Patient versus clinician symptom reporting during chemoradiation for rectal cancer.

Abstract

646 Background: Pelvic radiotherapy with concurrent 5-fluorouracil based chemotherapy (chemoradiation) is a component of standard therapy for patients with T3/T4 or node-positive rectal cancer. Chemoradiation can be associated with significant acute gastrointestinal toxicity. This study sought to retrospectively compare patient and clinician reports of acute symptoms experienced by rectal cancer patients receiving chemoradiation. Methods: The charts of 199 rectal cancer patients who received chemoradiation from 11/06 to 2/11 were reviewed. Clinicians assessed toxicity weekly using Common Terminology for Clinical Adverse Event (CTCAE) version 3.0. Patient-reported outcomes (PROs) were collected weekly, in clinic, beginning 9/09 using the 7-item Bowel Problems Scale. 197 patients had at least one clinician assessment or PRO and were eligible for this study. Patient and clinician assessments were compared among a subgroup of 65 patients (paired group) who had at least one patient and clinician assessment on the same date using descriptive statistics. Agreement between patient and clinician assessments was evaluated by Cohen’s kappa coefficient. Results: Characteristics were well-balanced between all rectal patients and the paired group, with the exception of the use of intensity modulated radiotherapy (IMRT). IMRT has been used increasingly over time, and IMRT was therefore used in a larger proportion of the paired group versus all patients (77% vs. 51%, respectively). Diarrhea and proctitis were reported more often by patients than clinicians throughout treatment. Uncorrected agreement for diarrhea and proctitis was 82% and 72%, respectively. Corrected for chance, Cohen’s kappa was .64 for diarrhea, indicating moderate agreement, and .22 for proctitis, indicating only slight agreement. Conclusions: Our findings suggest a discrepancy between clinician and patient symptom reports. Further study is warranted to discern potential benefits of including PROs in prospective studies, and to find whether PROs can help clinicians set patient expectations, and/or enhance communication for optimal symptom management.

Prospective Evaluation of Acute Toxicity and Quality of Life After IMRT and Concurrent Chemotherapy for Anal Canal and Perianal Cancer

“…To our knowledge, no study has compared patient-reported outcomes with physician reports of acute toxicity experienced by patients with anal cancer. A study on patients with rectal cancer showed moderate agreement between physicians and patients for diarrhea reporting (33). In our study, there was good agreement between physicians and patients in reporting diarrhea and perianal skin reaction (CTCAE !1 vs QOL score !2: 61% vs 65% and 100% vs 95%); McNemar test PZ.62 and PZ.48, respectively.…”

The association between clinician-based common terminology criteria for adverse events (CTCAE) and patient-reported outcomes (PRO): a systematic review

“…This included disease specific modules of the European Organization for Research and Treatment of Cancer (EORTC) [12–20] and Functional Assessment of Cancer Therapy (FACT) [21–23] instruments, as well as the dermatology-specific Skindex-16, [24, 25] the EuroQol EQ-5D, [26] the Short-Form 36 Health Survey (SF-36) [27], and two recently developed bowel symptom inventories [28, 29]. Patient-adapted versions of the CTCAE were used in four studies [27, 30–32], with visual analog scales used to capture patient-rated AEs in three studies [11, 33, 34].…”

“…Independent studies that made use of the Bowel Problem Scale in cohorts of patients with rectal [28] or anal [29] cancer found poor agreement with clinician ratings for proctitis (κ = 0.22 and 0.11, respectively) and moderate agreement for diarrhea (κ = 0.64 and 0.68, respectively). Additionally, independent studies of neuropathy reported a poor to moderate relationship between PRO and CTCAE reports, as measured by the FACT Gynecologic Oncology Group – Neurotoxicity Module (FACT/GOG-Ntx) ( r ’s range 0.23–0.69) [23, 36].…”

Single Nucleotide Polymorphism TGFβ1 R25P Correlates with Acute Toxicity during Neoadjuvant Chemoradiotherapy in Rectal Cancer Patients

“…For example, it has been shown that clinicians tend to underreport proctitis during CRT for rectal cancer, compared with patients (10). Grading of subjective symptoms, such as proctitis, by the individual patient should be considered an essential standard.…”

“…Weekly during CRT, these patients completed the 7-item Bowel Problems Scale, a questionnaire originally designed to assess bowel symptoms in prostate cancer patients and later applied to rectal cancer patients (10-12). This questionnaire asks patients to score the frequency of diarrhea, bowel urgency, rectal tenderness or pain, hematochezia, abdominal cramping or pain, mucus passage from the rectum, and tenesmus.…”