Background
Methods
Patients
Symptom assessments
Factors associated with agreement
Statistics
Results
Patients
Respondents (N = 1933) | Non respondents (N = 356) | p-valuea
| ||||
---|---|---|---|---|---|---|
N (%)
|
Mean (SD)
|
N (%)
|
Mean (SD)
| |||
Age
| 61.6 (12.1) | 65.7 (12.9) | < 0.001 | |||
Karnofsky Performance Status (KPS)
| 61.6 (16.4) | 46.0 (16.0) | < 0.001 | |||
Mini Mental State (MMS), total score
| 26.9 (3.3) | 25.7 (4.0) | 0.003 | |||
Time since diagnosis (months) | 32.8 (46.7) | 25.3 (44.3) | 0.001 | |||
Time on opioids (months) | 5.2 (11.3) | 3.1 (7.1) | 0.002 | |||
Gender
| Female | 922 (47.7) | 165 (47.1) | 0.862 | ||
Male | 1011 (52.3) | 185 (52.9) | ||||
Department
| Hospitalized patients | 1513 (78.3) | 338 (97.1) | < 0.001 | ||
Out-patients | 420 (21.7) | 10 (2.9) | ||||
Status of opioid treatment
| Recently initiated, titration | 353 (18.4) | 94 (27.5) | < 0.001 | ||
Stable dosing | 1564 (81.6) | 248 (72.5) | ||||
Metastases
b
| Bone | 875 (45.3) | 146 (42.0) | 0.266 | ||
CNS | 104 (5.4) | 28 (8.0) | 0.060 | |||
Liver | 466 (24.1) | 95 (27.3) | 0.223 | |||
Lung | 426 (22.0) | 77 (22.1) | 1.000 | |||
Other | 762 (39.4) | 151 (43.4) | 0.172 | |||
Cancer diagnosis
b
| Breast | 268 (13.9) | 33 (9.5) | 0.025 | ||
Female reproductive organs | 145 (7.5) | 29 (8.3) | 0.584 | |||
Gastrointestinal | 442 (22.9) | 83 (23.8) | 0.730 | |||
Haematological | 113 (5.8) | 20 (5.7) | 1.000 | |||
Head and neck | 105 (5.4) | 20 (5.7) | 0.799 | |||
Lung | 346 (17.9) | 71 (20.6) | 0.257 | |||
Other | 168 (8.7) | 40 (11.5) | 0.106 | |||
Prostate | 230 (11.9) | 34 (9.7) | 0.275 | |||
Unknown origin | 51 (2.6) | 11 (3.2) | 0.591 | |||
Urological | 139 (7.2) | 27 (7.7) | 0.737 | |||
Country
| Denmark | 29 (1.5) | 2 (0.6) | 0.213 | ||
Finland | 30 (1.6) | 0 | 0.010 | |||
Germany | 273 (14.1) | 178 (50.0) | < 0.001 | |||
Greece | 5 (0.3) | 0 | 1.000 | |||
Iceland | 145 (7.5) | 5 (1.4) | < 0.001 | |||
Italy | 398 (20.6) | 62 (17.4) | 0.195 | |||
Lithuania | 54 (2.8) | 0 | < 0.001 | |||
Norway | 475 (24.6) | 88 (24.7) | 0.947 | |||
Sweden | 119 (6.2) | 16 (4.5) | 0.270 | |||
Switzerland | 114 (5.9) | 1 (0.3) | < 0.001 | |||
United Kingdom | 291 (15.1) | 4 (1.1) | < 0.001 | |||
Reason for not completing all assessment forms
| Did not want to complete | 96 (27.8) | ||||
