Survey Reveals Differing Physician, Patient Perceptions
Nearly three out of four patients with ulcerative colitis (UC) consider feeling unwell to be a normal part of life, while gastroenterologists estimate this to be true for only 37 percent of their UC patients, according to results from a nationwide series of surveys presented today at the 2007 Crohn's & Colitis Foundation's 6th Annual Advances in the Inflammatory Bowel Diseases conference.
The series of surveys, titled "UC: NORMAL (New Observations on Remission Management and Lifestyle)," were sponsored by Shire Pharmaceuticals, a specialty biopharmaceutical company, which markets once-daily LIALDA and PENTASA (mesalamines) for UC.
"Before these surveys, patient and physician views on UC's impact had not been compared and the 'real-life' impact of UC had not been explored to this extent," says lead author David Rubin, MD, a gastroenterologist and associate professor of medicine at the University of Chicago Medical Center who helped design the surveys. "This series of surveys brings to light some challenges for the UC community: patients accept a high level of disruption from UC on their lives; physician and patient views regarding the impact of UC are not in alignment; and compliance with medications requiring multiple daily dosing is a challenge."
The UC: NORMAL surveys were fielded online between February and March 2007. For the physician survey, doctors were recruited by fax from a complete list of US board-certified gastroenterologists. Gastroenterologists who spent less than half their time in direct patient care were excluded from the study.
At the time the surveys were fielded (prior to the availability of a once-daily mesalamine), patients reported they found it difficult to adhere to medication dosing schedules. Forty-six percent of patients (n=451) reported they had not taken all of their medication in the past week and 41 percent of gastroenterologists (n=300) believed their patients were not adhering to their medications.
Interestingly, 83 percent of patients report they would be willing to change to a new medication if their physician advised that they do so, and 89 percent of patients report that they would be interested in trying aonce-daily 5-ASA medication.
According to survey results, some gastroenterologists may underestimate the level of disruption UC can have on patient lives. For example, 42 percent of patients surveyed report symptoms of UC cause some disruption to their everyday activities, while physicians estimate that this is true for just 17 percent of patients.
These physicians and patients also differ in their beliefs on flare frequency. UC patients surveyed report experiencing an average of eight disease flares per year (self-defined: five flares for mild patients, eight flares for moderate patients, and 11 flares for severe patients). Additionally, the frequency of disease flares was underestimated by physicians: 58 percent of gastroenterologists estimate that patients with mild UC will experience only one flare-up per year; 40 percent of gastroenterologists estimate patients with moderate UC will experience two flare-ups per year and 30 percent of gastroenterologists estimate three flare-ups; while 22 percent of gastroenterologists estimate patients with severe UC will experience six or more flare-ups per year.
The authors conclude that many patients find it difficult to adhere to multi-dose medication schedules and have accepted frequent flares, symptoms, and disruptions as normal rather than re-examining their disease management strategies and helping to improve compliance. "Improved physician-patient communication and more convenient medication dosing regimens, such as once-daily formulations, could result in better disease control and we believe, improved quality of life for those who suffer from UC," says Dr. Rubin.
Ulcerative Colitis: Patients' Perception Compared with Other Chronic Diseases
A second presentation of the surveys' findings analyzed UC patients' responses to quality of life questions as compared to the responses of patients with three other chronic diseases (rheumatoid arthritis [RA], asthma, and migraine) and found that UC takes a relatively high psychological toll. Patients were recruited through an actively managed panel of approximately 900,000 US adults that includes people from all US demographic and geographic groups.
More UC patients indicate that they think their disease is controlling their lives (53 percent; n=451) than RA patients (44 percent; n=309), asthma patients (19 percent; n=305) or migraine patients (37 percent; n=305) (p<0.05). UC patients also report feelings of stress (82 percent), depression (62 percent), and embarrassment (70 percent) at higher rates than patients with any of the other chronic conditions surveyed (p<0.05).
The majority (62 percent) of patients with UC feel that the disease makes it difficult to lead a normal life, which is significantly higher than the proportion of patients with asthma (33 percent) or migraine (59 percent) who feel this way (p<0.05).
"We conclude that patients with UC experience a significantly higher psychological burden, and their symptoms are frequently more disruptive to their lives, than patients with the other diseases in the survey. As such, we as physicians should initiate communication with UC patients on quality of life issues in order to better understand the effects this disease is having on them and aggressively treat the disease and its concomitant psychological effects to lessen the burden," said Dr. Rubin.