Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 545 East 73rd Street, New York, NY, 10021, USA.
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Support Care Cancer. 2023 May 15;31(6):337. doi: 10.1007/s00520-023-07793-5.
Dermatologic adverse events (dAEs) occur frequently in hospitalized patients and can significantly reduce quality of life. Physicians grade dAEs using the Common Terminology Criteria of Adverse Events (CTCAE). However, they often underestimate symptom frequency and severity. The patient-reported outcomes (PRO) version of the CTCAE (PRO-CTCAE) was developed to assess symptoms from the patient's perspective. In this study, we assessed the patient-reported burden of dAEs via the PRO-CTCAE questionnaire and compared results with dAE assessment by treating oncologists and dermatologists.
Patients admitted to Memorial Sloan Kettering Cancer Center from 6/1/2018 to 4/30/2019 and received a dermatology consultation were eligible. Once enrolled, participants completed a PRO-CTCAE questionnaire on 14 dermatologic symptoms. CTCAE grades assigned by oncology and dermatology were obtained from clinical notes, and kappa statistics were calculated to evaluate the level of agreement between physician and patient evaluations.
A total of 100 patients (mean age 59.4, 55% male) were prospectively enrolled. The most common patient-reported dAEs were rash (72%), swelling (67%), pruritus (64%), bruising (53%), and hives (37%). Oncologists and dermatologists underreported dAEs except for rash (median kappa values 0.3 [0.02-0.84] and 0.32 [0.02-0.87], respectively). Oncologists and dermatologists were concordant with each other's documented assessment of dAEs (median kappa value 0.985 [0.55-1]).
Oncology patient-reported dAEs in a tertiary academic oncologic referral center were under-recognized by providers. PRO-CTCAE may be a useful tool to optimize inpatient dermatologic care for cancer patients by detecting and allowing management of patient-reported dAEs.
皮肤科不良事件（dAEs）在住院患者中频繁发生，并可显著降低生活质量。医生使用常见不良事件术语标准（CTCAE）来对 dAEs 进行分级。然而，他们往往低估了症状的频率和严重程度。从患者角度评估症状的患者报告结局（PRO）版 CTCAE（PRO-CTCAE）被开发出来。在这项研究中，我们通过 PRO-CTCAE 问卷评估了 dAE 对患者的报告负担，并将结果与皮肤科医生和肿瘤医生对 dAE 的评估进行了比较。
2018 年 6 月 1 日至 2019 年 4 月 30 日期间，在纪念斯隆凯特琳癌症中心住院并接受皮肤科会诊的患者符合入选条件。一旦入组，参与者就会完成一份关于 14 种皮肤科症状的 PRO-CTCAE 问卷。从临床记录中获得肿瘤科和皮肤科医生的 CTCAE 分级，并计算kappa 统计值以评估医生和患者评估之间的一致性水平。
共有 100 名患者（平均年龄 59.4 岁，55%为男性）前瞻性入组。最常见的患者报告的 dAEs 是皮疹（72%）、肿胀（67%）、瘙痒（64%）、瘀斑（53%）和荨麻疹（37%）。除皮疹外，肿瘤科医生和皮肤科医生均低估了 dAEs（中位数 kappa 值分别为 0.3[0.02-0.84]和 0.32[0.02-0.87]）。肿瘤科医生和皮肤科医生对 dAE 的记录评估是一致的（中位数 kappa 值为 0.985[0.55-1]）。
在一家三级学术肿瘤转诊中心，肿瘤科患者报告的 dAEs 被提供者低估了。PRO-CTCAE 可能是一种有用的工具，可以通过检测和管理患者报告的 dAEs，优化癌症患者的住院皮肤科护理。
