Variance in symptom assessment between patient and caregiver: A prospective study of patients staged as metastatic prostate cancer—An interim analysis.

Abstract

56 Background: Closely monitored and managed patient reported outcomes (PROs) can impact survival of cancer patients. However, the reliability and validity of patients’ self-reported symptoms are somewhat open to question, as past studies have shown that patients may underreport health information to their physicians. Identifying where the discrepancy between PROs and actual symptomology lies may be important in improving providers’ grasp of a patients’ disease state. The purpose of this study is to compare prostate cancer patients’ reports of their symptoms and functioning with the patients’ caregivers’ perception of the same factors. Methods: 50 patients with metastatic prostate cancer on Androgen Deprivation Therapy (ADT) and their caregivers were asked to independently complete the Functional Assessment of Cancer Therapy- Prostate (FACT-P), Brief Pain Inventory- Short Form (BPI-SF), and EQ-5D-3L questionnaires in relation to the patient’s condition. Patient and caregiver dyad responses to these instruments were then compared by t-tests for continuous measures and Chi-Square for discrete measures. Results: Not all patient and caregiver dyads completed all of the data collection instruments. Patients are more likely than caregivers to rate themselves as having fewer limitations on mobility (n=47, p≤0.001), less pain and/or discomfort (n=46, p≤0.001), and less limitations with self-care (n=46, p≤0.001). Furthermore, caregivers were more likely to rate patients as having more anxiety (n=47, p≤0.001), more severe pain (n=20, p<0.05), and lower overall physical wellbeing scores (n=40, p<0.005). Ratings for emotional and social functioning were not significantly different between the patient and their caregiver. Conclusions: Overall a high degree of agreement was reported between patient and caregiver ratings of the patient’s symptoms and functioning; however, when differences were present the caregivers consistently rated the patients’ conditions as more severe, particularly in relation to physical symptoms. This may indicate that patients are minimizing their symptoms when reporting to their physicians.