Physicians underrecognize ill effects of treatment in breast cancer patients
BY ALAN P. LYSS, MD
There are major discrepancies between patient and physician reports of toxicity related to breast cancer treatment, a new study suggests. The results are troublesome because accuracy in assessing toxicity can impact not only the supportive care patients receive but also patients’ ability to complete a planned course of therapy and benefit from it. In addition, clinical studies rely on physicians’ assessments of toxicity in making judgments about the risk-benefit ratio for new treatments. |
The current study was conducted by Reshma Jagsi, MD, DPhil, of the University of Michigan, Ann Arbor, and colleagues from the Michigan Radiation Oncology Quality Consortium (MROQC). Dr. Jagsi presented the study’s results at the 2020 San Antonio Breast Cancer Symposium (Abstract GS3-07). The study enrolled 13,725 breast cancer patients who received breast-conserving radiotherapy over an 8-year time span. The investigators asked patients to report their symptoms during radiation via patient-reported outcome (PRO) questionnaires. Physicians were asked to complete standard toxicity assessments, according to the Common Terminology Criteria for Adverse Events, within 3 days of a patient’s office visit. A total of 9,941 patients completed at least one questionnaire, and the investigators compared 37,593 independent paired observations from patients and their physicians. |
![]() Dr. Reshma Jagsi |
The investigators were specifically interested in how the physician-patient pairs reported four symptoms: pain, pruritus, edema, and fatigue. Physicians were deemed to have underrecognized pain when patients reported moderate pain (score, 4-6) that the physician recorded as grade 0, or when patients reported severe pain (score, 7-10) that the physician recorded as grade 1 or less. |
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Why this is importantIn an era in which office visits are increasingly conducted through telemedicine and interpersonal interactions are truncated by other pressures, oncologists need to be especially proactive about addressing any deficiencies in communication with patients and patients’ willingness to confide in them. The challenges will likely be augmented in the telemedicine era.As Dr. Jagsi suggested, better recognition of and acting upon treatment-related toxicity is one way in which physicians can improve health equity. It is “targetable” and within our control as providers. Unfortunately, it may also be more widespread than the specific example that was studied by these investigators. Underrecognition of acute adverse events has been observed in patients receiving pelvic radiation (J Clin Oncol. 2018 Aug 20;36[24]:2538-44) and those receiving chemotherapy for advanced cancer (JAMA. 2017;318[2]:197-8.). It is easy to imagine that accurate assessment of late toxicities is even more fraught with obstacles. |
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Dr. Lyss was a community-based medical oncologist and clinical researcher for more than 35 years before his recent retirement. His clinical and research interests were focused on breast and lung cancers, as well as expanding clinical trial access to medically underserved populations. He is based in St. Louis. He has no conflicts of interest. |
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