%, and46%, respectively, were definitely gettinghelp with the symptom.

Private payer data helps paint clearer picture of end-of-life care
Combining data from private payerswith data from cancer centers couldprovide a novel way of assessing thequality of end-of-life care (Abstract 1), according to a study that analyzedpatient information gathered fromboth Dana-Farber Cancer Institute andfrom Blue Cross Blue Shield of Massachusetts.The study found that inthe last 30 days of life, 59.6% of the674 patients studied were hospitalized,and in that same time period, 47.8% ofpatients visited the emergency department,8.5% underwent radiation,30.6% underwent red blood cell transfusion,and 5.9% received a platelettransfusion. The study also found that82 patients (12.2%) died in the intensivecare unit and 193 patients (28.6%)died in an acute care facility.

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