Too ill | 177 (51.3) | |||||
Unknown reason | 72 (20.9) |
Agreement between patients and health care providers
Symptom assessments | Wilcoxon signed-rank testa
| ||||||
---|---|---|---|---|---|---|---|
Intensity
|
None
|
Mild
|
Moderate
|
Severe
|
Total
| ||
Absolute number (%)
|
N (%)
|
N (%)
|
N (%)
|
N (%)
|
N
| ||
Pain
| Patient | 124 (6.4) | 508 (26.4) | 799 (41.5) | 492 (25.6) | 1923 | -18.5 b
|
Provider | 253 (13.1) | 761 (39.5) | 691 (35.8) | 223 (11.6) | 1928 | ||
Fatigue
c
| Patient | 142 (7.4) | 423 (21.9) | 634 (32.8) | 731 (37.9) | 1930 | -18.3 b
|
Provider | 230 (11.9) | 661 (34.3) | 741 (38.5) | 294 (15.3) | 1926 | ||
Generalized weakness
| Patient | 153 (8.0) | 517 (27.0) | 712 (37.1) | 536 (27.9) | 1918 | -16.1 b
|
Provider | 281 (14.6) | 740 (38.3) | 635 (32.9) | 275 (14.2) | 1931 | ||
Anorexia
| Patient | 510 (26.5) | 504 (26.2) | 477 (24.8) | 432 (22.5) | 1923 | -20.2 b
|
Provider | 910 (47.4) | 535 (27.9) | 322 (16.8) | 154 (8.0) | 1921 | ||
Depression
| Patient | 639 (33.4) | 683 (35.7) | 397 (20.8) | 192 (10.0) | 1911 | -16.8 b
|
Provider | 966 (50.1) | 644 (33.4) | 263 (13.6) | 57 (3.0) | 1930 | ||
Constipation
| Patient | 583 (30.3) | 476 (24.8) | 471 (24.5) | 392 (20.4) | 1911 | -17.2 b
|
Provider | 856 (44.4) | 487 (25.3) | 393 (20.4) | 192 (10.0) | 1928 | ||
Poor sleep
| Patient | 735 (38.2) | 572 (29.7) | 409 (21.2) | 209 (10.9) | 1925 | -13.8 b
|
Provider | 976 (50.8) | 554 (28.8) | 309 (16.1) | 84 (4.4) | 1923 | ||
Dyspnea
| Patient | 801 (41.7) | 552 (28.7) | 362 (18.8) | 208 (10.8) | 1923 | -18.5 b
|
Provider | 1199 (62.1) | 414 (21.5) | 219 (11.3) | 98 (5.1) | 1930 | ||
Nausea
| Patient | 871 (45.2) | 530 (27.5) | 342 (17.7) | 184 (9.5) | 1927 | -18.0 b
|
Provider | 1222 (63.3) | 439 (22.7) | 207 (10.7) | 62 (3.2) | 1930 | ||
Vomiting
| Patient | 1317 (68.3) | 351 (18.2) | 161 (8.4) | 99 (5.1) | 1928 | -16.2 b
|
Provider | 1635 (84.7) | 182 (9.4) | 83 (4.3) | 30 (1.6) | 1930 | ||
Diarrhea
| Patient | 1334 (69.6) | 313 (16.3) | 183 (9.5) | 88 (4.6) | 1918 | -16.5 b
|
Provider | 1664 (86.2) | 157 (8.1) | 84 (4.4) | 26 (1.3) | 1931 |
Symptom (difference) | Health care provider underestimation | Good agreement | Health care provider overestimation | ||||||
---|---|---|---|---|---|---|---|---|---|
-3
|
-2
|
%
|
