A systematic review and meta-analysis of clinician-reported versus patient-reported outcomes of radiation dermatitis

Abstract

Radiation dermatitis is a common adverse effect of radiotherapy (RT) in breast cancer patients. Although radiation dermatitis is reported by either the clinician or the patient, previous studies have shown disagreement between clinician-reported outcomes (CROs) and patient-reported outcomes (PROs). This review evaluated the extent of discordance between CROs and PROs for radiation dermatitis. Studies reporting both clinician and patient-reported outcomes for external beam RT were eligible. Nine studies met the inclusion criteria for the systematic review, while 8 of these studies were eligible for inclusion in a meta-analysis of acute and late skin toxicities. We found an overall agreement between CROs and PROs of acute skin colour change, fibrosis and/or retraction, and moist desquamation ( p > 0.005). Reporting of late breast pain, breast edema, skin colour change, telangiectasia, fibrosis and/or retraction and induration/fibrosis alone ( p > 0.005) were also in agreement between clinicians and patients. Our meta-analysis revealed a greater reporting of acute breast pain by patients (RR = 0.89, 95% CI 0.87–0.92, p < 0.001), greater reporting of acute breast edema by physicians (RR = 1.80, 95% CI 1.65–1.97, p < 0.001) and a greater reporting of late breast shrinkage by patients (RR = 0.61, 95% CI 0.44–0.86, p = 0.005). However, our review was limited by the discrepancies between PRO and CRO measurement tools as well as the absence of standard time points for evaluation of radiation dermatitis. Given potential discrepancies between CROs and PROs, both measures should be reported in future studies. Ultimately, we advocate for the development of a single tool to assess symptoms from both perspectives.

Comparing Hypofractionated With Conventional Fractionated Radiotherapy After Breast-Conserving Surgery for Early Breast Cancer: A Meta-Analysis of Randomized Controlled Trials

“…Thus, HFRT may minify the acute toxicity by decreasing the total dose. Breast induration is the possible outcome of advanced fibrosis following radiotherapy for breast cancer (48), and the possibility of breast fibrosis increased for 2 years after radiotherapy (49). It has been suggested that HFRT increases the incidence of fibrosis (34), but our data showed that the incidence of breast induration was improved in the HFRT group.…”

DNA damage response signaling pathways and targets for radiotherapy sensitization in cancer

“…RR leads to cancer relapse, poor treatment response, poor prognosis, decreased quality of life, and increased disease treatment burden. Furthermore, RR induces damage to canceradjacent normal tissues, disrupting the physiological and biochemical functions of normal tissue, resulting in symptoms, including radiation-related diarrhea, rectal bleeding, and radiation dermatitis [39][40][41] , as well as an increased risk of subsequent secondary cancer 26,[42][43][44] or chronic noncommunicable diseases including type II diabetes 45,46 or cardiovascular diseases 47 . Over the past century, to remove the barrier of RR, many studies have been carried out to investigate RR-related regulatory genes, molecules, and signaling pathways to uncover the underlying mechanisms of RR and to develop radiation sensitizers 48,49 .…”

An comparison of acute toxicities and patient‐reported outcomes between intensity‐modulated proton therapy and volumetric‐modulated arc therapy after ipsilateral radiation for head and neck cancers

“…Both reported significantly less acute toxicity with patients treated with passively scattered proton therapy. As retrospective collection and physicianreported toxicities, in general, are limited in their ability to accurately reflect the true patient experience, [25][26][27] these data are the first to demonstrate improvement in patient treatment burden by prospectively acquired patient-reported toxicities as it correlates to dosimetric improvement with IMPT.…”