Breast Radiotherapy Symptoms Often Under-Recognized By Providers

Physicians may miscalculate the severity of symptoms from radiotherapy (RT) in women with breast cancer, according to a study presented at the San Antonio Breast Cancer Symposium.

"Understanding whether physicians detect when their patients are experiencing substantial toxicity is important because recognition of symptoms is necessary for appropriate supportive care," Dr. Reshma Jagsi from University of Michigan, Ann Arbor, said during a press briefing.

This study shows 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 radiation therapy experiences and outcomes," she added.

The study included 9,868 women who underwent RT following lumpectomy and completed at least one patient-reported outcome (PRO) questionnaire during RT.

​

The PRO evaluations were compared against physician grades using the Common Toxicity Criteria for Adverse Events (CTCAE). CTCAE grades range from 0 (no symptom) to 5 (death related to the symptom). Patients and physicians rated four symptoms: breast pain, pruritus, edema and fatigue.

On standard assessment tools, 34.5% of women reported moderate or severe breast pain; 30.6% and 23.9% reported frequent bother from pruritus and edema, respectively; and 24.9% reported severe fatigue.

Physicians under-recognized pain in 30.9% of women. Under-recognition was defined as physicians grading pain as 0 (absent) when the woman graded it as moderate (score 4 to 6) or giving it a grade of 1 or less when the woman described her pain as severe (score 7 to 10).

Physicians under-recognized pruritus and edema in 36.7% and 51.4% of women, respectively, with physicians reporting these symptoms as absent when patients reported bother often or all of the time.

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

Among the 5,510 women who reported at least one substantial symptom during RT, more than half (53.2%) had under-recognition of at least one of the four symptoms.

Factors independently associated with symptom under-recognition were younger age and Black or other race (vs White). "It is possible that there is a misconception among medical professionals about the pain tolerance of patients based on age and race," Dr. Jagsi said in a news 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 added.

Briefing discussant for the study, Dr. Virginia Kaklamani, said the level of under-recognition of RT symptoms in this large study was "relatively surprising. We need to do a better job and we need to conduct studies where patient-reported outcomes are being reported. And we as physicians need to listen more to our patients," said Dr. Kaklamani, who leads the breast cancer program at UT Health San Antonio, Texas.

In a phone interview with Reuters Health, Dr. Richard Bakst, Associate Professor, Radiation Oncology, Tisch Cancer Institute at Mount Sinai in New York, said the study "highlights an under-addressed area and it is perhaps the tip of the iceberg in terms of appreciating this. And it's not going to be unique just to breast cancer. I wouldn't be surprised if it played out in prostate cancer and other cancers as well."

—Megan Brooks

Source