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Observational Study
. 2025 Jan:199:108072.
doi: 10.1016/j.lungcan.2024.108072. Epub 2024 Dec 27.

Professional-patient discrepancies in assessing lung cancer radiotherapy symptoms: An international multicentre study

Miguel E Aguado-Barrera  1 , Carlos Lopez-Pleguezuelos  1 , Antonio Gómez-Caamaño  2 , Patricia Calvo-Crespo  2 , Begoña Taboada-Valladares  2 , David Azria  3 , Pierre Boisselier  3 , Erik Briers  4 , Clara Chan  5 , Jenny Chang-Claude  6 , Carla Coedo-Costa  1 , Ana Crujeiras-González  1 , John J Cuaron  7 , Gilles Defraene  8 , Rebecca M Elliott  9 , Corinne Faivre-Finn  5 , Marzia Franceschini  10 , Olivia Fuentes-Rios  1 , Javier Galego-Carro  1 , Sara Gutiérrez-Enríquez  11 , Philipp Heumann  12 , Daniel S Higginson  7 , Kerstie Johnson  13 , Maarten Lambrecht  14 , Philippe Lang  15 , Yolande Lievens  16 , Meritxell Mollà  17 , Mónica Ramos  18 , Tiziana Rancati  19 , Tim Rattay  13 , Andreas Rimner  7 , Barry S Rosenstein  20 , Claudia Sangalli  10 , Petra Seibold  12 , Elena Sperk  21 , Hilary Stobart  22 , Paul Symonds  13 , Christopher J Talbot  23 , Katrien Vandecasteele  24 , Liv Veldeman  16 , Tim Ward  25 , Adam Webb  23 , David Woolf  5 , Dirk de Ruysscher  26 , Catharine M L West  9 , Ana Vega  27 ; REQUITE Consortium
Affiliations
Observational Study

Professional-patient discrepancies in assessing lung cancer radiotherapy symptoms: An international multicentre study

Miguel E Aguado-Barrera et al. Lung Cancer. 2025 Jan.

Abstract

Background and purpose: We investigate discrepancies in the assessment of treatment-related symptoms in lung cancer between healthcare professionals and patients, and factors contributing to these discrepancies.

Materials and methods: Data from 515 participants in the REQUITE study were analysed. Five symptoms (cough, dyspnoea, bronchopulmonary haemorrhage, chest wall pain, dysphagia) were evaluated both before and after radiotherapy. Agreement between healthcare professionals and people with lung cancer was quantified using Gwet's-AC2 coefficient. The influence of clinical variables, comorbidities, and quality-of-life outcomes on agreement was examined through stratified analyses.

Results: We found varying levels of agreement between healthcare professionals and people with lung cancer. Bronchopulmonary haemorrhage and dysphagia exhibited very good agreement (meanAC2 > 0.81), while cough and chest wall pain showed substantial agreement (meanAC2 = 0.64 and 0.76, respectively). Dyspnoea had the lowest agreement (meanAC2 = 0.59), with prior chemotherapy significantly reducing agreement levels. Chronic obstructive pulmonary disease (COPD) and early cancer stages also contributed to discrepancies in dyspnoea assessments. Regarding quality-of-life, the most relevant factor was fatigue, which reduced agreement in the assessment of dyspnoea (AC2 = 0.55 vs 0.70), dysphagia (AC2 = 0.48 vs 0.69), cough (AC2 = 0.58 vs 0.82), and chest wall pain (AC2 = 0.77 vs 0.91).

Conclusions: Our findings indicate strong alignment between healthcare professionals' and people with lung cancer evaluations of observable treatment-related symptoms, but less consistency for subjective symptoms such as dyspnoea. Factors such as prior chemotherapy, COPD, and cancer stage should be considered when interpreting symptom assessments. Furthermore, our study underscores the importance of integrating quality-of-life considerations, particularly fatigue, into symptom evaluations to mitigate potential biases in symptom perception.

Keywords: Correlation measures; Fatigue; Lung cancer; Patient reported outcome measures; Quality of life; Radiation effects; Symptom assessment.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dirk De Ruysscher reports relationships with AstraZeneca, BMS, BeiGene, Philips, and Olink that include research grants/support and advisory board positions, with institutional financial interests (no personal financial interests). Dirk De Ruysscher reports a relationship with Eli Lilly and Company that includes advisory board positions with institutional financial interests (no personal financial interests). Yolande Lievens reports a relationship with the European Society for Radiotherapy and Oncology (ESTRO) HERO-VBHC that includes funding grants. Liv Veldeman reports relationships with the Foundation Against Cancer, Founds voor Innovatie en Klinisch Onderzoek UZ Gent, the Clinical Mandate of the Foundation Against Cancer, and Stand Up To Cancer that include funding grants. Liv Veldeman holds a patent for Radiotherapy Board and Couch, issued as US20170028218A1 and EP3122256A1. Co-author Yolande Lievens has been an ESTRO Scientific Committee member, ESTRO-HERO Co-chair, a member of the Belgian College of Oncology, and EORTC-ESTRO E2-RADIATE Project PI, with no associated payments. Other author declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.].

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