Patient Reported Toxicities

In a given year, over 1.5 million new cases of cancer are diagnosed in the United States alone [1]. Their journey on the cancer care continuum starts with screening and continues through survivorship, getting matched with the most appropriate form of care. Radiation, chemo, or hormonal therapy as well as surgery, all have side-effects that are experienced first-hand by the patient and impact their families.

Currently, traditional biomedical outcome measures, such as survival and disease-free survival rates, are widely used to track the effectiveness of cancer treatment interventions [2]. Symptomatic toxicities are often underreported when collected by healthcare professionals [3]. In a chemo radiation cancer study, comparing patient-reported outcomes (PROs) with hospital charts of acute symptoms, the patients reported diarrhea and inflammation approximately 20% more often than clinicians [4]. Patients generally report symptoms earlier and more frequently than clinicians. They are also able and willing to self-report their own adverse symptoms, even when severely ill. [5]

In one clinical trial, it was concluded that physician reporting is neither sensitive or specific in detecting common chemotherapy adverse effects [6]. To enhance current assessment measures, novel approaches to evaluating symptomatic toxicities associated with cancer treatments (e.g. headaches, nausea, vomiting) need to be incorporated into the health tracking systems. The aim is to better capture the rate of toxicity of interventions at a personalized level.

Direct patient reporting through electronic platforms offers a mechanism that will enhance the efficiency and precision of current approaches. Accurate knowledge of the potential harms and risks of cancer treatment modalities is important to decision makers including patients, researchers, health professionals, and regulatory authorities. Patient reported toxicities help guide healthcare professionals in real time in an effort to reduce treatment-related side effects. Patients are also better able to identify baseline symptoms related to pre-existing conditions, and misinterpretation or transformation of information is avoided. Undoubtedly, they will receive more accurate information based on their own reporting and previous experiences of their peers, and will be more at ease about the care provided. Tools developed that enable the translation of side effects, from the patient perspective, would allow tremendous improvements in risk-benefit analyses.

A systematic collection of patient-reported outcomes has been proven to be a valid, reliable, and sustainable approach in obtaining symptomatic toxicities. E-platforms have the ability to positively complement clinician toxicity reports. The widespread adoption of patient-reported outcome toxicity monitoring in oncology care is on the rise. Companies including Equicare Health try to address the need through comprehensive patient-reported outcome questionnaires. They aim to address the previously dominant challenges pertaining data collection logistics, validated analytical approaches, and resource utilization.

Written by Dorri Mahdaviani , who holds a Masters of Public Health (MPH) from the University of British Columbia (UBC). Her academic and professional interests include the areas of chronic illnesses, health care systems and childhood health and development. 

Infographics and Design by Ann Wong, who holds a PhD in Biochemistry and Molecular Biology from the Faculty of Medicine at the University of British Columbia (UBC), Canada. She is an author of over 10 SCI publications, having taught at UBC and the Peking University Health Science Center (PUHSC) in Beijing

Patient engagement and empowerment tools enhance cancer care process

According to a recent survey, approximately 90% of patients with chronic illnesses need assistance with disease management, and 70% need healthcare providers to supply them with more educational resources [1]. However, the tools that have traditionally been in place do not provide the optimal level of assistance and communication to meet the needs of patients.

In essence, to improve health outcomes, patients and caregivers need to have access to tools that provide prognosis and procedural education, allowing for effective communication with the cancer care team. When patients are informed, they are able to express the urgency of their needs to better navigate through their care continuum.

In oncology, controlling and treating cancer ranges across a combination of surgery, radiation, and chemotherapy. Treatment measures can be effective in stopping tumor progression, managing pain, and extending life. These may be accompanied with unintentional side effects, ranging from short-term and transient to long-term and persistent that can arise years after the first treatment.

