4561 - Agreement between breast cancer patients and oncologists on the severity of patients’ symptoms and functions during a one-year follow-up after treatment.

Background

Discrepancies in perception of adverse events between patients and physicians may influence the follow up services of cancer patients. With patient ratings as the gold standard, physicians more often underrate the symptom severities. In breast cancer (BC) populations, studies of interrater agreement are deficient. We evaluated the agreement between BC patients and their oncologists on the rating of symptoms and functioning in a clinical follow-up study at Trondheim University Hospital.

Methods

At five clinical controls during the first year after primary treatment BC patients (n = 250) and their oncologist (n = 14) reported symptoms and functions by completing the EORTC QLQ-C30/QLQ-BR23 and CTCAE questionnaires, respectively. Fatigue, hot flushes, breast pain, arm pain, emotional and physical functioning were comparable and scored on a four point Likert scale: not at all, mild, moderate and severe. The degree of agreement was evaluated by the Kappa(κ) coefficient. The McNemar-Bowker Test was used to test for association between raters and rating outcome.

Results

Four symptoms and two functions were assessed five times. Of 35 assessments, poor agreement (κ < 0.20) was identified on 24 assessments, fair agreement (0.21< κ > 0.40) on 10 assessments and moderate agreement (κ = 0.41) on one assessment (physical function). Overall, the oncologists rated the severity of all symptoms and the functions significantly lower than the patients (p < 0.01). The agreement decreased with increasing symptom severity and function impairment.

Conclusions

Discrepancies in reporting symptom severity between patients and oncologists might be due to high subjectiveness of symptoms and different understanding of the construct being measured. Personal characteristics of both raters, the context of the clinical controls and the nature of the relationship between patients and physicians may also contribute to discrepancies. Our results emphasize the importance of collecting patient reported data during follow up after BC treatment as it may improve diagnosis and treatment of adverse effects.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

NTNU, Department of Circulation and Medical Imaging, the authors.

Funding

Norwegian University of Science and Technology.

Disclosure

All authors have declared no conflicts of interest.