Utilization of Patient-Reported Outcomes to Guide Symptom Management during Stereotactic Body Radiation Therapy for Clinically Localized Prostate Cancer

Abstract

IntroductionUtilization of patient-reported outcomes (PROs) to guide symptom management during radiation therapy is increasing. This study focuses on the use of the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) as a tool to assess urinary and bowel bother during stereotactic body radiation therapy (SBRT) and its utility in guiding medical management.MethodsBetween September 2015 and January 2017, 107 patients with clinically localized prostate cancer were treated with 35–36.25 Gy via SBRT in five fractions. PROs were assessed using EPIC-CP 1 h prior to the first fraction and after each subsequent fraction. Symptom management medications were prescribed based on the physician clinical judgment or if patients reported a moderate to big problem. Clinical significance was assessed using a minimally important difference of 1/2 SD from baseline score.ResultsA median baseline EPIC-CP urinary symptom score of 1.5 significantly increased to 3.7 on the day of the final treatment (p < 0.0001). Prior to treatment, 9.3% of men felt that their overall urinary function was a moderate to big problem that increased to 28% by the end of the fifth treatment. A median baseline EPIC-CP bowel symptom score of 0.3 significantly increased to 1.4 on the day of the final treatment (p < 0.0001). Prior to treatment, 1.9% of men felt that their overall bowel function was a moderate to big problem that increased to 3.7% by the end of the fifth treatment. The percentage of patients requiring an increased dose of alpha-antagonist increased to 47% by the end of treatment, and an additional 28% of patients required a short steroid taper to manage moderate to big urinary problems. Similarly, the percentage of patients requiring antidiarrheals reached 12% by the fifth treatment.ConclusionDuring the course of SBRT, an increasing percentage of patients experienced clinically significant symptoms many of which required medical management. Monitoring patient symptoms during treatment allowed for prompt detection and management of acute urinary and bowel symptoms. The usage of symptom management medications was high in this study compared to historical controls and may be due to increased physician awareness of moderate to big patient problems.

Web-Based Symptom Monitoring With Patient-Reported Outcomes During Definitive Radiation Therapy With Chemotherapy (SYMPATHY): A Prospective Single-Center Phase 1 Study

“…Excessive burden has shown to reduce survey response rates and data accuracy. 28 Shorter questionnaires were generally associated with higher response rate, 11 , 27 even when surveyed daily for a prolonged period of time. 26 We used the PRO-CTCAE instrument for both on-treatment and follow-up surveys because it has been validated in radiation oncology patients.…”

“… 7 , 9 , 10 , 11 , 12 , 23 , 24 , 25 Even in a limited selection of studies specifically for radiation patients, only a subset the patients underwent concurrent chemoradiation. 26 , 27 The experience for patients undergoing definitive CRT differs from patients with metastatic disease undergoing chemotherapy in several ways. First, patients undergoing definitive CRT experience the combined side effects from both chemotherapy and RT, although they may have a more limited disease burden.…”

Self-Reported Burden in Elderly Patients With Localized Prostate Cancer Treated With Stereotactic Body Radiation Therapy (SBRT)

“…The Expanded Prostate Cancer Index Composite (EPIC)-26 is a validated instrument that evaluates urinary, bowel, sexual function and bother, and hormonal outcomes (5). We have employed this questionnaire in our clinic and have previously reported on the use of EPIC-26 to assess for patient reported outcomes (5)(6)(7)(8). Critical gaps remain in our understanding of patients' perceived burden of disease and treatment and its correlation with urinary, bowel, sexual, and hormonal symptoms (6).…”