PATIENT REPORTED ADVERSE EVENTS WITH CHEMORADIOTHERAPY

NEW YORK (Reuters Health) - Patients receiving chemoradiotherapy for head and neck cancer differ from practitioners in their assessment of toxic effects, according to findings from a small study.

As Dr. Ethan M. Basch told Reuters Health by email, "This study adds to the growing body of evidence that collecting symptoms directly from patients is feasible and improves cancer care and communication."

In a May 6 online paper in JAMA Otolaryngology - Head and Neck Surgery, Dr. Basch, of the University of North Carolina, Chapel Hill, and colleagues noted that the level of agreement between patient- and practitioner-reported side effects of such therapy has been unknown.

To investigate further, the team conducted an analysis of findings in 44 patients involved in a phase 2 trial of deintensified chemoradiotherapy for oropharyngeal carcinoma.

Baseline, weekly, and post-treatment toxic effects were assessed by physicians or nurse practitioners using the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE). Patient-reported symptom severity was measured using the Patient-Reported Outcomes version of the CTCAE (PRO-CTCAE).

Over the course of about three years, the team compiled 327 analyzable pairs of CTCAE and PRO-CTCAE symptom surveys.

At baseline, when most symptoms were absent, patient and practitioner agreement was high. However, disagreement increased along with toxic effects. This was mainly due to lower severity of toxic effects reported by practitioners.

For example, at baseline there was 45% agreement on pain, but by the end of treatment that had fallen to 27%. This was particularly the case for fatigue, with 43% agreement at baseline, but only 12% in the final week of treatment.

The researchers point out that there is no objective standard for a correct ascertainment of symptoms severity. For instance, daily vomiting alone may not be not categorized as a high-grade toxic effect by the practitioner, but considered quite severe by the patient.

However, they concluded, "As PRO-CTCAE continues to be incorporated into clinical practice, there is an obvious benefit in systematically providing practitioners with patient-reported data, which may contribute to their assessment of toxic effects."

Commenting on the findings by email, Dr. Francis P. Worden, author of an accompanying editorial, told Reuters Health that the article "demonstrates the importance of assessing the toxicities experienced by patients during and after chemoradiotherapy for locally advanced head and neck cancers."

Dr. Worden, of the University of Michigan Comprehensive Cancer Center, Ann Arbor, concluded, "It is hoped that such research efforts might help to pioneer improvements in symptom-related patient outcomes."

The authors reported no funding or study-related disclosures.