When Doctors, Patients Disagree, It Affects Survival

The researchers found patients and their doctors disagree about the performance and the nutritional status more than half the time. Furthermore, the degree of disagreement is significant with physicians, who frequently rate their patients better than the patients rate themselves.

The implications are important in cancer patients because disagreement is associated with an increased death risk of death.

Ian Schnadig, M.D., principal investigator, a fellow in the Division of Hematology and Medical Oncology, OHSU Cancer Institute, OHSU School of Medicine, recently presented these findings at the 43rd annual meeting of the American Society of Clinical Oncologists in Chicago.

“These findings are important because performance and nutritional status according to a physician is one of the most important measurements in clinical cancer research and care because it can be a major factor in deciding between two or more therapeutic approaches. So when doctors overestimate how the patients are doing, the patients may end up not getting the right cancer treatment or receive futile therapy,” said Schnadig.

Performance status is a simple assessment tool oncologists use to categorize the overall fitness, physical well-being and ability to carry out daily activities. In clinical practice, patients do not provide these assessments.

For performance status, disagreement is associated with an 11 percent increased risk of death; nutritional status disagreement is associated with a 38 percent increased risk.

This large study, 1,636 subjects with advanced colorectal or lung cancer - were included in an analysis with follow-up after seven years.

It was also found that when patients are unable to work prior to retirement, have less then a high school education or are depressed more than half the time, the disconnect with their physician is more likely.

“This information is important because armed with this information, physicians can redouble their effort to better understand how their patients are doing,” said Tomasz Beer, M.D., the senior author of the study; director of the Prostate Cancer Research program at the OHSU Cancer Institute; and associate professor of medicine (hematology/medical oncology), OHSU School of Medicine.

“Our study points out how important it is that patients and doctors communicate well. Clearly, we need to work to understand why this disconnect happens and how we can close the gap to give patients the best chance as they fight their cancer,” said Schnadig.

“We knew that patient-reported performance assessment commonly differs from physician-only assessment. However, the extent and the direction (i.e., whether physician or patient tended to rate patients better) of these differences have never been evaluated in such a large group of subjects with advanced cancer. Also, neither the predictors, nor the implications of such disagreement have been previously been defined.

“Most importantly, this research highlights that being wrong about performance status matters in the outcomes of these patients. We need to develop tools to bring the patient and physician into line with one another. One way to do so would be to systematically collect this data during regular patient visits and to routinely present this information, much the same way we do vital signs to the clinician,” Schnadig said.

He suggests further clinical trials to validate such an approach.