Matching PROs With Medical Records to Assess Comorbidities in Prostate Cancer

According to a study published in JAMA Oncology, patient-reported data can be a reliable source of information to ascertain comorbidities in patients with prostate cancer. Importantly, this could be a less costly method compared with data abstraction from medical records for observational comparative effectiveness research (CER).

Patient input on their disease and treatment is key to the philosophy of patient-centered care. Further, researchers can use patient-reported outcomes to conduct CER.

For their study, researchers at the University of North Carolina evaluated data from 881 patients with newly diagnosed prostate localized cancer (median age, 65 [range, 41-80]; majority white [n = 633]) who were enrolled in the North Carolina Central Cancer Registry from January 1, 2011, through June 30, 2013. Presence of any of the following comorbidities was documented in this population: myocardial infarction, congestive heart failure, peripheral vascular disease, cerebrovascular disease, chronic obstructive pulmonary disease, peptic ulcer disease, liver disease, diabetes, kidney disease, other cancers, HIV or AIDS, coronary artery disease, arrhythmia, clotting disorders, hypertension, hyperlipidemia, inflammatory bowel disease, asthma, anemia and other blood conditions, and arthritis.

Comparisons were made between abstraction from medical records and the patient report for each comorbid condition. Subgroup analysis compared differences based on age, race, marital status, educational level, and income.

The analysis showed an agreement between patient reports and medical records in 80% of conditions (16 of 20) for more than 90% of patients—lowest agreement was observed for hyperlipidemia (68%) and arthritis (66%). Among older patients (at least 70 years old), agreement between the 2 sources of data was lower, especially for:

• Myocardial infarction (odds ratio [OR], 0.31; 95% CI, 0.12-0.80)
• Cerebrovascular disease (OR, 0.10; 95% CI, 0.01-0.78)
• Coronary artery disease (OR, 0.37; 95% CI, 0.20-0.67)
• Arrhythmia (OR, 0.44; 95% CI, 0.25-0.79)
• Kidney disease (OR, 0.18; 95% CI, 0.06-0.52)

The study did not find an influence of race and education on 18 of the disease conditions.

Stressing on the “economics” of using patient reports, the study authors concluded that using patient reports, which are less costly than medical record audits, is a reasonable approach for observational CER.

In an accompanying editorial, Zaina P. Qureshi, PhD, MPH, MS; Patricia A. Ganz, MD; and Charles L. Bennett, MD, PhD, MPP, underscored the importance of “including the patient voice as a component of evidence generation.” Identifying Ye et al’s study as a more economical strategy for identifying comorbid illness using information obtained from the patients themselves, Qureshi and colleagues wrote that the presence of comorbid conditions is central to identifying an appropriate treatment for the patient’s cancer.

Reference

Ye F, Moon DH, Carpenter WR, et al. Comparison of patient report and medical records of comorbidities: results from a population-based cohort of patients with prostate cancer. JAMA Oncol. 2017;3(8):1035-1042. doi: 10.1001/jamaoncol.2016.6744.