Patient, clinician adverse symptom reports show different strengths
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Patient, clinician adverse symptom reports show different strengths Clinician and patient adverse symptom reports differ in their ability to predict unfavourable clinical events and to reflect patient’s daily health status, according to a study of patients with lung cancer receiving chemotherapy. For each clinical visit, researchers collected patient and clinician (nurse or oncologist) adverse symptom assessments on the topics of fatigue, pain, nausea, vomiting, diarrhoea, constipation and Karnofsky Performance Status (KPS). Patients also completed the EuroQol EQ-5D questionnaire. Patients (initial n= 163; final visit n = 62) were followed prospectively for up to 28 months, or death. Unlike patient reports, clinician reports of the following symptoms were significantly associated with death: fatigue (moderate, HR 2.75; severe, HR 2.39), pain (severe, HR 2.29), nausea (moderate, HR 2.07), constipation (moderate, HR 1.68) and KPS (score ≤ 80, HR 4.91; score ≤ 70, HR 6.39). By contrast, patient reports of the following symptoms were numerically better correlated with EQ-5D scores than clinician reports: fatigue (patient 0.39 vs clinician 0.29*), pain (0.54 vs 0.37), nausea (0.22 vs 0.11), diarrhoea (0.09 vs 0.03), constipation (0.17 vs 0.12) and KPS score (0.53 vs 0.29). It was concluded that "patient reporting appeared to better reflect real-time suffering at the expense of sensitivity to impending sentinel events, such as death or hospitalization". * values indicate Kendall tau rank correlation coefficients Basch E, et al. Adverse symptom event reporting by patients vs clinicians: relationships with clinical outcomes. Journal of the National Cancer Institute 101: 801156683 1624-1632, No. 23, 2 Dec 2009
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Reactions 6 Mar 2010 No. 1291
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