Skip to main content

Advertisement

SpringerLink
Log in

Patient-reported outcomes are associated with patient-oncologist agreement of performance status in a multi-ethnic Asian population

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

This study aims to compare the performance status assessed by breast cancer patients and their oncologist and investigate the factors associated with the patient-oncologist disagreement in a multi-ethnic Asian population.

Methods

This is a cross-sectional study of 270 female breast cancer patients in Singapore. Patients’ performance status was rated by the patients and their treating oncologists. Patients were also asked to complete two instruments regarding their health status and health-related quality of life. The proportions of patients with assessment of performance status the same as and different from their oncologist were calculated. The level of agreement was quantified by Kappa statistics together with the confidence interval (CI). Multinomial logistic regression analyses were performed to examine potential factors associated with the patient-oncologist disagreement.

Results

Approximately half (136/270) of the patients agreed with the oncologist in assessing performance status. Among the disagreeing half, 48 (17.8 %) patients rated better and 86 (31.9 %) poorer than the oncologists. The unweighted and quadratic-weighted Kappa statistics were, respectively, 0.21 (95 % CI = 0.13 to 0.29) and 0.34 (95 % CI = 0.26 to 0.42). Multivariable multinomial logistic regressions showed that outpatient, language used, and evidence of disease were associated with patients’ better assessment than the oncologists, while age, physical well-being, and pain/discomfort were associated with patients’ poorer assessment.

Conclusions

The patient-oncologist agreement was weak to moderate. When discrepant, patients tended to rate themselves worse than the oncologists assessed. Poorer assessment rated by patients was associated with their physical well-being. Patients who self-rated poorer may require further evaluation of any unobserved symptoms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Blagden SP, Charman SC, Sharples LD, Magee LRA, Gilligan D (2003) Performance status score: do patients and their oncologists agree? Br J Cancer 89:1022–1027

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Dajczman E, Kasymjanova G, Kreisman H, Swinton N, Pepe C, Small D (2008) Should patient-rated performance status affect treatment decisions in advanced lung cancer? J Thorac Oncol 3:1133–1136

    Article  PubMed  Google Scholar 

  3. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET et al (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655

    Article  CAS  PubMed  Google Scholar 

  4. Taylor AE, Olver IN, Sivanthan T, Chi M, Purnell C (1999) Observer error in grading performance status in cancer patients. Support Care Cancer 7:332–335

    Article  CAS  PubMed  Google Scholar 

  5. Conill C, Verger E, Salamero M (1990) Performance status assessment in cancer patients. Cancer 65:1864–1866

    Article  CAS  PubMed  Google Scholar 

  6. Schnadig ID, Fromme EK, Loprinzi CL, Sloan JA, Mori M, Li H et al (2008) Patient-physician disagreement regarding performance status is associated with worse survivorship in patients with advanced cancer. Cancer 113:2205–2214

    Article  PubMed Central  PubMed  Google Scholar 

  7. Ando M, Ando Y, Hasegawa Y, Shimokata K, Minami H, Wakai K et al (2001) Prognostic value of performance status assessed by patients themselves, nurses, and oncologists in advanced non-small cell lung cancer. Br J Cancer 85:1634–1639

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Jeon HJ, Shim EJ, Shin YW, Oh DY, Im SA, Heo DS et al (2007) Discrepancies in performance status scores as determined by cancer patients and oncologists: are they influenced by depression? Gen Hosp Psychiatry 29:555–561

    Article  PubMed  Google Scholar 

  9. Mei Hsien CC, Wan Azman WA, Md Yusof M, Ho GF, Krupat E (2012) Discrepancy in patient-rated and oncologist-rated performance status on depression and anxiety in cancer: a prospective study protocol. BMJ Open 2:e001799. doi:10.1136/bmjopen-2012-001799

    Article  PubMed Central  PubMed  Google Scholar 

  10. Census of population 2010 statistical release 1: demographic characteristics, education, language and religion. Department of Statistics, Ministry of Trade & Industry, Republic of Singapore. Available at http://www.singstat.gov.sg/publicationspublications_and_papers/cop2010/census_2010_release1/cop2010sr1.pdf

