Disagreement With Doctor on Health Hurts Cancer Patients

Those with advanced lung, colon cancers more likely to die if disconnect exists, study found

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By
HealthDay Reporter

TUESDAY, June 5, 2007 (HealthDay News) -- Disagreeing with your doctor may be hazardous to your health, especially if you're battling cancer.

New research found that cancer patients with advanced disease have a higher risk of dying when they disagree with their physician about how well they're doing physically and nutritionally.

"Patients disagreed with their clinicians greater than 50 percent of the time," said study author Dr. Ian Schnadig, a fellow in hematology and medical oncology at Oregon Health & Science University's Cancer Institute in Portland. "There was a hazard ratio associated with this disagreement in terms of long-term outcome."

Discord about a patient's performance status was associated with an 11 percent increased risk of dying, while disagreeing on nutritional status was associated with a 38 percent increased risk, according to the study.

But that doesn't mean agreeing will help you live longer.

"That's the wrong implication," said Dr. Ted Gansler, director of medical content at the American Cancer Society. "But there may be some communication gap that could lead to a bad prognosis."

The study findings were to be presented Tuesday at the American Society of Clinical Oncology annual meeting, in Chicago.

Oncologists use something called "performance status" to categorize overall fitness and ability to carry out daily activities of their patients. Both a physician's report on performance status and a patient's report were predictive of how long the patient would live.

For this study, investigators at Oregon Health & Science University enlisted the help of 1,636 patients with advanced colorectal or lung cancer. The analysis included a seven-year follow-up.

Physicians and patients each completed two measures of performance status and one of nutritional status.

More than half of the patients disagreed with their physicians on the two performance measures and the nutritional score -- 56.6 percent, 67.1 percent and 58 percent, respectively.

Overall, physicians tended to rate their patients higher than the patients rated themselves.

The researchers also identified some predictors on which patients tended to disagree with their physician. "Working status, particularly those who were unable to work prior to retirement, were more likely to disagree," Schnadig said.

Those with less than a high school-level education tended to disagree more than those with a college or greater education. And people who reported being depressed more than half the time were more likely to disagree.

"We feel it's important to bring patient and clinician assessments about performance status and nutrition into line with one another," Schnadig said. "This is important for developing tools or mechanisms to formally assess patient reports and bring them into line with clinicians."

How to do this?

One way might be to collect data from the patient at regular intervals and present that to the physician, similar to getting vital signs, Schnadig said.

Adopting measurements used in clinical trials may also be helpful, Gansler said.

Or there may be a simpler solution.

"Doctors should listen to patients more often," said Dr. Robert Morgan, a professor of medical oncology at City of Hope Cancer Center in Duarte, Calif. "Patients seem to know what they're going through."

More information

The U.S. National Cancer Institute has more on cancer and nutrition.

SOURCES: Robert Morgan, M.D., professor, medical oncology, City of Hope Cancer Center, Duarte, Calif.; Ted Gansler, M.D., director, medical content, American Cancer Society, Atlanta; Ian Schnadig, M.D., fellow, hematology and medical oncology, Oregon Health & Science University Cancer Institute, Portland; June 5, 2007, presentation, American Society of Clinical Oncology annual meeting, Chicago

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