Introduction: Cancer patients experience a variety of symptoms, which can be measured and documented using the VSAS (VA Symptom Assessment Scale) in CPRS.We recently developed VAST (VA Symptom Management Tool ) to create and document symptom management plans. We describe 3 VAST templates that address pain, constipation, and distress, and outline initial VAST implementation results.
Methods: We retrospectively identified a cohort in the Durham VA Hematology/Oncology clinic. The cohort was limited to patients with moderate to severe symptoms, rated at scores of ≥ 4 (0 – 10 scale with 10 = most severe). We evaluated pain, constipation, and distress VSAS pre- and post-VAST, evaluating mean values and using the paired t-test. A control cohort consisted of patients with VSAS scores of ≥ 4 for the same symptoms, but for which no VAST plan was documented.
Results: Between 11/16/15 and 6/14/16, we identified 78, 36, and 76 Veterans with moderate to severe pain, distress, and constipation, respectively. The mean number of days between the pre-VAST and post-VAST documentation was 36, 29, and 55 for pain, distress, and constipation. Pre-VAST and post-VAST mean scores were 6.42 and 3.82 for pain (P < .0001, 41% reduction), 6.28 and 4.81 for distress (P = .006, 23% reduction), and 6.38 and 3.96 for constipation (P < .0001, 38% reduction). In the control cohort, 542, 243, and 315 Veterans had pain, distress, and constipation scores documented in the same time frame. The mean number of days between the first and second VSAS score documentation were 122, 62, and 119 for pain, distress, and constipation. In the control cohort, pain scores fell from 6.41 to 4.87 (24% reduction), distress scores fell from 6.63 to 4.63 (30% reduction), and constipation scores fell from 6.21 to 4.27 (31% reduction).
Discussion: The VAST is a tool to document and address cancer-related symptom management using a template form, so data can be extracted from the CDW for quality assessment and improvement. VAST may improve the management of and the severity of cancer-related symptoms. Future plans include development of other VAST symptom templates and integration of VAST with nationally used oncology quality measurement tools, such as ASCO QOPI.
