Society for Surgery of the Alimentary Tract
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Natalie Bath*, Marilly Palettas, Lena Stevens, Angela Sarna, Aslam Ejaz, Alex Kim, Timothy M. Pawlik, Jordan Cloyd
Surgery, The Ohio State University Wexner Medical Center, Columbus, OH

Cancer care coordination (CCC) is an integral component of health care delivery. Neoadjuvant therapy (NT) is increasingly used prior to surgery for most localized gastrointestinal (GI) and hepatopancreatobiliary (HPB) cancers. Although NT necessitates a multidisciplinary approach, there is little existing literature on the quality of CCC during NT. The objective of this study was to characterize patient perceptions of CCC during NT using a mixed methods approach.

A cross-sectional analysis of patients with GI/HPB cancers receiving NT were enrolled as part of a prospective longitudinal cohort study to evaluate their real-time experience using a customized smartphone application. Enrolled patients completed the Cancer Care Coordination Questionnaire for Patients (CCCQ-P), a 20-item validated measure of care coordination. Items were scored on a 5-point Likert scale and subsections on communication (13 questions) and navigation (7 questions) were calculated with higher scores signifying better cancer care coordination. Univariate linear regression was used to calculate the impact of fragmented care and other factors on perceived CCC. Semi-structured interviews were conducted among a convenience sample of patients (n=5) using an interview script developed via preliminary survey results, evidence synthesis, and expert opinion.

Among 82 participants, mean age was 61 years and 68% were male. The most common malignant diagnoses included rectal (44%), pancreas (29%), and esophagus (16%). Mean length of NT treatment was 3.3 months; 72% of patients underwent surgical resection following NT. Overall (mean 76.6 out of 100), communication subsection (48.6 out of 65) and navigation subsection (28.0 out of 35) CCCQ-P scores suggested overall positive perceptions of care coordination. Specific items rated lowest by respondents included whether providers asked patient how they were coping with treatment (3.3) and how visits with other providers were going (3.3) (Figure). On a scale from 1-10, perceived care coordination and quality of care was rated as 8.5 and 9.0, respectively. Fragmented care during NT was not associated with worse CCCQ-P scores (β=1.15, p=0.66). Qualitative analysis of patient interviews highlighted the need for better coordination among physicians before communicating the plan to patients, as well as the importance of providers summarizing plans to patients in verbal and written form.

Successful completion of neoadjuvant therapy requires significant care coordination among patients and healthcare professionals. In this cross-sectional analysis of a prospective cohort study, patient perceptions of CCC during NT were generally positive. Future research should focus on optimizing all aspects of care delivery in order to maximize completion of NT and receipt of surgical resection.

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