The following article features coverage from the 2020 San Antonio Breast Cancer Symposium. Click here to read more of Cancer Therapy Advisor‘s conference coverage.

Physicians commonly underrecognized adverse events of pain, pruritus, edema, and fatigue that patients with breast cancer experienced after radiotherapy, found a study presented at the 2020 Virtual San Antonio Breast Cancer Symposium (SABCS).

The study included 9868 patients from 29 practices in Michigan who had breast cancer and received radiotherapy after lumpectomy.

Study researchers reviewed 37,593 reports of pain, pruritus, edema, and fatigue from patient reports and compared them with the grade physicians gave the adverse events. Physicians graded adverse events using the Common Toxicity Criteria for Adverse Events (CTCAE).

Physicians were considered to underrecognize pain if they graded the severity as 0 — that is, absent — and the patient reported the severity as moderate, or if they graded the severity as 1 or lower and the patient reported the severity as severe. Pruritis and edema were considered underrecognized if physicians graded the severity as 0 and patients reported bother often or all of the time. Fatigue was considered underrecognized if physicians graded the severity as 0 and patients reported having significant fatigue most of the time or always.


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For more than half of patients (53.2%) at least 1 of the 4 adverse events were underrecognized by physicians. Edema was the most frequently underrecognized symptom, with 51.4% of reports of edema made by patients underrecognized by physicians. Patient reports of pain were underrecognized 30.9% of the time, pruritis 36.7% of the time, and fatigue 18.8% of the time.

A multivariate analysis revealed several factors associated with underrecognition of symptoms — and the most prominent were race and age.

Compared with White patients, Black patients had a 92% increased odds of having adverse events underrecognized (odds ratio [OR], 1.92; 95% CI, 1.65-2.23; P <.001).

Compared with patients aged 60 to 69 years, patients who were younger than 50 years had a 35% increased odds of having adverse events underrecognized (OR, 1.4).

In addition, patients who were treated at an academic facility had a higher — albeit small — odds of having adverse events underrecognized compared with patients treated at a community facility (OR, 1.1).

“We need to do a better job — that’s really what it is,” commented SABCS Codirector Virginia Kaklamani, MD, UT Health San Antonio MD Anderson Cancer Center, Texas. “We need to conduct studies where patient-reported outcomes are being reported, and we as physicians need to listen more to our patients.”

Disclosure: Study presenter Reshma Jagsi, MD, disclosed having received personal fees from Amgen and Vizient and grant funding from the National Institutes of Health, the Doris Duke Foundation, the Greenwall Foundation, the Komen Foundation, and BCBSM for the MROQC. Dr Jagsi is contracted to conduct a study with Genentech.

Read more of Cancer Therapy Advisor‘s coverage of the 2020 SABCS meeting by visiting the conference page.

Reference

Jagsi R, Griffith KA, Vicini F, et al. Identifying patients whose symptoms are under-recognized during breast radiotherapy: comparison of patient and physician reports of toxicity in a multicenter cohort. Presented at: 2020 Virtual San Antonio Breast Cancer Symposium; December 8-11, 2020. Abstract GS3-07.