Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
J Geriatr Oncol. 2019 Jan;10(1):42-47. doi: 10.1016/j.jgo.2018.05.016. Epub 2018 Jun 11.
The agreement between clinician- and patient-reported toxicities and their association with poor tolerance to therapy were assessed in an older population receiving curative radiotherapy (RT).
Patients ≥ 65 years old with newly-diagnosed head and neck or lung cancer receiving curative RT ± chemotherapy were enrolled on a prospective, observational study. Agreement between clinician (CTCAEv4.02) and patient (PRO-CTCAE, EORTC QLQ-C30) report of toxicities were assessed at baseline, during treatment, and post-treatment. The association of clinician- and patient-reported symptoms with poor tolerance to therapy (defined as hospitalization, >3-day treatment delay, change in treatment regimen, or death) was assessed.
Among 45 patients, median age was 71, 60% had head and neck cancer, and 47% received concurrent chemotherapy with RT. In comparing CTCAE vs PRO-CTCAE, there was good agreement at baseline except for fatigue, anorexia, and pain, where clinicians under-reported the severity. The discrepancy increased during treatment with clinicians reporting lower severity in ≥50% of matched pairs for 4/10 symptoms assessed. At follow-up, clinicians under-reported severity in ≥50% of pairs for 7/10 symptoms. CTCAE vs EORTC QLQ-C30 mirrored these findings. Patient-reported symptoms of nausea and dysphagia at 2 weeks and clinician-observed symptoms of nausea and dysphagia at 4 weeks were associated with poor tolerance to therapy.
Clinicians under-report toxicities during and after curative RT in older patients with head and neck or lung cancer. Select toxicities reported by patients early in treatment and clinicians later in treatment were associated with poor tolerance to cancer therapy, providing valuable complementary information.
评估在接受根治性放疗（RT）的老年人群中，临床医生和患者报告的毒性及其与治疗耐受性差之间的一致性。
招募了新诊断为头颈部或肺癌并接受根治性 RT ± 化疗的年龄≥65 岁的患者，进行前瞻性观察性研究。在基线、治疗期间和治疗后评估临床医生（CTCAEv4.02）和患者（PRO-CTCAE，EORTC QLQ-C30）报告毒性的一致性。评估临床医生和患者报告的症状与治疗耐受性差（定义为住院、治疗延迟超过 3 天、治疗方案改变或死亡）的相关性。
在 45 例患者中，中位年龄为 71 岁，60%患有头颈部癌症，47%接受了同期 RT 化疗。在 CTCAE 与 PRO-CTCAE 比较中，除疲劳、厌食和疼痛外，基线时具有良好的一致性，而临床医生对这些症状的严重程度报告不足。在治疗期间，这种差异增加，对于评估的 10 个症状中的 4 个，有≥50%的匹配对中临床医生报告的严重程度较低。在随访时，对于≥50%的配对，临床医生对 7/10 个症状的严重程度报告不足。CTCAE 与 EORTC QLQ-C30 也存在这些发现。治疗 2 周时患者报告的恶心和吞咽困难症状以及治疗 4 周时临床医生观察到的恶心和吞咽困难症状与治疗耐受性差相关。
在接受头颈部或肺癌根治性 RT 的老年患者中，临床医生在治疗期间和治疗后报告毒性时存在不足。治疗早期患者报告的某些毒性和治疗后期临床医生观察到的某些毒性与癌症治疗耐受性差相关，提供了有价值的补充信息。
