Cost and Medical Care of Patients With Advanced Serious Illness in Singapore (COMPASS) Study

Study Overview
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Brief Summary
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Cost and Medical Care of Patients with Advanced Serious Illness in Singapore (COMPASS),is a cohort study which aims to capture health care utilization, cost, and quality of life indicators of patients with advanced cancer and their primary caregivers.

Detailed Description
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The study will recruit 600 patients with advanced cancer, their primary informal caregivers and their treating physicians. Eligible patients will be recruited from study-sites in Singapore and will be followed until death. Patients and their consenting primary informal caregivers will be interviewed first at baseline and then every 3 months thereafter until the patient's death. A post-death interview with primary informal caregiver will be conducted at 8th week and 6 months after the patient's death. As the majority of the care during last year of life is provided by hospices, the eligible patients will be followed as they receive treatment and care at various hospices. Treating physicians of the patients will be invited to take part in the study. They will be asked to answer a survey conducted only once during the duration of the study. Data on medical expenditures incurred by a patient from diagnosis of advanced cancer until death will be collected. With patient consent, these data will be extracted every 6 months from the time of patient enrolment from relevant databases, including hospitals and hospices.

Official Title
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Cost and Medical Care of Patients With Advanced Serious Illness in Singapore (COMPASS) Study

Conditions
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Cancer

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria for patients are: Age ≥ 21 years old Singaporean or Singapore Permanent Resident Diagnosis of advanced/ stage IV solid cancer (for non-breast and non-prostate cancer patients). If it is breast or prostate cancer it should be stage IV with metastases to an organ site. Graded 0-2 on the Eastern Cooperative Oncology Group Performance Status Intact cognition (of patients ≥60 years of age) as determined by the Abbreviated Mental Test. If patient fails the cognitive test, he/she continues to be eligible for the study although self-reported data will no longer be collected. The Legal Representative of the patient will be approached for providing consent on behalf of the patient, to allow access to review of patient's medical and billing records The exclusion criteria for patients are Patients who are not Singaporeans or Singapore Permanent Residents Patients who are graded 3 (confined to bed more than 50% of waking hours) and 4 (completely disabled) on the Eastern Cooperative Oncology Group Performance Status. Patients who are ≤21 years of age The inclusion criteria for primary informal caregivers are: Age ≥ 21 years old Main person or one of the main providing care to the patient (e.g. accompanying patient for doctor's visits, helping the patient with day to day activities) Main person or one of the main ensuring provision of care (e.g. supervision of foreign domestic worker so that the patient is looked after) Main person or one of the main involved in making decisions regarding treatment the patient receives Patient they are caring for is enrolled in the study The exclusion criteria for primary informal caregivers are: a) Foreign domestic workers/ maids will be excluded from this study The inclusion criteria for physicians are: Age ≥ 21 years old Patients they are treating are enrolled in the study

Ages Eligible for Study
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Minimum Age: 21 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in overall quality of life among patients through the last year of life. | We will assess patient's quality of life through FACT-G | From recruitment to death of patient (baseline, 3 month, 6 months, 9 months, 12 months) | 
| Change in anxiety and depression among patients through the last year of life | We will assess patients' anxiety and depression through the Hospital Anxiety and Depression Scale (HADS). | From recruitment to death of patient (baseline, 3 month, 6 months, 9 months, 12 months) | 
| Change in pain severity among patients through the last year of life | We will assess pain reported by patients through visual analog pain scores | From recruitment to death of patient (baseline, 3 month, 6 months, 9 months, 12 months) | 
| Change in activities of daily living among patients through the last year of life | We will assess limitations in activities of daily living of patients through OARS Multidimensional Functional Assessment Questionnaire | From recruitment to death of patient (baseline, 3 month, 6 months, 9 months, 12 months) | 
| Change in patient's perceived quality of care during the last year of life | We will describe patients' assessment of their own care using a scale used by Ayanian et al (JCO, 2010) that consists of 13 questions. | From recruitment to death of patient (baseline, 3 month, 6 months, 9 months, 12 months) | 
| Total health care expenditure during the last year of life through analysis of medical bills | We will calculate total health care expenditure during the last year of patient's life as the sum total of expenditures incurred at clinics etc. | From recruitment to death of patient (baseline, 3 month, 6 months, 9 months, 12 months) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in patient's awareness of prognosis by asking if the patients believe that their current treatment regimen is likely to cure them of cancer | We will assess knowledge of disease by asking the extent to which advanced cancer patients understand the severity of their condition and if the patients believe that a treatment regimen is available that could cure them | From recruitment to death of patient (baseline, 3 month, 6 months, 9 months, 12 months) | 
| Change in caregiver burden through the last year of life | We will assess caregiver burden through modified Caregiver Reaction Assessment Scale Instrument | From recruitment to death of patient (baseline, 3 month, 6 months, 9 months, 12 months) | 
| Change in caregiver's levels of emotional distress through the last year of life | We will assess caregiver's anxiety and depression through the Hospital Anxiety and Depression Scale (HADS). | From recruitment to death of patient (baseline, 3 month, 6 months, 9 months, 12 months) | 
| Caregiver's perception of patient's end-of-life care assessed after patient's death | We will assess caregiver perceived quality of end-of-life care through Caregiver Evaluation of the Quality of End-Of- Life Care( CEQUEL) | 8 weeks bereavement | 
| Caregivers bereavement adjustment assessed after patient's death | Post-patient death bereavement adjustment will be assessed through Brief Grief Questionnaire | 6 months bereavement |