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University of North Carolina Lineberger Comprehensive Cancer Center researchers report a gap in communication between women with early-stage breast cancer and physicians about the severity of their chemotherapy treatment-related symptoms.

The study compared how women with breast cancer rated the severity of 17 of their own symptoms with physician ratings of chemotherapy toxicity.

Kirsten Nyrop, PhD, UNC Lineberger member and assistant professor in the UNC School of Medicine Division of Hematology/Oncology.
UNC Lineberger’s Kirsten Nyrop, PhD.

At best, the researchers found patients and physicians showed “moderate” agreement on the severity for 53 percent of symptoms, “fair” agreement for 41 percent and “slight” agreement for six percent.

The biggest differences in symptom severity ratings were linked to race, specifically between physicians and black women with breast cancer and racial minorities, researchers reported. Published in the journal Cancer, the findings showed the need to improve communication between physicians and patients, the researchers said.

“The highest level of agreement on symptom severity was ‘moderate;’ this is suboptimal,” said UNC Lineberger’s Kirsten Nyrop, PhD, research assistant professor at the UNC School of Medicine Division of Hematology/Oncology. “Patient-reported symptom severity is considered the ‘gold standard’ for measuring treatment toxicity and its impact on the patient’s quality of life. There needs to be improved communication between patients and their clinicians regarding symptom severity, especially for non-white patients.”

Utilizing patient-reported symptoms

There has been growing evidence supporting the inclusion of patient-reported symptom severity assessments as a complement to physician assessments of toxicity, researchers reported. To encourage this, the National Cancer Institute developed a standardized patient-reported outcomes measurement system, Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Advances, or PRO-CTCAE.

In the study, Nyrop and her colleagues collected data from 276 women receiving chemotherapy treatment for early-stage breast cancer using patient-reported symptom measures.

They compared patient rankings of their own symptoms as moderate, severe or very severe with CTCAE toxicity rankings from physicians of grade two, three or four.

“Patients and clinicians are not communicating as well as they need to about symptom severity,” Nyrop said of the findings.

For example, 22 percent of patients rated their fatigue symptoms as severe or very severe, while just 8 percent of physicians did. Forty-one percent of patients and 46 percent of physicians rated fatigue symptoms as moderate, while 32 percent of patients and 39 percent of physicians rated symptoms as mild.

Racial disparities in communication

The study also found physicians underestimated certain symptoms to a greater degree in black women compared to white women. Researchers reported that the finding warrants further research, but could reflect previous findings that support racial disparities in patient-provider communication.

Doctors rated severity lower for black patients and other minorities compared with white patients for peripheral neuropathy, nausea, arthralgia and dyspnea.

Caption available
UNC Lineberger’s Hyman B. Muss, MD.

“This study points to the importance of integrating patient-reported outcomes in the care of patients with early breast cancer to improve symptom monitoring and timely interventions to mitigate symptoms,” said UNC Lineberger’s Hyman B. Muss, MD, Mary Jones Hudson Distinguished Professor of Geriatric Oncology and the study’s senior author.

The researchers also concluded that patient reporting can highlight symptoms that need to be addressed in a timely manner and improve overall monitoring.

“What our study shows is that the patient’s experience during treatment includes toxicities that affect their quality of life, and also possibly their ability to recovery quality of life after treatment,” Nyrop said. “Timely identification of symptoms that can be managed through medications or dose reductions could do much to improve quality of life, and possibly treatment completion. That is why patient-clinician communication is so important.”

Authors and Disclosures

In addition to Nyrop and Muss, other authors included A.M. Deal; B. Reeve; E. Basch; Y.T. Chen; J.H. Park; S.S. Shachar; L.A. Carey; K. Reeder-Hayes; C. Dees; T. Jolly; G. Kimmick; M. Karuturi; R. Reinbolt; J.E. Speca; J.T. Lee; and W.A. Wood.

Funding: Breast Cancer Research Foundation; Kay Yow Fund; and University Cancer Research Fund.