The Cambridge Breast Intensity-modulated Radiotherapy Trial: Comparison of Clinician- versus Patient-reported Outcomes.
AIMS
Breast radiotherapy-associated toxicity is often reported using clinical and photographic assessments. The addition of patient-reported outcome measures (PROMs) is becoming more common. This study investigated the concordance between clinician- and patient-reported outcomes.


MATERIALS AND METHODS
The Cambridge Breast Intensity-modulated Radiotherapy (IMRT) trial prospectively collected data on clinician assessment and PROMs at 2 and 5 years after breast radiotherapy. Clinician assessment included physical examination and photographic assessment. PROMs included European Organization for Research and Treatment of Cancer (EORTC) BR23 questionnaire and four breast radiotherapy-specific questions. The correlation between patient and clinician scores were analysed on an independent patient basis using percentage agreement, Cohen's kappa coefficient (k) and Bowker's test of symmetry. The analysis was repeated after stratifying patients based on age, baseline Hospital Anxiety and Depression Score (HADS) and baseline body image score.


RESULTS
At 2 and 5 years, a weak level of concordance was seen between the clinician-based assessment and PROMS for all the five toxicity end points (k = 0.05-0.21), with individual patient-based agreement of 32.9-78.3% and a highly discordant Bowker's test of symmetry (P < 0.001). The most frequently reported moderate-severe toxicity by patients was change in breast appearance (14% at both 2 and 5 years), whereas it was breast induration (36% and 25% at 2 and 5 years, respectively) by the clinicians. The lack of concordance was not affected by patient's age, baseline HADS and baseline body image score.


CONCLUSIONS
This study found that moderate-severe toxicity reported by patients is low and the overall concordance between clinicians and patients is low. This could be due to methodological limitations or alternatively reflects the subjective nature of PROMs. Incorporation of a patient's perception on treatment-related toxicity will have important implications for treatment decisions and follow-up care.
['Mukesh|M B|MB|', 'Qian|W|W|', 'Wah Hak|C C|CC|', 'Wilkinson|J S|JS|', 'Barnett|G C|GC|', 'Moody|A M|AM|', 'Wilson|C|C|', 'Coles|C E|CE|']
D001007:Anxiety D001291:Attitude of Health Personnel D001943:Breast Neoplasms D018270:Carcinoma, Ductal, Breast D002285:Carcinoma, Intraductal, Noninfiltrating D003863:Depression D005260:Female D006801:Humans D063868:Patient Outcome Assessment D000071066:Patient Reported Outcome Measures D058996:Quality Improvement D011832:Radiation Injuries D050397:Radiotherapy, Intensity-Modulated D011795:Surveys and Questionnaires
radiotherapy concordance Breast cancer late treatment toxicity