Symptom management in women with recurrent ovarian cancer: Do patients and providers agree on what symptoms are most important?

Abstract

Objectives: Symptom management requires communication, documentation, and intervention, yet little is known about how this occurs within gynecologic oncology. This study analyzes concordance between patient-reported symptoms within a randomized controlled trial and those documented by providers during the same time period. Methods: The WRITE Symptoms Study (NIH/NR010735; GOG 259) is a randomized controlled trial of web-based ovarian cancer symptom management that included 497 women with recurrent ovarian, fallopian tube, or primary peritoneal cancer from 68 GOG sites. This analysis includes 50 women from a single institution. Women completed the Symptom Representation Questionnaire for 28 symptoms and selected 3 priority symptoms (PS). Electronic medical records were reviewed for provider documentation of symptoms and interventions pursued. Results: Table 1 describes PS reported, documented, and intervened for. Providers documented at least 1 PS in 92% of patients and intervened in 58% of patients. Of 150 PS, 53% were never documented. Providers never documented PS of sexuality concerns, hot flashes, or memory problems. When documented, the mean number of visits in which a PS was documented was 2.3. Twenty-nine patients (58%) had at least 1 PS intervention. On average, PS intervened for were documented at 2.58 visits (1–7) versus 0.50 visits (0–5) for PS not receiving intervention (P ≤ .0001). Conclusions: The 4 most common PS were also the 4 most commonly documented PS, showing that providers are identifying and documenting symptoms important to patients. Symptoms documented by providers but not reported by patients tended to be related to physiologic effects of disease and acute treatment toxicity, whereas symptoms reported by patients but not documented by providers tended to be more psychosocial in nature. The number of visits documenting a PS correlated with intervention, suggesting that improving physician-patient communication could improve intervention rates. The etiology of discordance between patient and provider-report is likely multifactorial and requires further investigation; this study illustrates the need to improve identification of PS and increase intervention rates to enhance quality of life in women with recurrent ovarian cancer.Table 1Priority Symptoms (PS) Reported, Documented and Intervened for.