Patient reported outcomes for symptom toxicity in breast cancer patients undergoing radiotherapy

Patient reported outcomes (PRO) usually report greater symptom toxicity compared to physician reported outcomes (PhyRO). In the present study, we measured PRO about symptom toxicity in breast cancer patients undergoing adjuvant radiotherapy and compared them with the PhyRO. We analysed the factors responsible for greater symptom severity on PRO. We also assessed the health-related Quality of Life (QoL).

Sixty-seven breast cancer patients undergoing adjuvant radiotherapy were prospectively enrolled. PhyRO were reported using the CTCAE v5.0 while PRO were reported using PRO CTCAE v1.0. To determine the level of agreement between the PRO and PhyRO, we employed weighted Kappa statistics. EQ-5D-5 L scale was used to assess the QoL.

Post radiotherapy, when PRO were compared with PhyRO, fair agreement (K = 0.21-0.40) was seen for nausea, vomiting, dysphagia, dysgeusia, anorexia and fatigue; moderate agreement (K = 0.41-0.60) was seen for pain; slight agreement (K = 0.01-0.20) was seen for myalgia; almost perfect agreement (K = 0.81-1.00) was seen for pruritis and substantial agreement (K = 0.61-0.80) was seen for dermatitis. Overall, the concordance between PhyRO and PRO appeared poor. Factors which were significantly associated with lesser symptom toxicity on PhyRO were patient age (41-60 years), literacy, housewives, married females, rural background, poor financial status, stage II, treated with three fields, treated with hypofractionation and male gender of the physician. There was no difference in the mean utility values of patients corresponding to the severity of toxicities reported by PhyRO or PRO.

This study strongly supports the inclusion of PRO in routine clinical care as complimentary information to PhyRO to improve patient care, compliance and clinical outcomes.