  11. Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D et al (2011) Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res 20:1727–1736

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Rabin R, Oemar M, Oppe M, Janssen, B, Herdman M (2011) EQ-5D-5L user guide: basic information on how to use the EQ-5D-5L instrument. EuroQoL Group 2011. Available at http://www.euroqol.org/fileadmin/user_upload/Documenten/PDF/Folders_Flyers/UserGuide_EQ-5D-5L.pdf. Assessed 2 July, 2011

  13. Brady M, Cella D, Mo F, Bonomi AE, Tulsky DS, Lloyd SR et al (1997) Reliability and validity of the Functional Assessment of Cancer Therapy-Breast quality-of-life instrument. J Clin Oncol 15:974–986

    CAS  PubMed  Google Scholar 

  14. Wan C, Zhang D, Yang Z, Tu X, Tang W, Feng C et al (2007) Validation of the simplified Chinese version of the FACT-B for measuring quality of life for patients with breast cancer. Breast Cancer Res Treat 106:413–418

    Article  PubMed  Google Scholar 

  15. Cella D (1997) FACIT Manual: Manual of the Functional Assessment of Chronic Illness Therapy (FACIT) Measurement System. Evanston, IL, CORE

  16. Ng R, Lee CF, Wong NS, Luo N, Yap YS, Lo SK et al (2012) Measurement properties of the English and Chinese versions of the Functional Assessment of Cancer Therapy-Breast (FACT-B) in Asian breast cancer patients. Breast Cancer Res Treat 131:619–625

    Article  PubMed  Google Scholar 

  17. Lee CF, Ng R, Luo N, Wong NS, Yap YS, Lo SK et al (2013) The English and Chinese versions of the 5-level EuroQoL Group’s 5-dimension questionnaire (EQ-5D) were valid and reliable and provided comparable scores in Asian breast cancer patients. Support Care Cancer 21:201–209

    Article  PubMed  Google Scholar 

  18. Sun X, Yang Z (2011) Generalized McNemar’s test for homogeneity of the marginal distributions. SAS Global Forum 2008, Paper 382–2008. Available at http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.176.2925&rep=rep1&type=pdf. Assessed 29 July, 2011

  19. Mehta CR, Patel NR (1983) A network algorithm for performing Fisher’s exact test in r × c contingency tables. JASA 78:427–434

    Google Scholar 

Download references

Acknowledgments

The study was funded by National Medical Research Council, Singapore (NMRC/EDG/0063/2009).

Conflict of interest

We declare that we have no potential conflict of interest; the funding agency has no involvement in any procedure of this study. This manuscript has not been published and is not under consideration for publication elsewhere. We have full control of all primary data and we agree to allow the journal to review their data if requested. YBC was supported by the Singapore Ministry of Health’s National Medical Research Council under its Clinician Scientist Award.

Author information

Authors and Affiliations

  1. Center for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore, Singapore

    Chun Fan Lee & Yin Bun Cheung

  2. Department of Biostatistics, Singapore Clinical Research Institute, 31 Biopolis Way Nanos #02-01, Singapore, Singapore, 138669

    Chun Fan Lee & Yin Bun Cheung

  3. Department of Medical Oncology, National Cancer Center, Singapore, Singapore

    Raymond Ng

  4. Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore

    Nan Luo

  5. Department of International Health, University of Tampere, Tampere, Finland

    Yin Bun Cheung

Authors
  1. Chun Fan Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Raymond Ng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nan Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yin Bun Cheung
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chun Fan Lee.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, C.F., Ng, R., Luo, N. et al. Patient-reported outcomes are associated with patient-oncologist agreement of performance status in a multi-ethnic Asian population. Support Care Cancer 22, 3201–3208 (2014). https://doi.org/10.1007/s00520-014-2336-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-014-2336-7

Keywords

Search

Navigation