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Quality of Life and Patient- and Clinician-Reported Cumulative Toxicity

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Key Points

  • The strongest impact on quality of life came from cumulative toxicities, regardless of the NCI CTCAE grade.
  • Patient-reported toxicity scores were more associated with quality-of-life outcomes than clinician-reported scores.

New research has found that quality of life for people with cancer is reduced by an accumulation of low-level toxicities just as much as it is from high-level adverse events. Additionally, patient-reported outcomes were more likely to reflect the impact on a patient’s physical well-being than those reported by their doctor. These findings were reported by Schuurhuizen et al in JNCCN–Journal of the National Comprehensive Cancer Network.

“Incorporating patient-reported toxicity into routine cancer care will help make sure people with cancer get high-quality care with better symptom detection and management,” explained first study author Claudia Schuurhuizen, MD, of Amsterdam UMC Cancer Center. “These patient-reported outcomes appear to have a better correlation to patient quality of life. Our results also suggest that clinicians shouldn’t lose sight of lower-grade adverse events. We want physicians to be more aware of how addressing lower-grade toxicities can be just as important as higher[-grade] ones for optimizing physical health status.”

For this study, the researchers looked at 184 patients who were enrolled in a multicenter phase III randomized trial for patients with metastatic castrate-naive prostate cancer between October 2004 and December 2008. Each patient completed quality-of-life assessments before treatment, as well as at 3 and 6 months into treatment. Separate toxicity data were reported by both the patients and their clinicians.

Study Findings

According to the results, the strongest impact on quality of life came from cumulative toxicities, regardless of the National Cancer Institute’s Common Terminology Criteria for Adverse Events (CTCAE) grade. The researchers also found that patient-reported toxicity scores were more associated with quality-of-life outcomes than clinician-reported scores.

“This study clearly demonstrates that patients self-report higher rates of toxicities when independently queried, compared with clinician-elicited toxicities during office visits,” said Terry S. Langbaum, Administrative Director, The Comprehensive Transplant Center, Johns Hopkins, and Patient Advocate, NCCN Guidelines® Panel for Survivorship. “This may be due to a reluctance, on the part of patients, to ‘complain’ to their clinicians in a face-to-face encounter, especially when the symptoms are sensitive, such as impact on sexual function. Additionally, the significant differences in reporting may be due to less thorough inquiry on the part of the clinicians, who may be rushed for time during visits. If a full understanding of the impact of toxicities on quality of life is the goal, this study demonstrates that patients can self-report and grade their toxicities more completely in a setting independent of the office visit than clinicians can during a clinical encounter.”

Moving forward, the researchers would like to see reliable tools for assessing toxicity, particularly in patient-reported outcomes, used more frequently. They encourage the use of electronic data collection as one method for improving reporting rates and accuracy.

Disclosure: The study authors’ full disclosures can be found at jnccn.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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