Patient-physician disagreement regarding performance status is associated with worse survivorship in patients with advanced cancer

Ian D. Schnadig, Erik K. Fromme, Charles Lawrence Loprinzi, Jeff A Sloan, Motomi Mori, Hong Li, Tomasz M. Beer

Research output: Contribution to journalArticle

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Abstract

BACKGROUND. Physician-reported performance status (PS) is an important prognostic factor and frequently influences treatment decisions. To the authors' knowledge, the extent, prognostic importance, and predictors of disagreements in PS assessment between physicians and patients have not been adequately examined. METHODS. Using North Central Cancer Treatment Group (NCCTG) clinical trial data from 1987 through 1990, the authors compared PS (Eastern Cooperative Oncology Group [ECOG] and Karnofsky [KPS]) and nutrition scores reported by physicians and patients individually. Differences were analyzed using a Student t test for paired data and degree of disagreement by kappa statistic. The effect of disagreement on overall survival was determined by the Kaplan-Meier method and Cox regression analysis. Predictors of disagreement were identified by logistic regression. RESULTS. In all, 1636 patients with advanced lung and colorectal cancer had a median survival of 9.8 months (95% confidence interval [95% CI], 9.4-10.4 months). Percent disagreement between patients and physicians regarding KPS, ECOG PS, and nutrition score were 67.1%, 56.6%, and 58.0%, respectively. Physicians were more likely to rate patients better than individual patients were to rate themselves: ECOG (mean 0.91 vs 1.30; P < .0001), KPS (mean 83.3 vs 81.7; P < .0001), and nutrition score (mean 1.6 vs 2.1; P < .0001). Disagreement between patients and their physicians was associated with increased risk of death: KPS (hazards ratio [HR] of 1.16; 95% CI, 1.04-1.30 [P = .008]) and nutrition scores (HR of 1.44; 95% CI, 1.29-1.61 [P < .0001]) after adjustment for covariates. Patient sociodemographic factors that predict disagreement were identified. CONCLUSIONS. Physicians and patients frequently disagree regarding PS and nutritional status. Disagreement is associated with an increased risk of death in patients with advanced malignancies. These findings illustrate the limitations of physician-only assessed PS.

Original languageEnglish (US)
Pages (from-to)2205-2214
Number of pages10
JournalCancer
Volume113
Issue number8
DOIs
StatePublished - Oct 15 2008

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Survival Rate
Physicians
Neoplasms
Confidence Intervals
Nutritional Status
Survival
Colorectal Neoplasms
Lung Neoplasms
Logistic Models
Regression Analysis
Clinical Trials
Students
Therapeutics

Keywords

  • Advanced cancer
  • Eastern Cooperative Oncology Group
  • Karnofsky
  • Patient-physician communication
  • Performance status
  • Prognosis
  • Survival

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Patient-physician disagreement regarding performance status is associated with worse survivorship in patients with advanced cancer. / Schnadig, Ian D.; Fromme, Erik K.; Loprinzi, Charles Lawrence; Sloan, Jeff A; Mori, Motomi; Li, Hong; Beer, Tomasz M.

In: Cancer, Vol. 113, No. 8, 15.10.2008, p. 2205-2214.

Research output: Contribution to journalArticle

Schnadig, Ian D. ; Fromme, Erik K. ; Loprinzi, Charles Lawrence ; Sloan, Jeff A ; Mori, Motomi ; Li, Hong ; Beer, Tomasz M. / Patient-physician disagreement regarding performance status is associated with worse survivorship in patients with advanced cancer. In: Cancer. 2008 ; Vol. 113, No. 8. pp. 2205-2214.
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abstract = "BACKGROUND. Physician-reported performance status (PS) is an important prognostic factor and frequently influences treatment decisions. To the authors' knowledge, the extent, prognostic importance, and predictors of disagreements in PS assessment between physicians and patients have not been adequately examined. METHODS. Using North Central Cancer Treatment Group (NCCTG) clinical trial data from 1987 through 1990, the authors compared PS (Eastern Cooperative Oncology Group [ECOG] and Karnofsky [KPS]) and nutrition scores reported by physicians and patients individually. Differences were analyzed using a Student t test for paired data and degree of disagreement by kappa statistic. The effect of disagreement on overall survival was determined by the Kaplan-Meier method and Cox regression analysis. Predictors of disagreement were identified by logistic regression. RESULTS. In all, 1636 patients with advanced lung and colorectal cancer had a median survival of 9.8 months (95{\%} confidence interval [95{\%} CI], 9.4-10.4 months). Percent disagreement between patients and physicians regarding KPS, ECOG PS, and nutrition score were 67.1{\%}, 56.6{\%}, and 58.0{\%}, respectively. Physicians were more likely to rate patients better than individual patients were to rate themselves: ECOG (mean 0.91 vs 1.30; P < .0001), KPS (mean 83.3 vs 81.7; P < .0001), and nutrition score (mean 1.6 vs 2.1; P < .0001). Disagreement between patients and their physicians was associated with increased risk of death: KPS (hazards ratio [HR] of 1.16; 95{\%} CI, 1.04-1.30 [P = .008]) and nutrition scores (HR of 1.44; 95{\%} CI, 1.29-1.61 [P < .0001]) after adjustment for covariates. Patient sociodemographic factors that predict disagreement were identified. CONCLUSIONS. Physicians and patients frequently disagree regarding PS and nutritional status. Disagreement is associated with an increased risk of death in patients with advanced malignancies. These findings illustrate the limitations of physician-only assessed PS.",
keywords = "Advanced cancer, Eastern Cooperative Oncology Group, Karnofsky, Patient-physician communication, Performance status, Prognosis, Survival",
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T1 - Patient-physician disagreement regarding performance status is associated with worse survivorship in patients with advanced cancer

