Discrepancies Exist Between Patient and Clinician Reports of Adjuvant Chemotherapy-related Adverse Effects
Patient self-reports of adjuvant chemotherapy-related adverse effects are consistently higher in frequency and greater in severity than physician reports, according to a study published online first in the journal JAMA Oncology.1
In an evaluation of a 10-item written questionnaire derived from the US National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 for patient-reported chemotherapy-related adverse effects, a team of Italian researchers found significant discrepancies between patient self-reports and clinician reports among a cohort of patients with breast cancer.
For the prospective, single-arm study, the researchers recruited 604 women with breast cancer receiving standard adjuvant chemotherapy at 11 outpatient oncology clinics at academic and nonacademic Italian hospitals between January 2011 and October 2013. The CTCAE version 4.0 definitions of grade of severity for nausea, vomiting, constipation, anorexia, dysgeusia, diarrhea, fatigue, pain, paresthesia, and dyspnea were translated into Italian and rephrased. Patients were asked to complete the questionnaires after cycles 1 and 3 of adjuvant chemotherapy. Information on adverse effects was extracted from the patients' medical records for comparison with the patient self-reports.
The researchers collected 596 patient questionnaires after cycle 1 and 581 patient questionnaires after cycle 3. Corresponding questionnaire results were extracted from the medical records of 594 and 573 patients, respectively, at the same time point. The percentage of completed questionnaire fields was 80% to 88% (median 82%) for the 2 patient questionnaires.
A comparison of the 2 patient-completed questionnaires indicated a reduction in severity of vomiting, incidence and severity of diarrhea, and incidence and severity of pain, and a statistically significant increase in incidence and severity of both dysgeusia and dyspnea from the first patient-completed questionnaires to the second.
Frequency and severity of chemotherapy-related adverse effects were greater in the patient-reports compared with the physician-reported data. A strong correlation between the magnitude of discrepancy between physician reports and patient reports for each site and the number of patients enrolled at each site (2 to 236 patients) was also seen.
The researchers conclude that adherence to reporting of chemotherapy-related adverse effects is high among women with breast cancer receiving adjuvant chemotherapy treatment. They also conclude workload may limit the physician-patient relationship, thereby contributing to discrepancies between patient and physician reports of adverse effects.
1. Montemurro F, Mittica G, Cagnazzo C, et al. Self-evaluation of adjuvant chemotherapy-related adverse effects by patients with breast cancer [published online ahead of print December 23, 2015]. JAMA Oncol. doi:10.1001/jamaoncol.2015.4720.