0
|
± 1
|
%
|
2
|
3
|
%
| |
Pain
| 28 | 148 | 9.2 | 904 | 822 | 90.0 | 16 | 0 | 0.8 |
Fatigue
| 32 | 226 | 13.4 | 795 | 838 | 84.9 | 30 | 2 | 1.7 |
Generalized weakness
| 26 | 178 | 10.6 | 781 | 883 | 86.8 | 44 | 4 | 2.5 |
Anorexia
| 127 | 243 | 19.4 | 865 | 636 | 78.5 | 33 | 8 | 2.1 |
Depression
| 50 | 149 | 10.4 | 1028 | 652 | 88.1 | 28 | 1 | 1.5 |
Constipation
| 66 | 156 | 11.6 | 1101 | 570 | 87.2 | 21 | 3 | 1.3 |
Poor sleep
| 46 | 150 | 10.2 | 1037 | 649 | 88.0 | 26 | 7 | 1.7 |
Dyspnea
| 41 | 153 | 10.1 | 1127 | 577 | 88.8 | 17 | 5 | 1.1 |
Nausea
| 50 | 149 | 10.3 | 1177 | 534 | 88.9 | 13 | 1 | 0.7 |
Vomiting
| 39 | 87 | 6.5 | 1445 | 346 | 93.0 | 8 | 0 | 0.4 |
Diarrhea
| 33 | 106 | 7.3 | 1465 | 307 | 92.5 | 4 | 1 | 0.3 |
Total | Difference scorea
| Intraclass correlation | |||
---|---|---|---|---|---|
Symptom
|
N
|
Mean
|
SD
|
ICC
b
|
95% CI
|
Pain
| 1918 | -0.40 | 0.86 | 0.46 | 0.31 - 0.57 |
Fatigue
| 1923 | -0.44 | 0.97 | 0.40 | 0.27 - 0.51 |
Generalized weakness
| 1916 | -0.38 | 0.96 | 0.41 | 0.31 - 0.50 |
Anorexia
| 1912 | -0.58 | 1.10 | 0.38 | 0.22 - 0.51 |
Depression
| 1908 | -0.38 | 0.90 | 0.46 | 0.33 - 0.55 |
Constipation
| 1917 | -0.39 | 0.92 | 0.59 | 0.47 - 0.68 |
Poor sleep
| 1915 | -0.31 | 0.93 | 0.49 | 0.41 - 0.56 |
Dyspnea
| 1920 | -0.39 | 0.85 | 0.56 | 0.41 - 0.66 |
Nausea
| 1924 | -0.38 | 0.84 | 0.53 | 0.39 - 0.63 |
Vomiting
| 1925 | -0.28 | 0.70 | 0.51 | 0.40 - 0.60 |
Diarrhea
| 1916 | -0.28 | 0.69 | 0.51 | 0.39 - 0.60 |
Factors associated with symptom agreement
Factors possibly affecting agreement | Health care provider underestimation | Good agreement | Health care provider overestimation | Chi-square | ||||
---|---|---|---|---|---|---|---|---|
Number
|
%
|
Number
|
%
|
Number
|
%
| |||
Age
| ≤ 60 | 1013 | 10.9 | 8122 | 87.7 | 126 | 1.4 | 0.629 |
> 60 | 1268 | 10.7 | 10410 | 88.0 | 146 | 1.2 | ||
Body Mass Index
| < 25 | 1378 | 10.3 | 11855 | 88.5 | 169 | 1.3 | 0.583 |
≥ 25 | 693 | 9.8 | 6274 | 88.9 | 89 | 1.3 | ||
KPS
b
| < 80 | 1808 | 11.1 | 14110 | 86.8 | 347 | 2.1 | 0.032 |
≥ 80 | 474 | 9.9 | 4240 | 88.2 | 94 | 2.0 | ||
Mini Mental State,
total score
| ≤ 23 | 265 | 9.5 | 2455 | 87.6 | 81 | 2.9 | < 0.001 |
> 23 | 1927 | 11.3 | 14806 | 86.7 | 340 | 2.0 | ||
Time since
diagnosis (months) | ≤ 3 | 550 | 12.5 | 3797 | 86.5 | 43 | 1.0 | < 0.001 |
