Under-ascertainment of clinically-meaningful symptoms during prostate cancer radiation therapy - does this vary by patient characteristics?

Abstract

PURPOSE/OBJECTIVES\nIt is well known that physicians under-ascertain chemotherapy-related toxicity compared to patient self-report. However, under-ascertainment in radiation therapy and characterization of patient groups at increased risk for under-ascertainment have not been examined.\n\n\nMATERIALS/METHODS\nAs part of routine clinical care, 7 urinary and gastrointestinal symptoms were prospectively collected with both patient report (PROs) using the validated Prostate Cancer Symptom Indices, and physician-graded symptoms using CTCAE for 544 consecutive patients from 2010-18 who received IMRT to the prostate or prostate bed. Data from weekly treatment visits and the first post-treatment follow-up were analyzed. Under-ascertainment was defined as an occurrence when a clinically-meaningful symptom was indicated on PROs but not physician CTCAE assessment. Univariate and multivariable logistic regression examined characteristics associated with under-ascertainment.\n\n\nRESULTS\n85.3% of patients had under-ascertainment of at least one symptom. Per PRO 16.9% of assessments reported clinically meaningful symptom in contrast to only 3.4% per CTCAE representing an approximate 5-fold difference. Multivariable analysis showed under-ascertainment was more common in patients who were unmarried (OR 1.28, 95%CI 1.18-1.38), lived in rural regions (OR 1.10, 95%CI 1.01-1.21), incarcerated (OR 1.58, 95%CI 1.36-1.84), retired/unemployed (OR 1.29, 95%CI 1.18-1.40), receiving prostate gland (vs prostate bed) treatment (OR 1.43, 95%CI 1.31-1.58) and concurrent hormone therapy (OR 1.16, 95%CI 1.04-1.29). Patients age >70 were less likely to have under-ascertainment compared to <60 (OR 0.82, 95%CI 0.73-0.92).\n\n\nCONCLUSIONS\nThis is the first study to show under-ascertainment of clinically-meaningful symptoms in radiotherapy patients in routine clinical care, and further demonstrated that certain patient groups are especially vulnerable to under-ascertainment. These results highlight the importance of incorporating PROs in the clinical care of radiotherapy patients. If PROs are not routinely used, vulnerable patient groups may need additional attention during cancer treatment to ensure accurate toxicity assessment and management.