Concordance between patient-reported and physician-documented comorbidities and symptoms among Stage 4 breast cancer patients

IF 2.9 2区医学 Q2 ONCOLOGY Cancer Medicine Pub Date : 2023-10-30 DOI:10.1002/cam4.6632

Saumya Umashankar, Amrita Basu, Laura Esserman, Laura van't Veer, Michelle E. Melisko

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Abstract

Background

Comorbidities and symptoms in metastatic breast cancer patients impact treatment decisions and influence prognosis and quality of life. The objective of this study is to examine the concordance between physician documentation and patient reports of comorbidities and symptoms to understand their comparative effectiveness.

Methods

New patients with metastatic breast cancer completed an electronic intake survey assessing patient health history and symptoms. Physician documentation across 54 comorbidities and 42 symptoms was abstracted from notes for the corresponding clinic visits between November 2016 and March 2020. Concordance between patient reports and medical records for each condition and hazards ratios for each patient versus physician reported comorbidity and symptom were assessed.

Results

A total of 168 patients were included in the analysis (age, median = 56 years, range = 29–86 years; 131 white [78.9%]). Twenty-three of 54 comorbidities had a moderate to high level of agreement between patients and physicians (κ ≥ 0.40). Physicians documented higher numbers of comorbidities that can be objectively measured which also had higher concordance (e.g., diabetes [κ = 0.83] and hypertension [κ = 0.79]) while patients reported higher numbers of comorbidities that are more subjective which also had lower concordance (anxiety [κ = 0.30], GERD [κ = 0.36]). One physician-documented and two patient-reported comorbidities were significantly associated with survival (p < 0.05). Only 2 of 42 symptoms had a moderate to high level of agreement between patients and physicians. One physician-documented and nine patient-reported symptoms were significantly associated with decreased survival (p < 0.05).

Conclusion

Agreement between patients' and physicians' reporting of comorbidities varies substantially, and patient reports can complement physician documentation. Physicians significantly underreported symptoms versus patients; thus, concordance was also low. Multiple patient-reported symptoms were predictive of survival; thus, incorporating them can provide more informative estimates of predicted survival.

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癌症4期患者中患者报告和医生记录的合并症和症状的一致性。

背景：转移性癌症患者的合并症和症状影响治疗决策，影响预后和生活质量。本研究的目的是检查医生文件和患者合并症和症状报告之间的一致性，以了解它们的比较有效性。方法：癌症转移性新患者完成电子摄入量调查，评估患者的健康史和症状。从2016年11月至2020年3月期间相应门诊就诊的笔记中摘录了54种合并症和42种症状的医生文件。评估了每种情况的患者报告和医疗记录之间的一致性，以及每种患者与医生报告的合并症和症状的危险比。结果：共有168名患者被纳入分析（年龄、中位数 = 56 年，范围 = 29-86 年；131例白人[78.9%]）。54例合并症中有23例患者和医生之间存在中度至高度一致性（κ ≥ 0.40）。医生记录了更高数量的可客观测量的合并症，这些合并症也具有更高的一致性（例如，糖尿病[κ = 0.83]和高血压[κ = 0.79]），而患者报告的更主观的合并症数量更高，其一致性也更低（焦虑[κ = 0.30]，GERD[κ = 0.36]）。一名医生记录和两名患者报告的合并症与生存率显著相关（p 结论：患者和医生报告合并症的一致性差异很大，患者报告可以补充医生的文件。与患者相比，医生明显少报了症状；因此，一致性也很低。多个患者报告的症状可预测生存率；因此，结合它们可以提供对预测生存率的更具信息性的估计。

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来源期刊

Cancer Medicine ONCOLOGY-

CiteScore

5.50

自引率

2.50%

发文量

907

审稿时长

19 weeks

期刊介绍： Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas: Clinical Cancer Research Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations Cancer Biology: Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery. Cancer Prevention: Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach. Bioinformatics: Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers. Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.