Patient portals containing electronic personal health records linked to health systems, patient reported outcomes, and patient-centered education are currently recognized as promising tools to enhance health outcomes. Studies show that patient engagement throughout diagnostic, workup, and treatment, improves patient-provider relationships, enhances patient safety, and empowers patients and their caregivers [2].

Portals allow health professionals the ability to efficiently “track preventive measures such as screening tests and immunizations [3]”, and enable shared-decision making between health professionals and the patient. Communication between patients and the care team is enhanced with careful documentation of each interaction. A study by Easley et al. highlights that better communication among health professionals and with patients is the most common factor contributing to a positive experience within cancer care coordination [4]. When health professionals are given suitable tools to further enhance health literacy and promote self-management – patient outcomes throughout cancer treatment and survivorship planning improve.

Patient safety is further enhanced through the usage of portals that allow the tracking of stages of care in a centralized manner [5]. When supplemented with other software tools (i.e. tailored evidence-based educational articles, and patient reported outcomes and questionnaires) patients are able to monitor their health and efficiently report their status to the care provider.


Equicare Health is amongst the leading patient navigation health IT companies, currently serving over 250,000 oncology patients at over 240 cancer centers across the globe. Equicare Health provides efficient communication tools, a platform of educational content, and patient reported outcomes and questionnaires. The aim is to empower oncology navigation teams, caregivers and their patients.

The educational content provided is personalized for the patient and their care team. Equicare’s partnership with Oncolink and the inclusion of comprehensive drug fact sheets provides patients access to an extensive set of cancer educational content. Equicare has integrated Oncolink’s Education Library into their system to allow for timely and appropriate education provision.

Patient reported outcomes and questionnaires are measurements of any aspect of a patient’s health status that are provided directly from the individual [6]. They can provide invaluable information for timely risk management and assessing the overall effectiveness of cancer interventions. Cancer care organizations have begun integrating patient reported outcomes into their routine clinical practice. The hope is to improve cancer symptom screening and management across their jurisdiction.

Informal patient reported outcome measures in cancer care have always been in play. However, it has only been recently that there is growing interest on collecting information in a systematic and efficient manner through electronic collection and e-patient reported outcomes. Electronic collection yields reliable data that are of higher quality than health professional reported data that, in turn, facilitate conversation and increase patient involvement in their care.

Written by Dorri Mahdaviani , who holds a Masters of Public Health (MPH) from the University of British Columbia (UBC). Her academic and professional interests include the areas of chronic illnesses, health care systems and childhood health and development. 

Infographics and Design by Ann Wong, who holds a PhD in Biochemistry and Molecular Biology from the Faculty of Medicine at the University of British Columbia (UBC), Canada. She is an author of over 10 SCI publications, having taught at UBC and the Peking University Health Science Center (PUHSC) in Beijing. 

Cancer Care: From screening positive to diagnosis, and oncology team connection

Cancer screening procedures strive for effective early detection. In order to screen large numbers of at risk individuals, screening practices need to be simple, cheap and efficient. Diagnostic tests are used to determine the presence or absence of cancer. Symptomatic individuals, or individuals with positive cancer screening results, go through potentially invasive and expensive diagnostic procedures to establish the presence of a tumor.

As the cancer journey is complex and convoluted, the patient needs to meet with health professionals with different skill sets to facilitate the process. An oncologist oversees a patient’s care from diagnosis and throughout the course of treatment. Patients consult with their general practitioner and, at times in combination with, health insurance providers to be referred to the most appropriate oncologist. Databases, such as the American Society of Clinical Oncology (ASCO) [1], also provide open access lists.

Within the United States, approximately one third of patients aged 0 – 64 years (a population of approximately over 90 million) are referred to a specialist by their primary care physician [2]. A well-coordinated referral system needs to be established to accommodate this high frequency of referrals, in addition to connecting primary and specialty care.

