Abstract PS9-05: Concordance between patient-reported and physician-documented comorbidities among stage 4 breast cancer patients
Authors: Umashankar Saumya , Melisko Michelle E. , Matthys Madeline , Van't Veer Laura , Basu Amrita 
Published: February 2021

Background

Comorbidities in metastatic breast cancer patients (pts) impact treatment decisions, eligibility for clinical trials, and influence prognosis and quality of life (QoL). The aim of this study was to evaluate the concordance between pt-reported and physician-documented (PD) comorbidities in an electronic medical record to (1) reliably document pts’ health histories to establish eligibility for clinical trials and novel therapeutics, and, (2) identify comorbidities that may be more comprehensively reported by pts rather than physicians.

Patients and Methods

All new pts at UCSF’s Breast Care Center (BCC) are administered an electronic intake survey that includes an assessment of pt-reported health history, comorbidities and symptoms. Between November 2016 and March 2020, 305 pts self-reported metastatic breast cancer (described as “breast cancer spread to sites other than breast or axillary lymph nodes”), and 222 consented to use of their clinical data for research. Chart-reviews were conducted for PD comorbidities at their initial BCC clinic visit. Pt and physician concordance was summarized for 54 comorbidities. Cohen’s kappa (κ) was used to quantify level of agreement. Concordance was classified using Landis and Koch thresholds with agreement as poor or slight (κ &lt;0.20), fair (κ ≥0.20 to &lt;0.40), moderate (κ ≥0.40 to &lt;0.60), substantial (κ ≥0.60 to &lt;0.80), or almost perfect (κ ≥0.80).

Results

Of the 222 pts, 37 pts (17%) incorrectly reported having metastatic breast cancer, 4 (2%) had duplicate surveys, 7 (3%) cancelled appointment and 5 (2%) had metastatic cancer from another primary. Thus, 168 pts with confirmed metastatic disease were included in the analysis (median age, 56 years; age range, 29-86 years; median time from diagnosis of metastatic breast cancer, 0.46 years). Highest PD comorbidities were obesity, hypertension (HTN) and thyroid disease, while highest reported comorbidities by pts were HTN, depression and arthritis. 23 of 54 comorbidities had a moderate to high level of agreement between physician and pt reports (κ≥0.40). As shown in Table 1, agreement was high for diabetes (type 1 or 2), HTN and thyroid disease, moderate for asthma/bronchitis and depression, and low for obesity, anxiety, stomach ulcers/gastroesophageal reflux disease (GERD) and arthritis.

Conclusion

In this review of data collected as part of routine care at an academic medical center, rates of comorbidities were relatively low, and there is substantial variance in the concordance of comorbidity reporting between pt and physicians. Pt-reported comorbidity data may help physicians more comprehensively document conditions such as depression, anxiety, arthritis and stomach ulcers/GERD, which in some cases may be subjective in nature but may significantly impact a pt’s quality of life and performance status. However, pts may underreport conditions such as obesity and heart disease, and inaccurately report other conditions such as non-insulin dependent diabetes. Recognition of depression, anxiety and GERD as comorbidities is important since some medications for these conditions may be contraindicated in some clinical trials.

Understanding this concordance data may inform how we collect pt reported data to optimize understanding of a pt’s global health condition.

Table 1: Concordance between physician-documented and patient-reported comorbiditiesComorbidityPhysician ReportedPatient ReportedConcordanceκDiabetes6%5%98%0.83Hypertension24%20%93%0.79Thyroid Disease20%18%92%0.74Insulin dependent Diabetes1%1%99%0.66Depression11%20%87%0.51Asthma/bronchitis12%15%89%0.51Stomach ulcers/ GERD11%18%84%0.36Obesity34%15%75%0.36Heart disease/heart valve disease7%4%93%0.32Anxiety10%18%83%0.30Non-insulin dependent diabetes3%1%97%0.27Arthritis9%20%78%0.14

Citation Format: Saumya Umashankar, Michelle E. Melisko, Madeline Matthys, Laura Van't Veer, Amrita Basu. Concordance between patient-reported and physician-documented comorbidities among stage 4 breast cancer patients [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-05.