title: Patient-physician disagreement regarding performance status is associated with worse survivorship in patients with advanced cancer.
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.
authors.affiliation: Division of Hematology and Medical Oncology, Oregon Health and Sciences University Cancer Institute, Oregon Health and Science University, Portland, Oregon 97239, USA.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Schnadig
authors.forename: Erik K
authors.initials: EK
authors.lastname: Fromme
authors.forename: Charles L
authors.initials: CL
authors.lastname: Loprinzi
authors.forename: Jeff A
authors.initials: JA
authors.lastname: Sloan
authors.forename: Motomi
authors.initials: M
authors.lastname: Mori
authors.forename: Hong
authors.initials: H
authors.lastname: Li
authors.forename: Tomasz M
authors.initials: TM
authors.lastname: Beer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001066:Appetite; D034462:Dissent and Disputes; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000401:mortality* / Q000523:psychology*; D010817:Physician-Patient Relations; D011379:Prognosis; D012720:Severity of Illness Index
references.citation: Cancer. 2002 May 15;94(10):2719-27
references.pmid: 12173342
references.citation: J Clin Oncol. 1994 Mar;12(3):601-7
references.pmid: 8120560
references.citation: Semin Hematol. 1997 Jul;34(3 Suppl 2):4-12
references.pmid: 9253778
references.citation: Br J Cancer. 1988 Jan;57(1):109-12
references.pmid: 3348942
references.citation: Eur J Cancer. 1996 Jun;32A(7):1135-41
references.pmid: 8758243
references.citation: Ann Intern Med. 2001 Jun 19;134(12):1096-105
references.pmid: 11412049
references.citation: Pain. 2003 Apr;102(3):289-296
references.pmid: 12670671
references.citation: Am J Med. 1980 Oct;69(4):491-7
references.pmid: 7424938
references.citation: J Clin Oncol. 2004 Sep 1;22(17):3485-90
references.pmid: 15337796
references.citation: J Urol. 1998 Jun;159(6):1988-92
references.pmid: 9598504
references.citation: J Pain Symptom Manage. 1999 Apr;17(4):240-7
references.pmid: 10203876
references.citation: J Clin Oncol. 1984 Mar;2(3):187-93
references.pmid: 6699671
references.citation: Nutr Cancer. 1993;19(2):159-67
references.pmid: 8502586
references.citation: Br J Cancer. 1988 Sep;58(3):355-8
references.pmid: 2460120
references.citation: Cancer. 1980 Apr 15;45(8):2220-4
references.pmid: 7370963
references.citation: Cancer. 1984 May 1;53(9):2002-7
references.pmid: 6704925
references.citation: J Clin Oncol. 1999 Oct;17(10):3299-306
references.pmid: 10506633
references.citation: JAMA. 1998 Jun 3;279(21):1709-14
references.pmid: 9624023
references.citation: J Natl Cancer Inst. 1990 Jul 4;82(13):1127-32
references.pmid: 2193166
references.citation: J Pain Symptom Manage. 1991 Feb;6(2):53-7
references.pmid: 2007792
references.citation: J Clin Oncol. 1993 Oct;11(10):2043-9
references.pmid: 8410128
references.citation: BMJ. 2000 Feb 19;320(7233):469-72
references.pmid: 10678857
references.citation: J Clin Oncol. 2006 Nov 20;24(33):5183-5
references.pmid: 17075108
references.citation: J Clin Oncol. 2000 Feb;18(4):893-903
references.pmid: 10673533
references.citation: Eur J Cancer. 1992;28A(8-9):1328-30
references.pmid: 1515244
references.citation: Cancer. 1984 Jun 15;53(12):2736-40
references.pmid: 6326993
references.citation: Biometrics. 1977 Mar;33(1):159-74
references.pmid: 843571
references.citation: J Clin Oncol. 2001 Aug 1;19(15):3539-46
references.pmid: 11481361
references.citation: Br J Cancer. 2003 Sep 15;89(6):1022-7
references.pmid: 12966419
references.citation: Ann Intern Med. 2003 Sep 2;139(5 Pt 2):430-6
references.pmid: 12965971