> 3 | 1420 | 9.6 | 13162 | 89.0 | 204 | 1.4 | ||
Gender
| Female | 1122 | 11.1 | 8812 | 87.5 | 136 | 1.4 | 0.261 |
Male | 1161 | 10.5 | 9727 | 88.2 | 136 | 1.2 | ||
Department
| Hospitalized patients | 1992 | 12.1 | 14314 | 86.7 | 201 | 1.2 | < 0.001 |
Out-patients | 291 | 6.3 | 4225 | 92.1 | 71 | 1.5 | ||
Status of
opioid treatment
| Recently initiated | 593 | 15.4 | 3219 | 83.5 | 43 | 1.1 | < 0.001 |
Stable dosing | 1679 | 9.8 | 15159 | 88.6 | 228 | 1.3 | ||
Previous or ongoing
abuse alcohol
| Yes | 113 | 9.8 | 1017 | 88.5 | 19 | 1.7 | 0.304 |
No | 2161 | 10.9 | 17477 | 87.9 | 252 | 1.3 | ||
Previous or ongoing
abuse drugs
| Yes | 19 | 9.2 | 180 | 87.4 | 7 | 3.4 | 0.024 |
No | 2250 | 10.8 | 18283 | 87.9 | 267 | 1.3 | ||
Chemotherapy the
past 24 hours
| Yes | 331 | 10.4 | 2833 | 88.6 | 32 | 1.0 | 0.180 |
No | 1952 | 10.9 | 15706 | 87.8 | 240 | 1.3 | ||
Profession of health
care provider
c
| Physician | 859 | 10.6 | 6970 | 86.2 | 261 | 3.2 | < 0.001 |
Nurse | 1090 | 10.0 | 9573 | 88.1 | 208 | 1.9 | ||
Metastases
| None | 406 | 11.2 | 3176 | 87.7 | 39 | 1.1 | 0.430 |
One or more | 1917 | 11.0 | 15352 | 87.7 | 233 | 1.3 | ||
Cancer diagnosis
| Breast | 292 | 10.0 | 2609 | 89.0 | 31 | 1.1 | < 0.001 |
Female reproductive organs | 183 | 11.5 | 1383 | 87.2 | 20 | 1.3 | ||
Gastrointestinal | 455 | 9.4 | 4306 | 89.4 | 58 | 1.2 | ||
Haematological | 142 | 11.5 | 1077 | 87.3 | 14 | 1.1 | ||
Head and neck | 148 | 12.8 | 983 | 85.3 | 21 | 1.8 | ||
Lung | 481 | 12.8 | 3241 | 86.0 | 46 | 1.2 | ||
Other | 198 | 10.8 | 1607 | 87.6 | 29 | 1.6 | ||
Prostate | 237 | 9.4 | 2233 | 89.0 | 40 | 1.6 | ||
Unknown origin | 53 | 9.6 | 491 | 89.3 | 6 | 1.1 | ||
Urological | 171 | 11.4 | 1317 | 87.5 | 18 | 1.2 | ||
Country
| Denmark | 3 | 0.9 | 304 | 95.3 | 11 | 3.5 | < 0.001 |
Finland | 25 | 7.7 | 295 | 90.8 | 5 | 1.5 | ||
Germany | 662 | 22.4 | 2231 | 75.5 | 61 | 2.1 | ||
Greece | 5 | 9.3 | 48 | 88.9 | 1 | 1.9 | ||
Iceland | 105 | 6.6 | 1437 | 90.3 | 49 | 3.1 | ||
Italy | 137 | 3.1 | 4196 | 96.1 | 34 | 0.8 | ||
Lithuania | 44 | 7.5 | 533 | 90.5 | 12 | 2.0 | ||
Norway | 546 | 10.5 | 4578 | 88.4 | 54 | 1.0 | ||
Sweden | 182 | 14.0 | 1107 | 85.3 | 9 | 0.7 | ||
Switzerland | 281 | 22.8 | 937 | 76.1 | 13 | 1.1 | ||
United Kingdom | 293 | 9.2 | 2874 | 89.8 | 33 | 1.0 |