• Alison Zucca, Rob Sanson-Fisher, Amy Waller, Mariko Carey, Elizabeth Fradgley, and Tim Regan.
• Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle, and Hunter Medical Research Institute, Callaghan, New South Wales, Australia. Electronic address: Alison.Zucca@newcastle.edu.au.
• J Pain Symptom Manage. 2015 Oct 1; 50 (4): 436-44.

ContextIdentifying modifiable gaps in the symptom management pathway, as perceived by patients, is the first step to relieving patient suffering.ObjectivesThe objective is to describe the proportion of patients experiencing treatable cancer-related symptoms who reported 1) a health care provider at the treatment center offered assistance for their symptom, 2) they accepted the assistance offered, and 3) the assistance relieved suffering. Variation in symptom management among treatment centers also was examined.MethodsA survey was done with 528 medical oncology outpatients recruited from six treatment centers. Eight items explored management of prevalent, burdensome, and treatable cancer-related symptoms: pain, fatigue, other physical side effects, and emotional distress. Participants were asked about symptom management provided at the clinic from where they were recruited. Questions referred to the last occasion the patient experienced the symptom.ResultsFewer patients were offered help to relieve fatigue (44%) and emotional distress (57%), than pain (90%) and other physical side effects (84%). In most cases, help was not offered as clinic staff were not aware of the patient's symptom. Although the vast majority of patients accepted the help that was offered, more patients accepted help for physical symptoms (pain, 97%; fatigue, 95%; and other side effects, 98%) than emotional symptoms (87%). When care was provided, most patients experienced at least a little relief from pain (99%), fatigue (94%), and emotional distress (96%). Symptom management did not vary significantly by treatment center (P = 0.073).ConclusionQuality improvement initiatives must focus primarily on improving providers' awareness of their patients' symptoms and ensuring that patients are subsequently offered help.Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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