Prevalence of patient-reported gastrointestinal symptoms and agreement with clinician toxicity assessments in radiation therapy for anal cancer Journal Article


Authors: Tom, A.; Bennett, A. V.; Rothenstein, D.; Law, E.; Goodman, K. A.
Article Title: Prevalence of patient-reported gastrointestinal symptoms and agreement with clinician toxicity assessments in radiation therapy for anal cancer
Abstract: Purpose: 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. Materials and methods: 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. Results: 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). Conclusions: 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. © 2017, Springer International Publishing AG.
Keywords: adult; aged; major clinical study; fatigue; intensity modulated radiation therapy; cisplatin; fluorouracil; cancer combination chemotherapy; diarrhea; capecitabine; quality of life; radiation; gastrointestinal symptom; retrospective study; imrt; folinic acid; nausea and vomiting; dermatitis; patient-reported outcomes; cystitis; mitomycin; oxaliplatin; anus cancer; chemoradiation; oral mucositis; muscle cramp; rectum hemorrhage; anal cancer; patient-reported outcome; proctitis; tenesmus; human; male; female; priority journal; article; defecation urgency; patient-reported symptoms
Journal Title: Quality of Life Research
Volume: 27
Issue: 1
ISSN: 0962-9343
Publisher: Springer  
Date Published: 2018-01-01
Start Page: 97
End Page: 103
Language: English
DOI: 10.1007/s11136-017-1700-8
PROVIDER: scopus
PUBMED: 28884454
DOI/URL:
Notes: Article -- Export Date: 6 February 2018 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Karyn A Goodman
    244 Goodman
  2. Ashlyn Tom
    13 Tom
  3. Ethel Beeling P Law
    20 Law