Comparison Between Patient-Reported and Clinician-Observed Symptoms in Oncology

Xiao, Canhua; Polomano, Rosemary C.; Bruner, Deborah Watkins

doi:10.1097/ncc.0b013e318269040f

Cited by 151 publications

(122 citation statements)

References 44 publications

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“…It’s a huge issue’ [24]. The disparity between patient-reported and clinician-reported symptoms can negatively impact patient care [25], with one study indicating that healthcare providers underestimated the percentages of moderate or severe symptoms relative to patients’ reports of symptom intensity [26]. …”

Section: Discussionmentioning

confidence: 99%

A tolerability burden index in schizophrenia: incorporating patient perspective in clinical trial adverse event reporting

François

Guiraud-Diawara²,

Lançon³

et al. 2017

Journal of Market Access & Health Policy

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Background: Adverse event (AE) reporting in clinical trials does not fully capture the patient-level perspective and comparing tolerability across treatments or among studies is difficult. Objective: This study was designed to develop a treatment tolerability index algorithm that combines AE reporting with physician- and patient-level AE information into a global burden score to allow comparison of the overall tolerability of antipsychotic medications used in treating schizophrenia. Study design: Data from a 4-arm, placebo-controlled clinical trial were used in the proposed tolerability index algorithm. For each patient, AEs were adjusted by frequency, severity, duration, and patient-experienced importance, and average tolerability-related burden scores were calculated. Setting: Algorithm development analyses. Patients: This study analyzed data from a previously completed clinical trial that evaluated a potential antipsychotic medication; no patients were involved in the current study. Intervention: No interventions were administered in this study; the analyses described used data derived from a previously completed clinical trial in which patients received bifeprunox, risperidone, or placebo. Main outcome measure: Burden scores and tolerability index scores were compared for patients who did or did not discontinue treatment because of AEs. Results: The number of AEs varied widely among patients. Burden scores were significantly worse for patients who discontinued treatment because of AEs. Mean tolerability index scores, adjusted based on AE frequency, severity-adjusted duration, and patient-experienced impact, were poorer for active medications than placebo, and increased with dose. Conclusion: The treatment tolerability index will allow comparison of AE burden and tolerability between treatments using existing clinical trial information. This suggests that scoring is possible, is clinically relevant, and allows standardized comparison of antipsychotic tolerability.

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Section: Discussionmentioning

confidence: 99%

A tolerability burden index in schizophrenia: incorporating patient perspective in clinical trial adverse event reporting

François

Guiraud-Diawara²,

Lançon³

et al. 2017

Journal of Market Access & Health Policy

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“…A systematic review demonstrated that this has been a consistent finding across multiple studies, and concluded that PRO data were essential for the evaluation of symptoms in cancer survivors [3]. Many researchers have hypothesized the reasons behind this discrepancy in physician/patient ratings of symptoms, including poor communication, inadequate physician time spent per patient, and patients' underreport of symptoms to physicians [3].…”

Section: Patient-reported Outcomes To Accurately Capture Treatment-rementioning

confidence: 99%

“…Many researchers have hypothesized the reasons behind this discrepancy in physician/patient ratings of symptoms, including poor communication, inadequate physician time spent per patient, and patients' underreport of symptoms to physicians [3]. Therefore, it is important to incorporate PRO assessment in clinical trials, especially those assessing new treatments.…”

Section: Patient-reported Outcomes To Accurately Capture Treatment-rementioning

confidence: 99%

“…Incorporation of PRO data into routine clinical care can also facilitate better detection and management of cancerand treatment-related effects [3,5]. In a prospective trial, Velikova et al examined the feasibility and utility of PRO integration into clinical care.…”

Section: Patient-reported Outcomes To Accurately Capture Treatment-rementioning

confidence: 99%

“…Multiple studies have consistently demonstrated that PROs more accurately capture patient symptoms than physician assessment [3,4]. In a prospective trial, Falchook et al investigated patient versus physician report of symptoms in head and neck cancer patients undergoing radiotherapy (N ¼ 44) [4].…”

Section: Patient-reported Outcomes To Accurately Capture Treatment-rementioning

confidence: 99%

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Patient-reported outcomes in cancer survivorship