All members of the oncology care team (oncologists, general practitioners, radiologists, nurse navigators, patient coordinators, registered dietitians, etc.) play an integral role in enhancing the quality of care received. The care provided encompasses diverse aspects of health services. In addition to appropriate care that is timely and appropriate, other elements of cancer care include psychosocial assessment, suitable and timely referral, and individualized treatment that considers each patient’s needs and preferences. A multidisciplinary team is needed to address these tasks, which may create complexities to care coordination in both hospital and community settings. Challenges include recognizing health professional roles and responsibilities, communication between the care team and with the patient, managing scarce resources, and transitioning patients through care.

Digital technologies have aimed to address these challenges [3]. These include:

  • Electronic portals

  • Electronic Health Records (EHRs)

  • Patient reported outcomes measures

  • Patient-centered education

They are utilized to enable collaborative care coordination systems. Patient experience and outcome is enhanced when implementation of optimal technologies are coupled with proper training and support for patients and the care team.

Recent evidence-based research has proven that improving quality of care through enhanced communication and a well-coordinated system is advantageous for the patient, the medical team, and healthcare system. Researchers have embarked on a series of studies aimed at identifying quality measures. Two examples of these cover:

1. The impact of EHRs and oncology EMR tools used by multidisciplinary teams in GP-oncologist communication and facilitation of cancer care. [4]

2. Use of IT-enabled measurements and patient reported outcomes by patients and the care team to enhance patient-centered care (allowing for a seamless incorporation of patient perspectives into cancer care practices). [5]

As a patient moves through from screening and diagnostics to workup, treatment plan, and the care planning stages – clear communication, education tools, and access improve patient engagement.

In our next article, we will take a closer look at different ways of engaging patients and their caregivers (e.g. patient portals, patient reported outcomes, and patient-centred education), and how they can ultimately improve the quality of health outcomes.

Main resources:

Written by Dorri Mahdaviani , who holds a Masters of Public Health (MPH) from the University of British Columbia (UBC). Her academic and professional interests include the areas of chronic illnesses, health care systems and childhood health and development. 

Infographics and Design by Ann Wong, who holds a PhD in Biochemistry and Molecular Biology from the Faculty of Medicine at the University of British Columbia (UBC), Canada. She is an author of over 10 SCI publications, having taught at UBC and the Peking University Health Science Center (PUHSC) in Beijing. 

Impacts of Cancer Screening on Patients, Oncologists, and the Care Process

Cancer screening revolutionized the world of cancer care with its aim to detect cancer before symptoms appear. Early detection is paramount for the control of any disease. When symptoms are detected or apparent, diagnostic tests are used to find out the cause of the symptoms. A procedure, ranging in complexity and invasiveness, can have significant influences on detection, diagnosis, and trajectory of care. Once detected, engaging an oncologist early and connecting the screening results to the expertise needed enhances patient outcomes.

There are different cancer screening procedures in use across the range of cancer types. In the case of breast cancer and colorectal cancer, early detection is correlated with lowering mortality rates [1]. There are times that early detection does not lengthen the life of the patient, but may have other benefits with creating patient awareness. In general, screening tests are recommended and offered to all at-risk individuals, regardless of the outcome. This makes it imperative to be aware of the positive and negative impacts.

Two procedures that have been proven to be very effective at reducing cancer mortality rates are colorectal cancer and breast cancer screening. Colorectal cancer is the second leading cause [2] of cancer deaths in the United States. It mainly develops from abnormal growths in the colon or rectum. Screening tests can identify these abnormal growths. They can also detect tumors, and prevent the development of cancer before growths metastasize.

Interestingly, breast cancer mortality rates are lower than colorectal cancer rates. However, the rate of breast cancer diagnosis are higher within American women [3]. How is it that death rates are lower and diagnoses are higher for breast cancer, when compared to colorectal cancer? The answer is complex and depends on the screening tools used along with the nature of the cancer type and stage. Mammography is currently the most commonly supported screening procedure for breast cancer. Its greatest benefit is the decrease in breast cancer mortality: mammography screening has been associated with a 15% to 20% reduction in breast cancer mortality in women aged 40 to 74 years [4]. Despite the differences between colorectal and breast cancer, it is evident that timely and regular screening is key in lowering mortality rates.

