Swipe om te navigeren naar een ander artikel
Gastrointestinal (GI) symptoms pose a significant burden to patients receiving chemoradiation therapy (CRT) for anal cancer; however, the impact of symptoms from the patient perspective has not been quantified. This retrospective study examined and compared patient and clinician reports of acute GI toxicity during CRT.
Patients treated with definitive RT using intensity-modulated radiation therapy for anal cancer between 9/09 and 11/12 were reviewed. Median RT dose was 56 Gy (range 45–56), and 76 patients (97%) received concurrent 5-fluorouracil-based chemotherapy. During RT, patients completed the 7-item Bowel Problem Scale (BPS) weekly. Clinicians assessed toxicity separately using CTCAE v. 3.0. Scores of BPS ≥ 3 and CTCAE ≥ 1 were considered to be clinically meaningful. Agreement of the two assessments was evaluated by Cohen’s kappa coefficient.
Seventy-eight patients completed at least one BPS and had a corresponding clinician assessment. Patients reporting scores of ≥3 was highest at week 5 (n = 68) for diarrhea (44.1%), proctitis (57.4%), and mucus (48.4%), while urgency (47.6%), tenesmus (31.7%), and cramping (27%) were highest at week 4 (n = 63). Baseline bleeding scores (26.7%; score ≥3) improved during treatment (13.4% at week 5). “Poor” agreement was observed between patient- and clinician-reported proctitis (Cohen’s k = 0.11; n = 58); however, there was “good” agreement for diarrhea (Cohen’s k = 0.68; n = 58).
Acute GI toxicity during definitive CRT for anal cancer was most significant during weeks 4–5, while rectal bleeding improved during treatment. Discrepancies in patient- and clinician-reported symptoms demonstrate the potential for patient-reported outcomes to be useful tools for anal cancer clinical assessments.
Log in om toegang te krijgen
Met onderstaand(e) abonnement(en) heeft u direct toegang:
Devisetty, K., Mell, L. K., Salama, J. K., Schomas, D. A., Miller, R. C., Jani, A. B., et al. (2009). A multi-institutional acute gastrointestinal toxicity analysis of anal cancer patients treated with concurrent intensity-modulated radiation therapy (IMRT) and chemotherapy. Radiotherapy and Oncology, 93(2), 298–301. CrossRefPubMed
Kachnic, L. A., Tsai, H. K., Coen, J. J., Blaszkowsky, L. S., Hartshorn, K., Kwak, E. L., et al. (2012). Dose-painted intensity-modulated radiation therapy for anal cancer: A multi-institutional report of acute toxicity and response to therapy. International Journal of Radiation Oncology Biology Physics, 82(1), 153–158. CrossRef
Han, K., Cummings, B. J., Lindsay, P., Skliarenko, J., Craig, T., Le, L. W., et al. (2014). Prospective evaluation of acute toxicity and quality of life after IMRT and concurrent chemotherapy for anal canal and perianal cancer. International Journal of Radiation Oncology Biology Physics, 90(3), 587–594. CrossRef
Basch, E., Iasonos, A., McDonough, T., Barz, A., Culkin, A., Kris, M. G., et al. (2006). Patient versus clinician symptom reporting using the National Cancer Institute common terminology criteria for adverse events: Results of a questionnaire-based study. Lancet Oncology, 7(11), 903–909. CrossRefPubMed
Myerson, R. J., Garofalo, M. C., El Naqa, I., Abrams, R. A., Apte, A., Bosch, W. R., et al. (2009). Elective clinical target volumes for conformal therapy in anorectal cancer: a radiation therapy oncology group consensus panel contouring atlas. International Journal of Radiation Oncology Biology Physics., 74(3), 824–830. CrossRef
National Cancer Institute (NCI) Cancer therapy program, common terminology criteria for adverse events, Version 3.0. August 9, 2006. Retrieved October 20, 2014, from http://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/ctcaev3.pdf
Cohen, Jacob. (1960). A coefficient of agreement for nominal scales. Educational and Psychological Measurement, 20(1), 37–46. CrossRef
Karnofsky, D. A., & Burchenal, J. H. (1949). The clinical evaluation of chemotherapeutic agents in cancer. In C. M. MacLeod (Ed.), evaluation of chemotherapeutic agents (p. 196). New York: Columbia Univ Press.
Bennett, A. V., Jensen, R. E., & Basch, E. (2012). Electronic patient-reported outcome systems in oncology clinical practice. CA: A Cancer Journal for Clinicians, 62(5), 336–347.
- Prevalence of patient-reported gastrointestinal symptoms and agreement with clinician toxicity assessments in radiation therapy for anal cancer
Antonia V. Bennett
Karyn A. Goodman
- Springer International Publishing