Abstract
Simple SummaryPatient reported outcomes (PROs) are frequently integrated into routine toxicity monitoring in clinical studies but not so often in everyday clinical practice. Our investigation, conducted on patients with early stage breast cancer, showed disproportion between patient and physician perceptions of side effects by using a PRO questionnaire for patients and then the questionnaire with the same questions for physicians estimation. We found this result to be very important because the use of PRO in our clinical practice helped us determine the group of patients which required additional care to help them tolerate treatment-related side effects, have better quality of life during treatment and ultimately have best possible outcome.Knowledge about the patient’s experience and perception of side effects and their impact on daily life is crucial for the adequate planning of interventions to provide the highest attainable levels of quality of life during oncology treatment. We conducted a study on consecutive samples of 69 early breast cancer patients treated with four cycles of neoadjuvant or adjuvant anthracycline-based chemotherapy. Patients completed the questionnaire about side effects experienced after the previous cycle of chemotherapy. The questionnaire was a modified PRO for the evaluation of treatment toxicity consisting of 18 questions related to the very common and common side effects of doxorubicin and cyclophosphamide, valued from 0 to 3 according to the subjective assessment of the patient. During the same cycles of therapy, data were also collected by the physician who completed a questionnaire consisting of the same questions as the questionnaire for patients, on the same scale. Most of the side effects reported by patients were mild to moderate in intensity, while physicians reported side effects much less frequently. The results also indicated a disproportionate reporting, in which physicians reported statistically significantly fewer side effects than patients. This study reported a level of disagreement between patients and physicians in the experience of therapy toxicity. In conclusion, use of PRO in clinical practice can help us avoid physician subjectiveness in the estimation of side effects and determine the group of patients who can benefit from additional and individualized supportive care measures, which could lead to better adherence to therapy and ultimately best outcomes.
Highlights
Introducing patients to the side effects of chemotherapy and its impact on quality of life (QoL) during treatment is an important part of communication between physicians and patients, as is discussing the prognosis of the disease itself.Over the past few decades, several clinical trials have shown that the presence of physical symptoms and side effects can substantially affect patient acceptance and engagement in treatment, and indirectly affect treatment outcomes [1,2]
The discrepancy between patients and physicians experience of side effects is well known. We used this fact to objectify and emphasize the importance of use of patient reported outcomes (PROs) in everyday clinical practice by giving the same questionnaire to physicians and patients and showing that there is an objective need for this type of communication in order to overcome physician subjectiveness regarding side effects and their impact on patient quality of life
Examining the overall results of the intensity of side effects reported by patients, it is evident that most of the side effects listed in the questionnaire were not reported at all, and the reported side effects were usually mild to moderate. This is in some way expected considering that the currently available symptomatic and supportive treatments have significantly improved the tolerability of chemotherapy
Summary
Introducing patients to the side effects of chemotherapy and its impact on quality of life (QoL) during treatment is an important part of communication between physicians and patients, as is discussing the prognosis of the disease itself.Over the past few decades, several clinical trials have shown that the presence of physical symptoms and side effects can substantially affect patient acceptance and engagement in treatment, and indirectly affect treatment outcomes [1,2]. Introducing patients to the side effects of chemotherapy and its impact on quality of life (QoL) during treatment is an important part of communication between physicians and patients, as is discussing the prognosis of the disease itself. It is possible that the symptoms and side effects that occur during the course of treatment which are very important from the patient’s perspective, may be underestimated or misjudged by the physician designing the treatment. Even when verbal communication between physician and patient is adequate, an assessment of the intensity and duration of treatment side effects is often not recorded in the medical records of patients treated for early breast cancer [7]
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