Breast Cancer Patients Perceive Psychosocial Side Effects of Cancer Radiation Therapy as Worse than Non-Breast Cancer Patients

Abstract

As cancer care improves, quality-of-life (QOL) is increasingly paramount but is difficult to quantify. No studies report which side effects (SE) patients undergoing a prolonged course of radiotherapy (RT)-predominant care perceive as the most severe. The prevalence, absolute severity, and natural history of psychosocial SE in cancer patients is well understood, but their severity relative to physical SE is unknown. We conducted a survey to use patient report outcomes to identify and rank SE perceived by 55 patients on the final day of ≥ 4 weeks of RT. Patients who had received ≥ 4 weeks of chemotherapy prior to RT start were excluded. Patients selected from 67 cards listing symptoms all those experienced (40 physical and 27 psychosocial) and the 5 most troublesome. A score of 5, 4, 3, 2, and 1 (15 points total) was assigned to top 5 selected SE, respectively. A total of 49% were female, mean age was 57 years, 58% were Hispanic, and mean RT dose was 57 Gy. Differences in ranking of severity of SE were evident when patient groups were divided by location of RT (Table). Psychosocial SE filled 46% of the 15 points in breast cancer patients compared to only 20% in non-breast cancer patients (p=.01; OR <.01 [<.01, .29]). Incidental cancer discovery (40% of cohort; e.g. mammogram, elevated PSA) versus discovery from symptoms showed 43% vs 23% (p=.01) in this manner but fell out of significance on logistic regression (OR 3.44 [0.59, 20]). Patients receiving concurrent systemic treatment (55% of cohort) perceived physical SE > psychosocial SE in severity (OR 0.12 [0.02, 0.89]). Patients with >6 months’ elapsed time from diagnosis to RT completion (44% of cohort) versus <6 months showed 44% vs 21% in this manner (OR 5.10 [1.08, 24.18]; worst SE anxiety and their sequelae). Perceptions of the SE of cancer RT are dominated by physical QOL concerns and are influenced by the anatomic area receiving RT. However, in certain groups, psychosocial SE are equivalent in severity to physical SE. Roughly half of the most severe SE in breast cancer patients are psychosocial in nature. In other groups, psychosocial SE are more common. Patients living with a cancer diagnosis for >6 months more commonly report anxiety-related psychosocial SE.Tabled 1Abstract TU_42_3738; Table 1Breast/Thorax/Abdomen (n=22)H&N (n=14)Pelvis (n=19)RankSymptomPsychosocial (Psy) or Physical (Ph)ScoreSymptomPsy or PhScoreSymptomPsy or PhScore1Burning or painful skinPh42Trouble or pain with swallowingPh30DiarrheaPh382Feeling tense or anxiousPsy24Sore mouth and/or throatPh23Increased urinationPh263Feeling low (depression)Psy18Loss of appetitePh22Painful urinationPh234Headaches, migrainePh17Difficulty sleepingPh16Weight lossPh165NauseaPh16Change in the way things tastePh15Loss of appetitePh146IrritabilityPsy16Dry mouthPh13Affects my work/home dutiesPsy137Constantly tiredPh15Weight lossPh12Stomach achePh128Affects my work/home dutiesPsy12NauseaPh11Burning or painful skinPh12 Open table in a new tab