Real-world quality outcomes following implementation of a comprehensive care program in community oncology practice in western India.

Abstract

e13575 Background: Malnutrition, psychosocial distress & impaired quality of life (QoL) adversely affect treatment tolerance & outcomes in cancer patients. Real-world data on structured comprehensive care models from community oncology settings in India remains limited. This study evaluated quality outcomes following implementation of an integrated nutritional, psychosocial & QoL care program. Methods: This retrospective study assessed 3 supportive care components: (1) nutritional status using Subjective Global Assessment (SGA) (2) psychosocial wellness using NCCN Distress Thermometer & (3) QoL using EORTC QLQ-C30. Pre & post-intervention outcomes were compared using paired t-test, Wilcoxon signed-rank test, linear transformation for percentage calculation & Kaplan Meier/ Binary logistics regression. Results: Nutritional status: Of 1155 patients (median age 57 years; M:F ratio 1:1.8), most common cancers evaluated were breast (30.7%), head & neck (16.4%), gastrointestinal (14.5%) & lung cancer (5.5%). SGA assessment was performed at baseline & 90.9% were assessed at cycle 1; 44.5% were malnourished at baseline. Median pre-SGA score of malnourished cohort was 5 vs 6 post-SGA assessmemt (p = < 0.001); categorical SGA status improved in 57.5% & remained stable in 32.7%, while 31.9% (205/642) of initially well-nourished patients deteriorated. Male Gender (OR 1.7; 95% CI 1.3–2.1), head & neck cancer (OR 4.2; 95% CI 2.9–6.1), lung cancer (OR 4.0; 95% CI 2.3-7.0), & gastrointestinal cancers (OR 3.1; 95% CI 2.1-4.6) were independently associated with malnutrition (p < 0.001) Psychosocial Wellness status: Of 2273 patients evaluated (median age 58 years; M:F ratio 1:1.4), the common cancers were: breast (25%), gastrointestinal (15.8%), gynaecologic (13%) & head & neck cancers ( 9.8%). A total of 57.4% had baseline distress scores ≥5. Mean distress score significantly reduced from 5.2 at baseline to 3.5 at follow-up (p < 0.001) with median scores improving from 5 to 3. Overall 50.7% improved, 42.8% remained stable & 6.5% worsened. Baseline distress was higher in patients < 60 years (p < 0.001) & varied by disease stage (p = 0.040) QoL status: Of 21 patients evaluated (median age 66 years; M:F ratio 1:1.6), 61.9% had stage IV disease. Common cancers included gastrointestinal (28%), gynecologic (23%) & breast (19%). Mean global QoL scores improved from 46.0 ± 18.6 at baseline to 59.1 ± 16.4 at follow up (p = 0.007). Improvements were observed across domains: emotional functioning (68.3 ± 19.7 to 85.7 ± 15.6), role functioning (73.0 ± 23.8 to 84.1 ± 19.3), social functioning (69.8 ± 26.2 to 81.0 ± 19.2) & physical functioning (81.3 ± 19.6 to 87.6 ± 13.9). Conclusions: Implementation of a structured comprehensive care program in community oncology practice was associated with significant improvements across nutritional status, psychosocial distress & patient-reported quality outcomes.