Documentation of Oral Versus Intravenous Chemotherapy Plans in Patients With Metastatic Non–Small-Cell Lung Cancer

• Copyright © 2014 by American Society of Clinical Oncology

Documentation of Oral Versus Intravenous Chemotherapy Plans in Patients With Metastatic Non–Small-Cell Lung Cancer

1. Joseph A. Greer, PhD⇑, 
2. Inga T. Lennes, MD, MPH, 
3. Emily R. Gallagher, RN,
4. Jennifer S. Temel, MD and 
5. William F. Pirl, MD, MPH

1. Massachusetts General Hospital Cancer Center, Boston, MA

1. Corresponding author: Joseph A. Greer, PhD, Center for Psychiatric Oncology & Behavioral Sciences, Massachusetts General Hospital Cancer Center, Yawkey Building, Suite 10B, 55 Fruit St, Boston, MA 02114; e-mail: jgreer2{at}partners.org.

Abstract

Purpose: Using the ASCO Quality Oncology Practice Initiative (QOPI) guidelines for assessing quality cancer care, we examined differences in clinician documentation of patient consent and treatment plans for oral versus intravenous chemotherapy among patients with metastatic non–small-cell lung cancer (NSCLC).

Materials and Methods: We conducted a retrospective review of the electronic health records of 175 patients diagnosed with metastatic NSCLC whose initial systemic treatment consisted of either oral or intravenous chemotherapy. Specifically, we collected data on whether oncology clinicians documented discussions of the intent of chemotherapy (eg, palliative v curative), the number of cycles or anticipated duration of the chemotherapy, and patient consent for the chemotherapy in the practitioner note.

Results: Of the 175 patients in the sample (54.3% female; mean age = 61.96 years, standard deviation = 10.81 years), 119 (68%) received intravenous chemotherapy, and 56 (32%) were prescribed oral agents for first-line chemotherapy. Compared with those who received intravenous chemotherapy, patients prescribed oral chemotherapy had lower rates of documented treatment plans, including intent (23.3% v 45.4%, P = .005) and anticipated duration of therapy (8.9% v 32.8%, P = .001). The rate of documentation of discussions regarding patient consent for chemotherapy did not differ significantly between groups (57.1% v 69.7, P = .13).

Conclusion: Documentation of discussions regarding the goals and course of chemotherapy administration for patients with metastatic NSCLC does not meet ASCO QOPI quality standards, especially for individuals prescribed oral agents. Considering the increasing numbers of targeted oral therapies used in oncology practice, further work is needed to ensure appropriate discussion and documentation of chemotherapy plans.