An example of where early screening does not necessarily decrease mortality rates is the prostate-specific antigen (PSA) test for prostate cancer detection [5]. This blood test is able to detect prostate cancer at an early stage. However, routine PSA testing is debated. It is unclear whether early detection and treatment lead to significant changes in the cancer trajectory and the patient’s quality of life. The inadequate evidence of benefits for PSA testing hinders support for this screening test, and shines light on some unintentional consequences.

Recognizing the diversity of cancer screening modalities allows us to understand the scope of their influence across the cancer care spectrum. All tests are followed by results, and cancer screening is no exception. The test has either identified cancer in the individual, or it has not. However, there are truly four outcomes:


True Negative The screening test says the patient does not have cancer when they do not truly have cancer
False Positive The screening test says the patient has cancer when they do not truly have it
False Negative The screening test was not able to detect cancer when the patient truly has cancer
True Positive The screening test says the patient has cancer and the patient truly has cancer


In the True Negative scenario (an ideal case as a patient is cancer free), the potential implications from the screening test are procedural and financial. For example, when screening for colorectal cancer through colonoscopy, perforation and bleeding may occur.

For False Positive and Negative results, the screening test was not able to accurately identify the true state of the disease. When screening results appear abnormal even though there is no cancer (False Positive), anxiety may arise and each additional procedure may pose its own risks. For breast cancer, on average, 10% of women will be recalled from each screening examination for follow-up, only 5 of the 100 women recalled will have cancer [6]. In the case of False Negative, medical care is not sought in a timely manner. Treatment may even be delayed if cancerous symptoms are present. Understandably, the severity of the unintended consequences depend on the type and stage of the cancer.

It has been argued that screening may result in unnecessary earlier treatment or over-treatment. For breast cancer, the diagnosis and treatment of cancers that would otherwise never have caused symptoms or death in a woman’s lifetime can expose a woman to immediate risks. These include surgical deformity or toxicity from radiation therapy, hormone therapy, or chemotherapy, and late effects of therapeutic radiation – new cancers, scarring, cardiac toxicity.

Timely screening has proven to be an effective tool in curtailing cancer mortality rates. With early screening and engagement, health professionals are able to better tailor treatment plans to the individual tumor characteristics. Some screening tests and treatments are almost always recommended as the benefits outweigh the risks posed.

In our next article, we will explore the need for tools that facilitate the transition of care following a positive screening (False Positive and True Positive) through diagnostic, workup, and treatment plan. We will also elaborate further on directly engaging oncologists and the care team.

Written by Dorri Mahdaviani , who holds a Masters of Public Health (MPH) from the University of British Columbia (UBC). Her academic and professional interests include the areas of chronic illnesses, health care systems and childhood health and development. 

Infographics and Design by Ann Wong, who holds a PhD in Biochemistry and Molecular Biology from the Faculty of Medicine at the University of British Columbia (UBC), Canada. She is an author of over 10 SCI publications, having taught at UBC and the Peking University Health Science Center (PUHSC) in Beijing. 

Over a Decade of Excellence in Oncology Patient Navigation & Care Coordination

At Equicare Health, a group of driven healthcare professionals, engineers, scientists and business leaders come together with a passion for innovative oncology solutions. They are on a mission to improve the lives of cancer patients and survivors around the world. With the help of their industry-leading software, Equicare CS (ECS), currently serves cancer centers, oncology care providers and patients across the globe.

ECS is a comprehensive approach to care coordination with unrivaled Oncology Information Systems (OIS) and Electronic Health Records (EHR) integration. It is designed to provide healthcare professionals with the necessary tools to coordinate patient care from screening, through treatments, survivorship and follow-up.

