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for the Michigan Radiation Oncology Quality Consortium IMPORTANCE Understanding whether physicians accurately detect symptoms in patients with breast cancer is important because recognition of symptoms facilitates supportive care, and clinical trials often rely on physician assessments using Common Toxicity Criteria for Adverse Events (CTCAE).OBJECTIVE To compare the patient-reported outcomes (PROs) of patients with breast cancer who received radiotherapy from January 1, 2012, to March 31, 2020, with physicians' CTCAE assessments to assess underrecognition of symptoms. DESIGN, SETTING, AND PARTICIPANTSThis cohort study included a total of 29 practices enrolled in the Michigan Radiation Oncology Quality Consortium quality initiative. Of 13 725 patients with breast cancer who received treatment with radiotherapy after undergoing lumpectomy, 9941 patients (72.4%) completed at least 1 PRO questionnaire during treatment with radiotherapy and were evaluated for the study. Of these, 9868 patients (99.3%) were matched to physician CTCAE assessments that were completed within 3 days of the PRO questionnaires.EXPOSURES Patient and physician ratings of 4 symptoms (pain, pruritus, edema, and fatigue) were compared. MAIN OUTCOMES AND MEASURESWe used multilevel multivariable logistic regression to evaluate factors associated with symptom underrecognition, hypothesizing that it would be more common in racial and ethnic minority groups. RESULTSOf 9941 patients, all were female, 1655 (16.6%) were Black, 7925 (79.7%) were White, and 361 (3.6%) had Other race and ethnicity (including American Indian/Alaska Native, Arab/Middle Eastern, and Asian), either as self-reported or as indicated in the electronic medical record. A total of 1595 (16.0%) were younger than 50 years, 2874 (28.9%) were age 50 to 59 years, 3353 (33.7%) were age 60 to 69 years, and 2119 (21.3%) were 70 years or older. Underrecognition of symptoms existed in 2094 of 6781 (30.9%) observations of patient-reported moderate/severe pain, 748 of 2039 observations (36.7%) of patient-reported frequent pruritus, 2309 of 4492 observations (51.4%) of patient-reported frequent edema, and 390 of 2079 observations (18.8%) of patient-reported substantial fatigue. Underrecognition of at least 1 symptom occurred at least once for 2933 of 5510 (53.2%) of those who reported at least 1 substantial symptom. Factors independently associated with underrecognition were younger age (younger than 50 years compared with 60-69 years: odds ratio [

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The average patient age, BMI and pre-treatment IPSS were 70 years old (range: 56-84), 30 kg/m 2 (range:19-55), and 8 (range: 0-21), respectively. Most patients (48/52) had rectal spacers placed prior to SBRT. Data analysis for predictors of intrafraction prostate motion revealed that larger pre-treatment bladder and rectal volumes were associated with more beam offs per fraction (p Z 0.018 and p Z 0.014, respectively). In addition, there was a trend for larger bladder volumes to predict greater shifts in the ventral-dorsal direction (pZ 0.052) and magnitude of the 3D vector (p Z 0.051). Patients using urinary medications had fewer number of beam offs during their treatment course (p Z 0.038). Patient age, BMI, baseline IPSS and pre-treatment gas volume did not correlate with prostate motion during treatment. Conclusion: Our results suggest that patient bladder and rectal volumes at the time of treatment can influence prostate motion during SBRT. We can conclude that rectal emptying prior to treatment is critical for rectal dose avoidance and prostate motion mitigation, however future studies will be needed to determine the optimal bladder volume during prostate SBRT.