School of Medicine, University of California, San Francisco, 1106 Stanyan St., San Francisco, CA 94117, USA.
Breast Cancer Res Treat. 2012 Aug;134(3):1327-35. doi: 10.1007/s10549-012-2150-1. Epub 2012 Jul 15.
Breast cancer (BC) patients experience multiple symptoms as a result of diagnosis and treatment. While surveillance for detecting cancer recurrence is fundamental to follow-up care, managing symptoms, and promoting health behaviors are equally important. UCSF has implemented a secure online health questionnaire enabling BC patients to provide updates of their health history and symptoms. We randomly selected a sample of stage I-III BC patients (n = 106) who completed a questionnaire before a medical oncology visit between August 2010 and January 2011 and consented to have data used for research. We conducted a chart review calculating the number of symptoms reported in the questionnaire, the clinic note only, and both questionnaire and clinic note, excluding chronic symptoms addressed previously. Self-reported data on exercise and alcohol consumption was compared to documentation of these lifestyle factors in clinic notes. Patients reported significantly more symptoms using the online questionnaire (mean = 3.8, range 0-13) than were documented by the provider in clinic notes (mean = 1.8, range 0-7; p < 0.001 for the difference). A regression plot comparing the percentage of symptoms agreed upon by the patient and provider and the percentage of symptoms addressed yields a slope of 0.56 (95 % CI 0.41-0.71). The number of self-reported symptoms correlates with self-reported Karnofsky scale such that the number of symptoms reported by the patient increases linearly with this score until a threshold and it then plateaus (p < 0.001). Exercise behavior and alcohol consumption were reported in 100 % of the online questionnaires, but was documented in only 30/106 (28 %) and 75/106 (70 %) of charts reviewed. In 19/75 (25 %) charts with alcohol consumption documented, there was substantial discordance between patient and clinician reporting. Electronic data collection of BC patient-reported outcomes has a positive effect on symptom management and identification of opportunities for risk-reducing behavior change.
乳腺癌（BC）患者因诊断和治疗而出现多种症状。虽然监测癌症复发以进行后续护理至关重要，但管理症状和促进健康行为同样重要。UCSF 实施了一个安全的在线健康问卷，使 BC 患者能够提供其健康史和症状的最新信息。我们随机选择了一组在 2010 年 8 月至 2011 年 1 月间接受医学肿瘤学就诊前完成问卷的 I-III 期 BC 患者（n = 106），并同意将数据用于研究。我们进行了病历回顾，计算了问卷中报告的症状数量、仅病历记录的症状数量以及问卷和病历记录均报告的症状数量，排除了先前已处理的慢性症状。将自我报告的运动和饮酒数据与病历记录中的这些生活方式因素进行了比较。患者使用在线问卷报告的症状明显多于提供者在病历记录中记录的症状（平均值 = 3.8，范围 0-13；差异具有统计学意义，p < 0.001）。比较患者和提供者同意的症状百分比与解决症状的百分比的回归图显示斜率为 0.56（95%CI 0.41-0.71）。自我报告的症状数量与自我报告的 Karnofsky 量表相关，患者报告的症状数量呈线性增加，直到达到一个阈值，然后趋于平稳（p < 0.001）。100%的在线问卷报告了运动行为和饮酒情况，但只有 30/106（28%）和 75/106（70%）的病历记录了这两项内容。在有饮酒情况记录的 75 份病历中，有 19 份（25%）患者和医生的报告存在较大差异。电子收集 BC 患者报告的结果对症状管理和确定减少风险的行为改变机会具有积极影响。
