title: [The initial symptom attributable to cancer in digestive tube tumors. A study of agreement between the patient and the physician].
abstract: BACKGROUND
  Clinical practice shows that certain patients may underestimate and others overestimate some initial symptoms of their disease. In studies on the interval between first symptoms and treatment onset, estimating the date in which symptoms first appeared is crucial. The study analyzed patient-physician agreement in assessing first symptom attributable to cancer.
  
  
  METHODS
  During two years, two physicians personally interviewed, through a structured questionnaire, all symptomatic patients with a neoplasm of the digestive tract admitted to Hospital del Mar (Barcelona, Spain). Patients had a mid-low sociocultural profile and most had been admitted through the Emergency Department.
  
  
  RESULTS
  Absolute agreement (symptom and date) occurred in 85% of the 183 subjects. In most discordant cases, patients had overlooked some component of the "toxic syndrome", and the date of symptom onset was, based on physician's assessment, chronologically prior to the date elicited from the patient. Disagreement was directly related to the patient's health status (p < 0.05) and to the number of reported symptoms until hospital admittance (p = 0.002), but not to tumour stage. Agreement increased with the importance attributed by the patient to the first symptom (p < 0.05).
  
  
  CONCLUSIONS
  In spite of difficulties inherent to measuring symptomatic onset of diseases, structured patient interviews appear to be a reasonably valid method and deserve further development in this and other areas of research.
authors.affiliation: Servicio de Aparato Digestivo, Hospital del Mar, Barcelona.
authors.forename: J
authors.initials: J
authors.lastname: Belloc Calmet
authors.forename: M
authors.initials: M
authors.lastname: Porta Serra
authors.forename: N
authors.initials: N
authors.lastname: Malats Riera
authors.forename: M
authors.initials: M
authors.lastname: Gallén Castillo
authors.forename: J
authors.initials: J
authors.lastname: Phanas Domingo
mesh_terms: D000368:Aged; D004067:Digestive System Neoplasms / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D011795:Surveys and Questionnaires; D013997:Time Factors
vernacular_title: El síntoma inicial atribuible al cáncer en los tumores del tubo digestivo. Un análisis de la concordancia entre el paciente y el médico.