Patient versus clinician symptom reporting: how accurate is the detection of distress in the oncologic after-care?

OBJECTIVE

The high prevalence of psychosocial distress in cancer patients is well known. The objective of this study was to investigate the agreement between the self-report of patients and the detection of distress by the treating physicians.

METHODS

The participating patients were all enrolled in a structured 5-year after-care program in Palatinate, Germany. All tumor-free patients with a scheduled follow-up exam in a 3-month time frame were asked to fill in a questionnaire regarding their psychosocial distress. The treating physicians participating in the program are family doctors or specialized physicians working in general practices. Their assessment of the patients' distress is part of the program. Agreement was evaluated using the kappa statistic.

RESULTS

The levels of psychosocial distress were very high in the self-rating of 2642 patients. Low concordance was observed between the ratings of the patients and the physicians, with all kappa values below 0.1. Only about every 10th patient reporting weak to severe problems with depression or anxiety was identified as such. Detection of problems by physicians was somewhat better for female than male patients and highest among breast cancer patients.

CONCLUSIONS

Overall the results of our study show that the need for psychosocial support extends past the acute treatment phase. The recognition of psychosocial distress in their patients seems to be extremely low in the outpatient, follow-on care phase. The application of an efficient rating method should become a routine part of the follow-up exams with physicians being trained to improve their abilities to detect the distress in the patient.