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. 2012 Jul;5(4):119-24.

Patient-Reported Outcomes vs. Clinician Symptom Reporting During Chemoradiation for Rectal Cancer

Libertad T Flores  1 , Antonia V Bennett, Ethel B Law, Carla Hajj, Mindy P Griffith, Karyn A Goodman
Affiliations

Patient-Reported Outcomes vs. Clinician Symptom Reporting During Chemoradiation for Rectal Cancer

Libertad T Flores et al. Gastrointest Cancer Res. 2012 Jul.

Abstract

Background: Pelvic radiotherapy with concurrent 5-fluorouracil-based chemotherapy is a component of standard therapy for patients with T3/T4 or node-positive rectal cancer and may be associated with acute gastrointestinal toxicity. In this retrospective study, we sought to compare patient-reported outcomes (PROs) with clinician reports of acute symptoms experienced by rectal cancer patients receiving chemoradiation.

Patients and methods: Charts of 199 patients with rectal cancer who received chemoradiation at some point from November 2006 through February 2011 were reviewed. Clinicians assessed toxicity weekly using Common Terminology for Clinical Adverse Events version 3.0, and, beginning in September 2009, the patients reported symptoms weekly, using the 7-item Bowel Problems Scale. One hundred ninety-seven patients with at least 1 clinician or patient assessment were eligible for the study. We used descriptive statistics to compare patient and clinician assessments in a subgroup of 65 patients (paired group) who had at least 1 patient and clinician assessment on the same day. Cohen's κ coefficient was used to evaluate agreement between the patients and the clinicians.

Results: The patients reported diarrhea and proctitis more often than clinicians reported them throughout treatment. Uncorrected agreement for diarrhea and proctitis was 82% and 72%, respectively. Cohen's κ was .64 for diarrhea, indicating moderate agreement, and .22 for proctitis, indicating only slight agreement.

Conclusions: Our findings suggest a discrepancy between clinician and PRO reports. Further study may discern potential benefits of collecting PROs in prospective studies and in clinical practice.

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Figures

Figure 1.
Figure 1.
Prevalence of acute side effects of chemoradiation as assessed by (a) the clinicians and (b) the patients.
Figure 2.
Figure 2.
Prevalence of clinically relevant acute side effects (score ≥3) of chemoradiation as reported by the patients.
Figure 3.
Figure 3.
Clinician- vs. patient-reported prevalence of diarrhea during chemoradiation.
Figure 4.
Figure 4.
Clinician- vs. patient-reported prevalence of proctitis during chemoradiation.
See this image and copyright information in PMC

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