AU - Schnadig, Ian D.

AU - Fromme, Erik K.

AU - Loprinzi, Charles Lawrence

AU - Sloan, Jeff A

AU - Mori, Motomi

AU - Li, Hong

AU - Beer, Tomasz M.

PY - 2008/10/15

Y1 - 2008/10/15

N2 - BACKGROUND. Physician-reported performance status (PS) is an important prognostic factor and frequently influences treatment decisions. To the authors' knowledge, the extent, prognostic importance, and predictors of disagreements in PS assessment between physicians and patients have not been adequately examined. METHODS. Using North Central Cancer Treatment Group (NCCTG) clinical trial data from 1987 through 1990, the authors compared PS (Eastern Cooperative Oncology Group [ECOG] and Karnofsky [KPS]) and nutrition scores reported by physicians and patients individually. Differences were analyzed using a Student t test for paired data and degree of disagreement by kappa statistic. The effect of disagreement on overall survival was determined by the Kaplan-Meier method and Cox regression analysis. Predictors of disagreement were identified by logistic regression. RESULTS. In all, 1636 patients with advanced lung and colorectal cancer had a median survival of 9.8 months (95% confidence interval [95% CI], 9.4-10.4 months). Percent disagreement between patients and physicians regarding KPS, ECOG PS, and nutrition score were 67.1%, 56.6%, and 58.0%, respectively. Physicians were more likely to rate patients better than individual patients were to rate themselves: ECOG (mean 0.91 vs 1.30; P < .0001), KPS (mean 83.3 vs 81.7; P < .0001), and nutrition score (mean 1.6 vs 2.1; P < .0001). Disagreement between patients and their physicians was associated with increased risk of death: KPS (hazards ratio [HR] of 1.16; 95% CI, 1.04-1.30 [P = .008]) and nutrition scores (HR of 1.44; 95% CI, 1.29-1.61 [P < .0001]) after adjustment for covariates. Patient sociodemographic factors that predict disagreement were identified. CONCLUSIONS. Physicians and patients frequently disagree regarding PS and nutritional status. Disagreement is associated with an increased risk of death in patients with advanced malignancies. These findings illustrate the limitations of physician-only assessed PS.

AB - BACKGROUND. Physician-reported performance status (PS) is an important prognostic factor and frequently influences treatment decisions. To the authors' knowledge, the extent, prognostic importance, and predictors of disagreements in PS assessment between physicians and patients have not been adequately examined. METHODS. Using North Central Cancer Treatment Group (NCCTG) clinical trial data from 1987 through 1990, the authors compared PS (Eastern Cooperative Oncology Group [ECOG] and Karnofsky [KPS]) and nutrition scores reported by physicians and patients individually. Differences were analyzed using a Student t test for paired data and degree of disagreement by kappa statistic. The effect of disagreement on overall survival was determined by the Kaplan-Meier method and Cox regression analysis. Predictors of disagreement were identified by logistic regression. RESULTS. In all, 1636 patients with advanced lung and colorectal cancer had a median survival of 9.8 months (95% confidence interval [95% CI], 9.4-10.4 months). Percent disagreement between patients and physicians regarding KPS, ECOG PS, and nutrition score were 67.1%, 56.6%, and 58.0%, respectively. Physicians were more likely to rate patients better than individual patients were to rate themselves: ECOG (mean 0.91 vs 1.30; P < .0001), KPS (mean 83.3 vs 81.7; P < .0001), and nutrition score (mean 1.6 vs 2.1; P < .0001). Disagreement between patients and their physicians was associated with increased risk of death: KPS (hazards ratio [HR] of 1.16; 95% CI, 1.04-1.30 [P = .008]) and nutrition scores (HR of 1.44; 95% CI, 1.29-1.61 [P < .0001]) after adjustment for covariates. Patient sociodemographic factors that predict disagreement were identified. CONCLUSIONS. Physicians and patients frequently disagree regarding PS and nutritional status. Disagreement is associated with an increased risk of death in patients with advanced malignancies. These findings illustrate the limitations of physician-only assessed PS.

KW - Advanced cancer

KW - Eastern Cooperative Oncology Group

KW - Karnofsky

KW - Patient-physician communication

KW - Performance status

KW - Prognosis

KW - Survival

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