To learn more, please visit the website and request a demo today.

*Infographics and Design by Ann Wong, who holds a PhD in Biochemistry and Molecular Biology from the Faculty of Medicine at the University of British Columbia (UBC), Canada. She is an author of over 10 SCI publications, having taught at UBC and the Peking University Health Science Center (PUHSC) in Beijing. 

Closing the information gap: Web-based PROs systems hold promise in supportive cancer care


Patients with cancer suffer from disease and treatment related symptoms. Many of these clinically- relevant details are often missed or forgotten as these patient-reported outcomes (PROs) are typically only discussed at clinic visits. “Prior research has shown that doctors miss up to half of patients’ symptoms during cancer treatment,” noted medical oncologist Ethan Basch Director of the UNC Lineberger Cancer Outcomes Research Program and an Associate Professor of UNC School of Medicine Division of Hematology and Oncology [1]. Symptoms can also arise from medical comorbidities, such as diabetes and chronic obstructive pulmonary disease (COPD), especially with an aging population [2].  Greater diversity of expertise is needed to address these added complexities.  Results from a comorbidity study in skin cancer patients suggest that patient-reported questionnaires may better identify any coexisting disorders (n=44; 79.5% and 88.6% by traditional medical interview and patient-reported questionnaire, respectively) even when there are discordant observations [3].

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Recognizing 2017 with Ready to Rocket


It is our pleasure to announce our recognition as one of the top digital health companies of 2017 by Rocket Builder’s Ready to Rocket list.

In its 15th year of profiling BC technology companies best positioned to capitalize on technology trends and fast growth, this is Ready to Rocket’s first year recognizing health care services in the digital health sector.

We were featured as one of the top Life Sciences Companies in BC last year.

We are pleased to be included with so many strong Canadian tech companies making waves in the community.

For more information about Ready to Rocket:

Year in Review of 2016

2016 finished on a high note for us at Equicare. We welcomed 25 new customers to our family with 60 facilities going live last year. Our highlights of 2016 included bringing greater diversity to our family . We welcomed a second customer from Puerto Rico, another from Australia and one from the UK. We saw our sites grow and service a whole range of cancer centers and patients around the world.


The Equicare Team continues to dream big in 2017. 2017 will see our team working hard on the release of ECS 4.7, an upgrade that welcomes a newly, modern designed patient portal with mobile support. The release will be unveiled later this year.

The Equicare Team will be back on the road this month at the  2017 HIMSS Annual Conference and Exhibition in Orlando, Florida. We will gather together with health members around the world to learn, network and connect with industry leaders working to open and innovate greater doors in the Health IT sector of healthcare. Our team is also excited to be exhibiting at NCBC for another year and presenting at this year’s March 14th Post-Conference session on  Survivorship: It’s Time for Clinical and Operational Specifics.

Join us and keep up-to-date on social media and our blog. We are excited to share with you the many things to come in 2017 for the Equicare Family.

Enhancing Patient Care: Utilizing Software in Chronic Illness Management

Innovation has taken great strides over the years as technology continues to grow and shift how we live, work and care in the spaces around us. We are collecting lots of data while we witness the consumerization of healthcare grow – we are living on the cusp of an evolution and increased sophistication of clinical technology in healthcare. The advancement in artificial intelligence (AI) within companies such as Google and Amazon[1] could forge new grounds in the way we coordinate patient care. Care management is evolving and the industry is taking note.

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Cancer Survivor Engagement: Your Successes & Challenges

We partnered with The Samfund at the 2016 ASTRO Annual Meeting, a yearly gathering held for the radiology oncology community dedicated to improving patient care, to survey attendees about their current approach to cancer survivor engagement, and the challenges they faced in doing more. It was an eye opening exercise with a positive outcome – we pledged to make a donation to The Samfund each time a survey was completed, and are pleased to donate $1500 to this great cause. Thanks to those who joined us at ASTRO!

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