title: Lower Patient Ratings of Physician Communication Are Associated With Unmet Need for Symptom Management in Patients With Lung and Colorectal Cancer.
abstract: Little is known about factors associated with unmet needs for symptom management in patients with cancer.
  
  
  
  Patients with a new diagnosis of lung and colorectal cancer from the diverse nationally representative Cancer Care Outcomes Research and Surveillance cohort completed a survey approximately 5 months after diagnosis (N = 5,422). We estimated the prevalence of unmet need for symptom management, defined as patients who report that they wanted help for at least one common symptom (pain, fatigue, depression, nausea/vomiting, cough, dyspnea, diarrhea) during the 4 weeks before the survey but did not receive it. We identified patient factors associated with unmet need by using logistic regression with random effects to account for clustering within study sites.
  
  
  
  Overall, 15% (791 of 5,422) of patients had at least one unmet need for symptom management. Adjusting for sociodemographic and clinical factors, African American race, being uninsured or poor, having early-stage lung cancer, and the presence of moderate to severe symptoms were associated with unmet need (all P < .05). Furthermore, patients who rated their physician's communication score < 80 (on a 0 to 100 scale) had adjusted rates of an unmet need for symptom management that were more than twice as high as patients who rated their physicians with a perfect communication score (23.1% v 10.0%; P < .001).
  
  
  
  A significant minority of patients with newly diagnosed lung and colorectal cancer report unmet needs for symptom management. Interventions to improve symptom management should consider the importance of physician communication to the patient's experience of disease.
authors.affiliation: David Geffen School of Medicine at University of California Los Angeles; Veterans Affairs Greater Los Angeles Healthcare System; UCLA Fielding School of Public Health, Los Angeles; RAND Corporation, Santa Monica; Kaiser Permanente Center for Effectiveness and Safety Research, Pasadena; California State University, Fullerton, CA; Brigham and Women's Hospital; Harvard Medical School; Dana-Farber Cancer Institute, Boston, MA; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Patient-Centered Outcomes Research Institute, Washington, DC awalling@mednet.ucla.edu.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Walling
authors.affiliation: David Geffen School of Medicine at University of California Los Angeles; Veterans Affairs Greater Los Angeles Healthcare System; UCLA Fielding School of Public Health, Los Angeles; RAND Corporation, Santa Monica; Kaiser Permanente Center for Effectiveness and Safety Research, Pasadena; California State University, Fullerton, CA; Brigham and Women's Hospital; Harvard Medical School; Dana-Farber Cancer Institute, Boston, MA; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Patient-Centered Outcomes Research Institute, Washington, DC.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Keating
authors.affiliation: David Geffen School of Medicine at University of California Los Angeles; Veterans Affairs Greater Los Angeles Healthcare System; UCLA Fielding School of Public Health, Los Angeles; RAND Corporation, Santa Monica; Kaiser Permanente Center for Effectiveness and Safety Research, Pasadena; California State University, Fullerton, CA; Brigham and Women's Hospital; Harvard Medical School; Dana-Farber Cancer Institute, Boston, MA; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Patient-Centered Outcomes Research Institute, Washington, DC.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Kahn
authors.affiliation: David Geffen School of Medicine at University of California Los Angeles; Veterans Affairs Greater Los Angeles Healthcare System; UCLA Fielding School of Public Health, Los Angeles; RAND Corporation, Santa Monica; Kaiser Permanente Center for Effectiveness and Safety Research, Pasadena; California State University, Fullerton, CA; Brigham and Women's Hospital; Harvard Medical School; Dana-Farber Cancer Institute, Boston, MA; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Patient-Centered Outcomes Research Institute, Washington, DC.
authors.forename: Sydney
authors.initials: S
authors.lastname: Dy
authors.affiliation: David Geffen School of Medicine at University of California Los Angeles; Veterans Affairs Greater Los Angeles Healthcare System; UCLA Fielding School of Public Health, Los Angeles; RAND Corporation, Santa Monica; Kaiser Permanente Center for Effectiveness and Safety Research, Pasadena; California State University, Fullerton, CA; Brigham and Women's Hospital; Harvard Medical School; Dana-Farber Cancer Institute, Boston, MA; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Patient-Centered Outcomes Research Institute, Washington, DC.
authors.forename: Jennifer W
authors.initials: JW
authors.lastname: Mack
authors.affiliation: David Geffen School of Medicine at University of California Los Angeles; Veterans Affairs Greater Los Angeles Healthcare System; UCLA Fielding School of Public Health, Los Angeles; RAND Corporation, Santa Monica; Kaiser Permanente Center for Effectiveness and Safety Research, Pasadena; California State University, Fullerton, CA; Brigham and Women's Hospital; Harvard Medical School; Dana-Farber Cancer Institute, Boston, MA; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Patient-Centered Outcomes Research Institute, Washington, DC.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Malin
authors.affiliation: David Geffen School of Medicine at University of California Los Angeles; Veterans Affairs Greater Los Angeles Healthcare System; UCLA Fielding School of Public Health, Los Angeles; RAND Corporation, Santa Monica; Kaiser Permanente Center for Effectiveness and Safety Research, Pasadena; California State University, Fullerton, CA; Brigham and Women's Hospital; Harvard Medical School; Dana-Farber Cancer Institute, Boston, MA; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Patient-Centered Outcomes Research Institute, Washington, DC.
authors.forename: Neeraj K
authors.initials: NK
authors.lastname: Arora
authors.affiliation: David Geffen School of Medicine at University of California Los Angeles; Veterans Affairs Greater Los Angeles Healthcare System; UCLA Fielding School of Public Health, Los Angeles; RAND Corporation, Santa Monica; Kaiser Permanente Center for Effectiveness and Safety Research, Pasadena; California State University, Fullerton, CA; Brigham and Women's Hospital; Harvard Medical School; Dana-Farber Cancer Institute, Boston, MA; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Patient-Centered Outcomes Research Institute, Washington, DC.
authors.forename: John L
authors.initials: JL
authors.lastname: Adams
authors.affiliation: David Geffen School of Medicine at University of California Los Angeles; Veterans Affairs Greater Los Angeles Healthcare System; UCLA Fielding School of Public Health, Los Angeles; RAND Corporation, Santa Monica; Kaiser Permanente Center for Effectiveness and Safety Research, Pasadena; California State University, Fullerton, CA; Brigham and Women's Hospital; Harvard Medical School; Dana-Farber Cancer Institute, Boston, MA; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Patient-Centered Outcomes Research Institute, Washington, DC.
authors.forename: Anna Liza M
authors.initials: AL
authors.lastname: Antonio
authors.affiliation: David Geffen School of Medicine at University of California Los Angeles; Veterans Affairs Greater Los Angeles Healthcare System; UCLA Fielding School of Public Health, Los Angeles; RAND Corporation, Santa Monica; Kaiser Permanente Center for Effectiveness and Safety Research, Pasadena; California State University, Fullerton, CA; Brigham and Women's Hospital; Harvard Medical School; Dana-Farber Cancer Institute, Boston, MA; Johns Hopkins Kimmel Cancer Center, Baltimore, MD; Patient-Centered Outcomes Research Institute, Washington, DC.
authors.forename: Diana
authors.initials: D
authors.lastname: Tisnado
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000628:therapy*; D003142:Communication; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010361:Patients; D010817:Physician-Patient Relations; D010820:Physicians; D011795:Surveys and Questionnaires; D055815:Young Adult