Patients’, Health Care Professionals’ Reporting of Comorbidities, Symptoms Varies in Breast Cancer

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The study findings indicate that health care professionals significantly underreport symptoms compared to patients with breast cancer, with reported comorbidities varying.

New study findings suggest that there are discrepancies between patient- and clinician-reported comorbidities and symptoms in breast cancer.

Comorbidities and symptoms in patients with metastatic breast cancer can impact treatment options, eligibility for clinical trials, and influence prognosis and quality of life. It is unclear whether physician documentation or patient-reported symptoms and health conditions more accurately reflect the medical history of a patient; however, clinician documentation typically remains the standard when assessing adverse events, symptoms, comorbidities, and estimating prognoses.

Patient receiving chemotherapy

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A study published in Cancer Medicine evaluated the similarities between patient reports and physician documentation of comorbidities and symptoms to accurately document patients with breast cancer and identify comorbidities and symptoms reported by patients rather than physicians. The investigators also aimed to understand whether patient-reported or physician-reported symptoms and comorbidities are more predictive of patient survival.

A total of 168 patients 29 to 86 years of age with metastatic breast cancer were included in the study. Patients completed an intake survey to assess their health history, comorbidities, and symptoms. The surveys asked patients to report whether or not they experienced 1 or more of 54 comorbidities (“Has a physician told you that you have any of the following health conditions?”) and 1 or more of 42 symptoms (“During the past week, have you had any of the following symptoms?”). Comorbidities were defined as conditions that were documented in the past medical history, disease specific problem list, or as a diagnosis in the assessment, whereas symptoms were defined as any symptom included in the clinical note narrative, review of systems, or as an item in the assessment and plan portion of the clinic note.

The highest comorbidities documented by physicians were obesity, hypertension, and thyroid disease, whereas the highest comorbidities reported by patients were hypertension, depression, and arthritis. Further, 23 of 54 comorbidities had a moderate to high level of agreement between patients and physicians. Agreement between patients and physicians was highest for diabetes, hypertension, and thyroid disease, moderate for asthma, bronchitis, lung disease, and depression, and low for anxiety, arthritis, obesity, stomach ulcers, and gastroesophageal reflux disease (GERD).

The results indicate that concordance was higher for comorbidities than symptoms, due to them being subjective in nature. Physicians had documented higher numbers of comorbidities that could be objectively measured through testing and imaging (eg, diabetes, hypertension), whereas patients reported more comorbidities that were more subjective (eg, anxiety, GERD). Patient-reported stomach ulcers and GERD as well as clotting disorders were associated with significantly lower survival, and physician-documented migraine disease was significantly associated with increased survival (HR = 1.87, 3.47 and 0.21 respectively, p < 0.05).

Concordance between patient and physician reports of symptoms was poor for most symptoms, with only 2 of 42 symptoms having a moderate to high level of agreement between patients and physicians. In addition, pain, lack of energy, and anxiety were the most reported and documented symptoms by both patients and physicians. Except for changes in skin, patients reported higher percentages of a symptom than physicians had documented.

Gastrointestinal symptoms, for which there was a fair concordance, were diarrhea and nausea (κ = 0.34 and 0.24 respectively), while concordance for vomiting and constipation was poor (κ = 0.17 and 0.10 respectively). In addition, the only endocrinological symptom or symptom related to sexual function with fair concordance was hot flashes and hot flushes (κ = 0.26), while concordance was poor for vaginal dryness and night sweats (κ = 0.08 and 0.10, respectively). Further, shortness of breath had a moderate level of agreement (κ = 0.58), whereas pain, nausea, and anxiety had a fair agreement (κ = 0.27, 0.24, and 0.25, respectively). Other symptoms with poor agreement consisted of lack of energy, sadness, drowsiness, and lack of appetite (κ = 0.15, 0.05, 0.08, and 0.15, respectively).

It is important to note that although there was significant variability in the agreement between physicians and patients with breast cancer when reporting comorbidities, patient-reported symptoms were predictive of patient survival. The authors suggest that incorporating patient-reported symptoms—whether related to breast cancer or other comorbidities—could offer a more informative estimate of predicting survival assisting physicians in effectively assessing treatment options.

Reference

Umashankar, S, Basu, A, Esserman, L, van't Veer, L, Melisko, ME. Concordance between patient-reported and physician-documented comorbidities and symptoms among Stage 4 breast cancer patients. Cancer Med. 2023; 00: 1-12. doi:10.1002/cam4.6632

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