Evaluation of agreement between physicians' notation of ‘no evidence of disease’ (NED) and patients' report of cancer status

Abstract

This study examines extent of agreement between oncologists' and cancer patients' reports of current cancer status. Participants with history of cancer were given a comprehensive geriatric assessment in which they were asked whether they had cancer at the present time. This was compared to cancer status concurrently recorded by their physicians in the chart. 75.5% of patients whose physicians reported 'no evidence of disease' (NED) reported that they currently had cancer. 30% of them were anxious and 27% were depressed. Among patients for whom both the patient and physician reported no cancer, only 12.5% were anxious and 7% depressed. Compared to patients with concordant responses, those who discrepantly reported they had cancer had significantly more comorbid illnesses, medications, and pain, and lower levels of social, emotional, and physical functioning. Moreover, equal levels of distress and dysfunction were found between those who reported cancer but had NED and those who reported cancer and did have active disease by physician notation. Although conclusions about cause and effect are limited due to study design, findings suggest that some patients might suffer unnecessarily from lack of understanding about current disease status. These findings also suggest the need for improved physician-patient communication and symptom recognition/management.

Geriatric Oncology and Primary Care: Promoting Partnerships in Practice and Research

“…7,16 Although not all PCP practices or relationships with patients are similar, PCPs can generally offer valuable care and support, particularly to older patients, who see them as important partners in cancer care. 17 Lack of understanding of disease and treatment decisions has been shown to affect older patients significantly, 18,19 and some subgroups of older patients may be particularly in need. For example, previous studies indicate that older women and patients with lower socioeconomic status may be less likely to seek treatment information and more likely to accept first recommendations.…”