Recognizing Adverse Symptoms in Patients Undergoing Breast Radiotherapy
Posted: Wednesday, January 6, 2021
Reliance on physician-reported adverse events through assessments such as the Common Toxicity Criteria for Adverse Events (CTCAE) may cause underreporting of patient symptoms, making patient-reported outcomes essential for clinical trial use. These results were reported at the 2020 San Antonio Breast Cancer Symposium by Reshma Jagsi, MD, DPhil, of the University of Michigan, Ann Arbor, and colleagues (Abstract GS3-07).
“Since physicians systematically miss substantial symptoms in certain patients, including patients who are younger or of Black or other race, improving symptom detection may be a targetable mechanism to reduce disparities in radiotherapy experiences and outcomes,” concluded the authors.
Researchers enrolled 13,725 patients who underwent radiotherapy after lumpectomy, 9,941 of whom completed at least one patient-reported outcomes questionnaire during their radiation treatment. Physician assessments using CTCAE were compared with the patient-reported outcomes evaluation, and the ratings of four symptoms were compared: breast pain, pruritus, edema, and fatigue. Physician assessments that did not recognize these symptoms at all (score of 0 on CTCAE) when patients reported moderate to severe symptoms were deemed underrecognition of symptoms.
Among this cohort, 34.5% of patients reported substantial breast pain, 30.6% reported frequent pruritus, 23.9% reported edema, and 24.9% experienced severe fatigue. In comparison, underrecognition of symptoms was observed in 30.9% of patients experiencing pain, 36.7% of patients experiencing pruritus, 54.1% of patients experiencing edema, and 18.8% of patients reporting fatigue. For patients reporting at least one of these substantial symptoms throughout treatment, underrecognition of one of these symptoms occurred 53.2% of the time.
The team performed multivariate analyses to assess independent factors that may contribute to physicians' underrecognition of adverse events. Patients who were younger than 50 or between the ages of 50 and 59 tended to have symptoms underrecognized compared with those between 60 and 69 (odds ratio = 1.4 and 1.2, respectively). Patients identifying as Black or other races seemed to experience more underrecognition of symptoms than White patients (odds ratio = 1.9 and 1.8).
Disclosure: For a full list of authors’ disclosures, visit www.sabcs.org.
