A comparison of patient and proxy symptom assessments in advanced cancer patients

The purpose of this study was to compare patient and proxy (physician and n urse) assessments of symptoms in advanced cancer patients. The sample consi sted of 49 patients with advanced cancer admitted to an acute palliative ca re unit. Three independent assessments were completed for each patient on t wo occasions within 11 days of admission. On each occasion, symptoms were r ated independently by the patient and two proxies (treating physician and n urse), using the Edmonton Symptom Assessment System (ESAS). The ESAS is a n ine-item visual analogue scale (VAS) for assessing pain, activity, nausea, depression, anxiety, drowsiness, appetite, well-being and shortness of brea th. Symptom ratings were compared using a repeated-measures ANOVA procedure and correlations. Average physician ratings were generally lower than aver age patient ratings for both occasions. Average nurse ratings agreed more c losely with patient ratings, with a trend towards lower ratings on occasion 1 and higher ratings on occasion 2. There was a significant rater (person rating the effects) effect (P < 0.01) for three of the nine symptoms: physi cians rated drowsiness, shortness of breath and pain significantly lower th an patients. For drowsiness and shortness of breath, these differences were clinically relevant, representing a difference of more than 12 mm on a 100 -mm VAS. The accuracy of assessments amongst those rating the symptoms did not improve over time. Proxy assessments of symptom intensity, particularly by physicians, were significantly lower than patient assessments for three of the nine symptoms. Further research regarding the reliability of patien t and proxy assessments is needed to assess and manage symptoms in advanced cancer effectively.