The agreement between clinician- and patient-reported toxicities and their association with poor tolerance to therapy were assessed in an older population receiving curative radiotherapy (RT).
Materials and Methods
Patients ≥ 65 years old with newly-diagnosed head and neck or lung cancer receiving curative RT ± chemotherapy were enrolled on a prospective, observational study. Agreement between clinician (CTCAEv4.02) and patient (PRO-CTCAE, EORTC QLQ-C30) report of toxicities were assessed at baseline, during treatment, and post-treatment. The association of clinician- and patient-reported symptoms with poor tolerance to therapy (defined as hospitalization, >3-day treatment delay, change in treatment regimen, or death) was assessed.
Among 45 patients, median age was 71, 60% had head and neck cancer, and 47% received concurrent chemotherapy with RT. In comparing CTCAE vs PRO-CTCAE, there was good agreement at baseline except for fatigue, anorexia, and pain, where clinicians under-reported the severity. The discrepancy increased during treatment with clinicians reporting lower severity in ≥50% of matched pairs for 4/10 symptoms assessed. At follow-up, clinicians under-reported severity in ≥50% of pairs for 7/10 symptoms. CTCAE vs EORTC QLQ-C30 mirrored these findings. Patient-reported symptoms of nausea and dysphagia at 2 weeks and clinician-observed symptoms of nausea and dysphagia at 4 weeks were associated with poor tolerance to therapy.
Clinicians under-report toxicities during and after curative RT in older patients with head and neck or lung cancer. Select toxicities reported by patients early in treatment and clinicians later in treatment were associated with poor tolerance to cancer therapy, providing valuable complementary information.
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- Recommendations for incorporating patient-reported outcomes into clinical comparative effectiveness research in adult oncology.J Clin Oncol Off J Am Soc Clin Oncol. 2012; 30: 4249-4255https://doi.org/10.1200/JCO.2012.42.5967
- Patient self-reports of symptoms and clinician ratings as predictors of overall cancer survival.J Natl Cancer Inst. 2011; 103: 1851-1858https://doi.org/10.1093/jnci/djr485
- Quality of life after the initial treatments of non-small cell lung cancer: a persistent predictor for patients' survival.Health Qual Life Outcomes. 2014; 12: 73https://doi.org/10.1186/1477-7525-12-73
- Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment.JAMA. 2017; 318: 197-198https://doi.org/10.1001/jama.2017.7156
- The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology.J Natl Cancer Inst. 1993; 85: 365-376
- Quality, interpretation and presentation of European Organisation for Research and Treatment of Cancer quality of life questionnaire core 30 data in randomised controlled trials.Eur J Cancer Oxf Engl. 2008; 44: 1793-1798https://doi.org/10.1016/j.ejca.2008.05.008
- Development of the National Cancer Institute's patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE).J Natl Cancer Inst. 2014; 106https://doi.org/10.1093/jnci/dju244
- Validity and reliability of the US national cancer institute's patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE).JAMA Oncol. 2015; 1: 1051-1059https://doi.org/10.1001/jamaoncol.2015.2639
- Future of cancer incidence in the United States: burdens upon an aging, changing nation.J Clin Oncol Off J Am Soc Clin Oncol. 2009; 27: 2758-2765https://doi.org/10.1200/JCO.2008.20.8983
- Comparison between patient-reported and clinician-observed symptoms in oncology.Cancer Nurs. 2013; 36: E1-16https://doi.org/10.1097/NCC.0b013e318269040f
- Geriatric assessment as a predictor of tolerance, quality of life, and outcomes in older patients with head and neck cancers and lung cancers receiving radiation therapy.Int J Radiat Oncol Biol Phys. 2017; 98: 850-857https://doi.org/10.1016/j.ijrobp.2016.11.048
- Effect of gap length and position on results of treatment of cancer of the larynx in Scotland by radiotherapy: a linear quadratic analysis.Radiother Oncol J Eur Soc Ther Radiol Oncol. 1998; 48: 165-173
- Effects of prolongation of overall treatment time due to unplanned interruptions during radiotherapy of different tumor sites and practical methods for compensation.Int J Radiat Oncol Biol Phys. 2007; 68: 654-661https://doi.org/10.1016/j.ijrobp.2007.03.010
- Patient versus clinician symptom reporting using the National Cancer Institute Common Terminology Criteria for Adverse Events: results of a questionnaire-based study.Lancet Oncol. 2006; 7: 903-909https://doi.org/10.1016/S1470-2045(06)70910-X
- Assessing health-related quality of life in palliative care: comparing patient and physician assessments.Eur J Cancer Oxf Engl. 2006; 42: 1159-1166https://doi.org/10.1016/j.ejca.2006.01.032
- Adverse symptom event reporting by patients vs clinicians: relationships with clinical outcomes.J Natl Cancer Inst. 2009; 101: 1624-1632https://doi.org/10.1093/jnci/djp386
- Health-related quality-of-life assessments and patient-physician communication: a randomized controlled trial.JAMA. 2002; 288: 3027-3034
- Measuring quality of life in routine oncology practice improves communication and patient well-being: a randomized controlled trial.J Clin Oncol Off J Am Soc Clin Oncol. 2004; 22: 714-724https://doi.org/10.1200/JCO.2004.06.078
- Cancer in the elderly: why so badly treated?.Lancet Lond Engl. 1990; 335: 1020-1022
- Treatment of older patients with head and neck cancer: a review.Oncologist. 2013; 18: 568-578https://doi.org/10.1634/theoncologist.2012-0427
- Cancer in the older person.Cancer Treat Rev. 2005; 31: 380-402https://doi.org/10.1016/j.ctrv.2005.04.012
- Comparison of patient- and practitioner-reported toxic effects associated with chemoradiotherapy for head and neck cancer.JAMA Otolaryngol Head Neck Surg. 2016; 142: 517-523https://doi.org/10.1001/jamaoto.2016.0656
- Patient-reported outcomes vs. clinician symptom reporting during chemoradiation for rectal cancer.Gastrointest Cancer Res GCR. 2012; 5: 119-124
- Postradiotherapy morbidity in long-term survivors after locally advanced cervical cancer: how well do physicians' assessments agree with those of their patients?.Int J Radiat Oncol Biol Phys. 2008; 71: 1335-1342https://doi.org/10.1016/j.ijrobp.2007.12.030
- Validation of the EORTC QLQ-C30 quality of life questionnaire through combined qualitative and quantitative assessment of patient-observer agreement.J Clin Epidemiol. 1997; 50: 441-450
- Do patient and physician expectations predict response to pain-relieving procedures?.Clin J Pain. 1997; 13: 348-351
- The association between clinician-based common terminology criteria for adverse events (CTCAE) and patient-reported outcomes (PRO): a systematic review.Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 2016; 24: 3669-3676https://doi.org/10.1007/s00520-016-3297-9
Published online: June 11, 2018
Accepted: May 22, 2018
Received in revised form: April 20, 2018
Received: March 12, 2018
© 2018 Elsevier Ltd. All rights reserved.