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10-12-2020 | SABCS 2020 | Conference coverage | News

Breast cancer radiotherapy side effects often under-recognized

Author: Shreeya Nanda

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medwireNews: Physicians and patients differ in their assessment of side effects following radiotherapy for breast cancer, researchers have found.

The collection of patient-reported outcomes (PROs) “appears essential for trials because relying on the [physician-reported] CTCAE to detect adverse events misses important symptoms,” presenting author Reshma Jagsi (University of Michigan, Ann Arbor, USA) told the press at the 2020 San Antonio Breast Cancer Symposium.

“Moreover, this work reveals that physicians systematically miss substantial symptoms in certain patients, including patients who are younger or of black or other race, and therefore, improving symptom detection may actually be a targetable mechanism to reduce disparities in radiotherapy experiences and outcomes,” she added.

The study included 9941 participants of the Michigan Radiation Oncology Quality Consortium who received radiotherapy after undergoing lumpectomy in January 2012–March 2020 and completed at least one PRO questionnaire during radiotherapy.

A total of 34.5% of patients reported moderate or severe breast pain on the Brief Pain Inventory (BPI), 30.6% and 23.9% reported frequent bother from pruritus and edema, respectively, on an adapted version of Skindex, and 24.9% reported severe fatigue.

Jagsi said that for 9868 patients, the symptoms reported could be compared with physician CTCAE assessments conducted within 3 days of the PRO evaluation.

Under-recognition of pain occurred in 30.9% of patients, where under-recognition was defined as physicians grading pain as absent (BPI score of 0 points) when patients graded it as moderate (score 4–6 points), or giving it a score of 1 point or less when patients described pain as severe (score 7–10 points).

Similarly, pruritus and edema were under-recognized in a respective 36.7% and 51.4% of participants, with physicians reporting the symptoms as absent when patients reported bother often or all of the time.

And in 18.8% of cases, physicians graded fatigue as absent even though patients reported having significant fatigue most of the time or always.

Of the 5510 patients who reported one or more substantial symptoms during radiotherapy, under-recognition of at least one of the four evaluated symptoms occurred in just over half (53.2%) of cases.

Jagsi also presented data on predictors of under-recognition, highlighting that patients aged younger than 50 years or 50–59 years were a significant 35% and 21% more likely to have symptoms under-recognized, respectively, than their counterparts aged 60–69 years.

The likelihood of under-recognition was increased a significant 92% for Black versus White patients, while for those of races other than Black or Asian, the odds were a significant 82% higher.

“It is possible that there is a misconception among medical professionals about the pain tolerance of patients based on age and race,” Jagsi said in a press release.

“Our study identifies some concerning patterns that need to be evaluated in future research, along with opportunities for intervention to improve the quality and equity of cancer care delivery,” she concluded.

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2020 Springer Healthcare Ltd, part of the Springer Nature Group

SABCS 2020: 8–11 December

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