While low-grade adverse events may not be providers’ primary reporting focus, accumulated low-level toxicities have the potential to reduce patients’ quality of life.
In oncology practice, clinicians must weigh the benefits of treatments with the possibility of adverse events (AEs), especially in patients with advanced disease. The main source of information on toxicity is a clinician-based assessment of AEs using the National Cancer Institute’s Common Terminology Criteria for Adverse Events, and in clinician reporting the focus is primarily on high-grade AEs. However, while low-grade AEs may not be providers’ primary focus, accumulated low-level toxicities have the potential to reduce patients’ quality of life (QoL).
In the December 2018 issue of the Journal of the National Comprehensive Cancer Network, Claudia S.E.W. Schuurhuizen, MD, of the Vrije Universiteit Medical Center’s cancer center in Amsterdam, Netherlands, and colleagues reported on a secondary analysis of data from the prospective phase 3 GETUG-AFU 15 trial of androgen deprivation therapy either alone or with docetaxel in hormone-sensitive prostate cancer.
The investigators assessed the records of the 184 enrolled patients who had completed QoL assessments before treatment, at 3 or 6 months after starting therapy. The investigators considered patient and clinician reports on the same 22 symptoms, which were graded on a scale of 1 to 4 (on which 1 reflected a mild AE and 4 reflected a life-threatening AE). Physical function and global QoL were assessed with subscales of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30.
The investigators found that clinicians reported AEs for 159 patients (86.9%) in the first 3 months of treatment for 108 patients (90%) between 3 to 6 months of treatment. At least 1 grade 3 or 4 AE was reported for each of 19 patients (10.4%) during the first 3 months and for each of 24 patients (20%) between 3 and 6 months.
However, all of the patients reported AEs for both time periods. In total, at least 1 grade 3 or 4 AE was reported by each of 149 patients (88.7%) after 3 months and by each of 93 patients (86.9%) between 3 and 6 months. Furthermore, mean patient-reported cumulative toxicity scores were all significantly higher than mean scores reported by clinicians, and all patient-reported cumulative toxicity scores were significantly associated with lower global and physical QoL.
These findings, write the authors, suggest that, if assessments of AEs are to be clinician based, cumulative toxicity scores should comprise all AEs, even those of low grades. Furthermore, patient-reported cumulative toxicity scores should be preferred over clinician-reported scores regarding AEs’ impacts on QoL.
“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,” said Schuurhuizen in a statement. “These patient-reported outcomes appear to have a better correlation to patient [QoL]. 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 ones for optimizing physical health status.”
Schuurhuizen CSEW, Marino P, Braamse AMJ, et al. Impact of patient- and clinician-reported cumulative toxicity on quality of life in patients with metastatic castration-naïve prostate cancer. J Natl Compr Canc Netw. 2018;16:1481-1488. doi: 10.6004/jnccn.2018.7069.