Vistad Ingvild, Cvancarova Milada, Fosså Sophie Dorothea, Kristensen Gunnar B
Department of Gynecology, Sorlandet Hospital HF, Kristiansand, Norway.
Int J Radiat Oncol Biol Phys. 2008 Aug 1;71(5):1335-42. doi: 10.1016/j.ijrobp.2007.12.030. Epub 2008 Mar 20.
Descriptions of late morbidity after radiotherapy in cervical cancer survivors (CCSs) are usually based on observations made by physicians, and rarely by patients themselves. We describe and compare physician-assessed morbidity with patient-rated symptoms more than 5 years after pelvic radiotherapy.
In 147 CCSs treated between 1994 and 1999 at The Norwegian Radiumhospital, morbidity data were regularly documented by physicians at least for 5 years after radiotherapy. Information on patient-rated symptoms was collected by a questionnaire from 91 (62%) of the 147 survivors after a median follow-up time of 96 months (65-131 months). The results were compared with physician-assessed morbidity scores recorded at 5 years, and to selected normative data using descriptive statistics. Physician-assessed morbidity data were modeled using Kaplan-Meier method. Agreement between physician data and patient data was expressed using weighted kappa statistics.
The 5-year Kaplan-Meier estimates of physician-assessed intestinal, bladder, and vaginal morbidity Grade 3-4 were 15%, 13%, and 23%, respectively. The prevalence of patient-rated severe symptoms from these organs was much higher (intestines 45%, bladder 23%, and 58% vaginal discomfort among sexually active CCSs). Poor agreement was confirmed by low values of kappa: For bladder the concordance was slight (kappa = 0.16) and for intestine it was fair (kappa = 0.27). Stress incontinence, diarrhea, nausea, and sexual problems were significantly (p < 0.001) more prevalent when compared with a control sample from the general female population.
Morbidity is common after pelvic radiotherapy. However, our data indicate that physicians underreport patients symptoms. It is important to incorporate patient-reported outcomes in the evaluation of treatment-related morbidity.
宫颈癌幸存者（CCSs）放疗后晚期发病率的描述通常基于医生的观察，很少来自患者自身。我们描述并比较了盆腔放疗5年多后医生评估的发病率与患者自评症状。
1994年至1999年在挪威镭医院接受治疗的147例CCSs中，医生定期记录放疗后至少5年的发病数据。在中位随访时间96个月（65 - 131个月）后，通过问卷调查从147例幸存者中的91例（62%）收集患者自评症状信息。将结果与5年时医生评估的发病率评分进行比较，并使用描述性统计与选定的标准数据进行比较。医生评估的发病数据采用Kaplan-Meier方法建模。医生数据与患者数据之间的一致性用加权kappa统计表示。
医生评估的肠道、膀胱和阴道3 - 4级发病率的5年Kaplan-Meier估计值分别为15%、13%和23%。这些器官患者自评的严重症状发生率要高得多（肠道45%，膀胱23%，性活跃的CCSs中阴道不适58%）。kappa值较低证实了一致性较差：膀胱的一致性轻微（kappa = 0.16），肠道的一致性尚可（kappa = 0.27）。与一般女性人群的对照样本相比，压力性尿失禁、腹泻、恶心和性问题的发生率显著更高（p < 0.001）。
盆腔放疗后发病率很常见。然而，我们的数据表明医生对患者症状的报告不足。在评估与治疗相关的发病率时纳入患者报告的结果很重要。
