Purpose: This study was performed as part of a large depression screen
ing project in cancer patients to determine the degree of physician re
cognition of levels of depressive symptoms in cancer patients and to d
escribe patient characteristics that influence the accuracy of physici
an perception of depressive symptoms. Methods: Twenty-five ambulatory
oncology clinics affiliated with Community Cancer Care, Inc of Indiana
enrolled and surveyed 1,109 subjects treated by 12 oncologists. Subje
cts completed the Zung Self-Rating Depression Scale (ZSDS) and physici
ans were asked to rate their patients' level of depressive symptoms, a
nxiety,and pain using numerical rating scales. Subjects' sex, age, pri
mary tumor type, medications, primary caregiver, and disease stage at
diagnosis were also recorded. Results: Physician ratings of depression
were significantly associated with their patients' levels of endorsem
ent of depressive symptoms on the ZSDS. However, agreement between phy
sicians and patients is most frequently clustered when patients report
little or no depressive symptoms. While physician ratings are concord
ant with patient endorsement of no significant depressive symptomatolo
gy 79% of the time, they are only concordant 33% and 13% of the time i
n the mild-to-moderate/severe ranges, respectively. Physician ratings
were most influenced by patient endorsement of frequent and obvious mo
od symptoms, ie, sadness, crying, and irritability. Physician ratings
also appeared to be influenced by medical correlates of patients' leve
l of depressive symptoms (functional status, stage of disease, and sit
e of tumor). Additionally, patients whose depression was inaccurately
classified reported significantly higher levels of pain and had higher
levels of disability. Physicians' ratings of depression were most hig
hly correlated with physicians' ratings of patients' anxiety and pain.
Conclusion: Physicians' perceptions of depressive symptoms in their p
atients are correlated with patient's ratings, but there is a marked t
endency to underestimate the level of depressive symptoms in patients
who are more depressed. They are most influenced by symptoms such as c
rying and depressed mood, and medical factors that are useful, but not
the most reliable, indicators of depression in this population. Physi
cians' ratings of their patients' distress symptoms seem to be global
in nature-they are highly correlated with anxiety, pain, and global dy
sfunction. Physician assessment might be improved if they were instruc
ted to assess and probe for the more reliable cognitive symptoms such
as anhedonia, guilt, suicidal thinking, and hopelessness. Screening in
struments and the use of brief follow-up interviews would help to iden
tify patients who are depressed. (C) 1998 by American Society of Clini
cal Oncology.