The role of patient-physician relationship on health-related quality of life and pain in cancer patients

  • Cleo A. SamuelEmail author
  • Olive Mbah
  • Jennifer Schaal
  • Eugenia Eng
  • Kristin Z. Black
  • Stephanie Baker
  • Katrina R. Ellis
  • Fatima Guerrab
  • Lauren Jordan
  • Alexandra F. Lightfoot
  • Linda B. Robertson
  • Christina M. Yongue
  • Samuel Cykert
Original Article



Health-related quality of life (HRQOL) and pain are important supportive cancer care outcomes. The patient-provider relationship, a modifiable care experience, has been linked to healthcare outcomes; however, less is known about associations between patient-provider relationship and supportive care outcomes in cancer patients. We examined the role of multiple aspects of the patient-provider relationship in explaining patterns of HRQOL and pain among breast and lung cancer patients.


Our analysis included 283 breast and lung cancer patients from two cancer centers. Clinical data and survey data on patient sociodemographic factors, physical and mental HRQOL, pain, and patient-physician relationship (i.e., doctor’s respectfulness, time spent with doctors, patient involvement in decision-making, satisfaction with care, and following doctor’s advice/treatment plan) were collected at baseline and during treatment. We estimated adjusted modified Poisson regression models to assess associations between patient-physician relationship factors and physical and mental HRQOL and pain.


Compared with patients reporting suboptimal respect from doctors, patients reporting optimal respect were less likely to report below average physical HRQOL (adjusted risk ratio (ARR), 0.73; 95%CI, 0.62–0.86), below average mental HRQOL (ARR, 0.71; 95%CI, 0.54–0.93), and moderate-to-severe pain (ARR, 0.53; 95%CI, 0.35–0.79). Patients reporting optimal involvement in care decision-making and patients who reported following their doctor’s advice/treatment plan were less likely to report below average mental HRQOL than their respective counterparts (ARR, 0.64; 95%CI, 0.50–0.83; ARR, 0.65; 95%CI, 0.48–0.86).


Multiple patient-physician relationship factors account for variations in HRQOL and pain in cancer patients. These findings provide insight into potential targets for improving the patient-provider relationship and supportive cancer care outcomes.


Quality of life Pain Patient-physician relationship Symptom management Equity 


Financial support

Cleo A. Samuel, Eugenia Eng, Samuel Cykert, and Linda B. Robertson

Author’s contribution

Conception and design: Cleo A. Samuel and Samuel Cykert. Collection and assembly of data: All authors. Data analysis and interpretation: Cleo A. Samuel and Olive Mbah. Manuscript writing: All authors. Final approval of manuscript: All authors. Administrative support: Cleo A. Samuel, Jennifer Schaal, Eugenia Eng, Samuel Cykert, and Christina M. Yongue.

Funding information

This study was conducted with funding support from the National Cancer Institute Award Diversity Supplement Award (grant number, 3 R01 CA150980-04S1) and the Mentored Research Scientist Development Award (grant number, 1 K01 CA218473-01A1).

Compliance with ethical standards

Conflicts of interest

Jennifer Schaal, MD, has stock or other ownership in Abbrie, Inc.; BristolMeyers Squibb; Pfizer; United Health Group; Merck&Co; Walgreens Boots; Johnson&Johnson, and Abbott Labs. All other authors have no conflicts of interests to report.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

520_2019_5070_MOESM1_ESM.docx (25 kb)
ESM 1 (DOCX 25 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Cleo A. Samuel
    • 1
    Email author
  • Olive Mbah
    • 1
  • Jennifer Schaal
    • 2
  • Eugenia Eng
    • 3
  • Kristin Z. Black
    • 3
  • Stephanie Baker
    • 4
  • Katrina R. Ellis
    • 3
  • Fatima Guerrab
    • 5
  • Lauren Jordan
    • 1
  • Alexandra F. Lightfoot
    • 3
  • Linda B. Robertson
    • 6
  • Christina M. Yongue
    • 7
  • Samuel Cykert
    • 8
  1. 1.Department of Health Policy and Management, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillUSA
  2. 2.The Partnership ProjectGreensboroUSA
  3. 3.Department of Health Behavior, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillUSA
  4. 4.Department of Public HealthElon UniversityElonUSA
  5. 5.Department of Public Health EducationNorth Carolina Central UniversityDurhamUSA
  6. 6.UPMC Hillman Cancer CenterUniversity of Pittsburgh School of MedicinePittsburghUSA
  7. 7.Department of Public Health EducationUniversity of North Carolina at GreensboroGreensboroUSA
  8. 8.Division of General Medicine and Clinical Epidemiology and The Lineberger Comprehensive Cancer CenterThe University of North Carolina School of MedicineChapel HillUSA

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