Urologic Oncology: Seminars and Original Investigations
Original articleConcordance between patient-reported and physician-reported sexual function after radical prostatectomy☆
Introduction
Treatment of localized prostate cancer with radical prostatectomy (RP) carries risks of functional impairment in urinary and sexual health-related quality-of-life (HRQOL) [1]. Patient-reported outcomes (PRO) are now critical components of clinical trials used to direct patient-centered care [2]. Providing PRO to individual surgeons helps them to counsel patients, improve surgical technique, and guide follow-up care decisions.
Systematic assessment of PRO is still lacking, however, though the American Urological Association guidelines for localized prostate cancer recommend an assessment of overall health and functional status to guide treatment and follow-up care [3], assessment of patient functional status has historically been sparse. In the Cancer of the Prostate Strategic Urological Research Endeavor (CaPSURE) and American College of Surgeons National Cancer Data Base cohorts, 22% to 64% of men had no documented assessment of urinary or sexual functional status [4], [5].
Even when physicians do assess and document patient functional status, research has demonstrated that physicians’ reports are often discordant with patient experience. For instance, in 1 study, surgeon and patient sexual function assessments were concordant for only 55% of patients [5]. These discordant physician assessments consistently underestimate the functional limitations that men experience across multiple domains before and after prostate cancer treatment [6].
Increasing awareness of the importance of PRO assessment in routine clinical care has failed to increase agreement between physician- and patient-assessed functional status. In separate reports from the CaPSURE cohort that were over a decade apart, there was no temporal convergence in the agreement of patient- and physician-reported outcomes [7]. We hypothesized that actively providing surgeons with systematic feedback as to their patients’ self-reported sexual function outcomes would improve the concordance between patient- and physician-reported outcomes.
Section snippets
Amplio feedback system
Starting January 2009, PRO were systematically collected as part of routine clinical care at Memorial Sloan Kettering Cancer Center (MSKCC). Patients with prostate cancer prospectively completed a validated HRQOL questionnaire assessing erectile, urinary, and bowel function as well as global quality-of-life before RP and at regular follow-up intervals [8]. The survey was administered using an interactive secure online form completed before clinical appointments via e-mail or immediately before
Results
In the period from January 2009 to April 2015, a total of 3,053 men completed at least 1 post-RP HRQOL self-assessment and had a concurrent, independently reported sexual function outcome from the physician. Patient characteristics are described in Table 1. Patients who received surgery after implementation of Amplio concordance feedback more often received robot-assisted laparoscopic surgery (71% vs. 45%; P<0.0001) and fewer patients harbored low-risk Gleason grade 3 + 3 prostate cancer (21%
Discussion
Despite the importance of accurately assessing functional status in prostate cancer treatment decision-making and survivorship, there have been few studies examining the issue of patient-physician agreement on outcomes and possible overestimation of functional recovery by surgeons. Prior work from Litwin et al. and Sonn et al. using the CaPSURE cohort demonstrated significant and persistent discordance between physician- and patient-reported functional assessments using the University of
Conclusions
In a large institutional cohort of men undergoing RP, standardized and systematic collection of patient- and physician-reported outcomes demonstrated a high degree of interrater agreement. Actively providing feedback to surgeons on their degree of agreement with patient self-assessments did not further improve the degree of agreement. There is ample reason to believe that the systematic collection of PRO as part of routine clinical care contributes to improved delivery of patient-centered
References (22)
- et al.
Patient-reported outcomes in randomised controlled trials of prostate cancer: methodological quality and impact on clinical decision making
Eur Urol
(2014) - et al.
Guideline for the management of clinically localized prostate cancer: 2007 update
J Urol
(2007) - et al.
Physician assessment of pretreatment functional status: a process-outcomes link
J Urol
(2011) - et al.
Differences in urologist and patient assessments of health related quality of life in men with prostate cancer: results of the capsure database
J Urol
(1998) - et al.
Differing perceptions of quality of life in patients with prostate cancer and their doctors
J Urol
(2009) - et al.
How do you know if you are any good? A surgeon performance feedback system for the outcomes of radical prostatectomy
Eur Urol
(2012) - et al.
Patients’ self-assessment versus investigators’ evaluation in a phase III trial in non-castrate metastatic prostate cancer (GETUG-AFU 15)
Eur J Cancer
(2014) - et al.
Patient versus clinician symptom reporting using the National Cancer Institute Common Terminology Criteria for Adverse Events: results of a questionnaire-based study
Lancet Oncol
(2006) - et al.
Patient-clinician information engagement increases treatment decision satisfaction among cancer patients through feeling of being informed
Patient Educ Couns
(2009) - et al.
The quality-of-life impact of prostate cancer treatments
Curr Urol Rep
(2010)
Variations in quality of care for men with early-stage prostate cancer
J Clin Oncol
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Funding: Supported by funds from David H. Koch provided through the Prostate Cancer Foundation, Sidney Kimmel Center for Prostate and Urologic Cancers, P50-CA92629 National Cancer Institute SPORE Grant, P30-CA008748 National Institutes of Health cancer center support Grant, and T32 CA82088-15 National Cancer Institute training Grant.