Gordon

Chen

2017

Acta Oncologica

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Background: There are currently 33 million cancer survivors worldwide. With improvements in early cancer detection and treatments, patients are living longer -and it is well-recognized that many survivors develop short-and long-term physical, psychosocial and spiritual effects as a result of their diagnoses and treatments. There is increasing awareness of the importance of using patient-reported outcomes (PROs) to accurately assess these effects in cancer survivors. Validated patient-reported outcome instruments: Traditionally, physicians have assessed the acute and late side effects of cancer treatments with standardized scales such as the CTCAE. However, multiple studies have demonstrated that PROs more accurately capture patient symptoms than physician assessment. In this article we describe frequently used, validated, general and cancer-specific PRO instruments that assess symptoms. We describe additional PRO instruments that assess unmet needs, interpersonal relationship issues, and psychosocial and financial problems. Published studies using these instruments have identified issues commonly faced by cancer survivors worldwide. Discussion and summary: While PROs are increasingly used in research, further efforts are needed to integrate PRO assessment into routine clinical care, so that timely and accurate assessments can translate into better management of issues -ultimately improving the lives of cancer survivors.

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Identifying Patients Whose Symptoms Are Underrecognized During Treatment With Breast Radiotherapy

et al. 2022

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for the Michigan Radiation Oncology Quality Consortium IMPORTANCE Understanding whether physicians accurately detect symptoms in patients with breast cancer is important because recognition of symptoms facilitates supportive care, and clinical trials often rely on physician assessments using Common Toxicity Criteria for Adverse Events (CTCAE).OBJECTIVE To compare the patient-reported outcomes (PROs) of patients with breast cancer who received radiotherapy from January 1, 2012, to March 31, 2020, with physicians' CTCAE assessments to assess underrecognition of symptoms. DESIGN, SETTING, AND PARTICIPANTSThis cohort study included a total of 29 practices enrolled in the Michigan Radiation Oncology Quality Consortium quality initiative. Of 13 725 patients with breast cancer who received treatment with radiotherapy after undergoing lumpectomy, 9941 patients (72.4%) completed at least 1 PRO questionnaire during treatment with radiotherapy and were evaluated for the study. Of these, 9868 patients (99.3%) were matched to physician CTCAE assessments that were completed within 3 days of the PRO questionnaires.EXPOSURES Patient and physician ratings of 4 symptoms (pain, pruritus, edema, and fatigue) were compared. MAIN OUTCOMES AND MEASURESWe used multilevel multivariable logistic regression to evaluate factors associated with symptom underrecognition, hypothesizing that it would be more common in racial and ethnic minority groups. RESULTSOf 9941 patients, all were female, 1655 (16.6%) were Black, 7925 (79.7%) were White, and 361 (3.6%) had Other race and ethnicity (including American Indian/Alaska Native, Arab/Middle Eastern, and Asian), either as self-reported or as indicated in the electronic medical record. A total of 1595 (16.0%) were younger than 50 years, 2874 (28.9%) were age 50 to 59 years, 3353 (33.7%) were age 60 to 69 years, and 2119 (21.3%) were 70 years or older. Underrecognition of symptoms existed in 2094 of 6781 (30.9%) observations of patient-reported moderate/severe pain, 748 of 2039 observations (36.7%) of patient-reported frequent pruritus, 2309 of 4492 observations (51.4%) of patient-reported frequent edema, and 390 of 2079 observations (18.8%) of patient-reported substantial fatigue. Underrecognition of at least 1 symptom occurred at least once for 2933 of 5510 (53.2%) of those who reported at least 1 substantial symptom. Factors independently associated with underrecognition were younger age (younger than 50 years compared with 60-69 years: odds ratio [

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Comparison Between Patient-Reported and Clinician-Observed Symptoms in Oncology

Abstract: Symptoms reported by patients themselves provide the necessary and different insight into cancer and its treatment, compared with those observed by clinicians. The use of patient-reported symptoms should be incorporated into routine clinical practice and not just research studies.

Cited by 151 publications

References 44 publications

A tolerability burden index in schizophrenia: incorporating patient perspective in clinical trial adverse event reporting

A tolerability burden index in schizophrenia: incorporating patient perspective in clinical trial adverse event reporting

Patient-reported outcomes in cancer survivorship

Identifying Patients Whose Symptoms Are Underrecognized During Treatment With Breast Radiotherapy

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