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How women with cervical or endometrial cancer who need postoperative radiation therapy (RT) view their treatment-related adverse events (AEs) can be vastly different from how their doctors view their AEs. The researchers compared the symptoms reported by patients and doctors during RT and found that doctors tended to underestimate symptomatic gastrointestinal side effects. The results of the study, published in the Journal of Clinical Oncology, also found that patients reported fewer symptoms with intensity-modulated RT (IMRT) compared to standard RT. Doctor-reported side effects showed no differences between IMRT and standard RT.
The study included women with cervical or endometrial cancer in need of postoperative RT, and patients were randomly assigned to a standard 4-field RT or IMRT (ClinicalTrials.gov Identifier: NCT00331760). Each person was treated at 45 or 50.4 Gy depending on the doctor’s preference, and all participants completed the 6-point version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) for gastrointestinal toxicity. This tool rates abdominal pain, diarrhea, and fecal incontinence at different times. The researchers compared the patients’ reported symptoms with those recorded by clinicians as CTCAE.
A total of 234 patients agreed to and completed the PRO-CTCAE. The researchers found that patients were 19.1% more likely to report severe abdominal pain than their doctors. The results were similar for high-grade diarrhea and fecal incontinence, which both patients reported more often than their doctors. For Grade 1 or greater CTCAE toxicity and patient reported toxicity of any grade, clinicians tended to underreport compared to patients.
The physician-reported CTCAE abdominal pain rate of all grades was 35.6%. However, 80.1% of the patients reported at least mild abdominal pain, and 69.5% reported abdominal pain that interfered with normal activities. The Grade 3 or greater CTCAE toxicity rate in physicians was 2.5%, but was significantly lower than in 21.6% of women who reported severe or very severe abdominal pain.
When the researchers examined high-grade AEs reported by patients at 5 weeks RT, they found that subjects who received IMRT reported fewer gastrointestinal AEs than subjects who received 4-field pelvic RT for diarrhea (33.7 % versus 51.9%) of fecal incontinence (1.1% versus 9.3%) and fecal incontinence disorder (4.4% versus 12.9%).
- Yeung AR, Pugh SL, Klopp AH et al. Improving patient-reported outcomes with intensity-modulated radiation therapy (RT) compared to standard RT: A report from the NRG Oncology RTOG 1203 study. J Clin Oncol. 2020; 38: 1685- 1692. doi: 10.1200 / JCO.19.02381
Gynecological cancers of endometrial cancer
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