been few experimental studies of case management in cancer care, and their results vary widely.

McCorkle and colleagues (2000) studied the effect of case management by advanced practice nurses on older postsurgical patients with solid tumors. The intervention consisted of home visits and telephone calls over a 4-week period that involved assessment, information sharing, and skills training for patients and family caregivers. The nurse-managed patients experienced better 2-year survival rates, confined to the group with laterstage disease (67 vs. 40 percent 2-year survival). Another randomized trial examined the effect of nurse case management on women with breast cancer. The results suggest that case management by an oncology nurse for the 12 months following diagnosis increased the likelihood that patients participated in decision making and received evidence-based treatment (Goodwin et al., 2003). Results of other randomized trials in England and Australia, however, suggest that much remains to be learned about the effectiveness of the various activities of nurse case managers in cancer care (McLachlan et al., 2001). One study of the effects of a nurse coordinator intervention with terminally ill cancer patients found no significant differences in symptoms, psychiatric morbidity, or care satisfaction between nurse-managed and control patients and families (Addington-Hall et al., 1992). In an analysis of the health care utilization and cost impacts of the nurse coordinator intervention, however, Raftery and colleagues (1996) found significant reductions in use of hospital and home care with care management. The Australian investigators studied 450 Cancer Institute outpatients with multiple cancers and stages of disease. All patients completed a baseline computerized assessment that included informational, psychosocial, and physical needs; functioning, symptoms, and quality of life; and depressive symptoms. For patients in the intervention group, a nurse coordinator reviewed the assessment results and formulated an individualized care plan in accordance with preset psychosocial guidelines. In addition, a summary of the assessment was made available to the physician seeing the patient that day. The nurses linked patients with needed services, monitored patients and families for changing needs, and attempted to coordinate the activities of the clinical team in support of the management plan. Although counseling was frequently recommended, fewer than 30 percent of patients accepted this recommendation. No significant improvements in satisfaction of needs, psychosocial functioning, or quality of life were found.

In summary, case management has demonstrated effectiveness in the care of high-risk patients with major chronic illnesses, but its role in cancer care remains uncertain. Despite this uncertainty, a number of health plans have implemented case management activities for patients with cancer (AHIP, 2007). Case management directed at increasing adherence to evidence-based treatment (Goodwin et al., 2003) and increasing the



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