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Underrecognition of Symptoms Caused by Breast Radiation Therapy
Clinicians will readily acknowledge that limited time with patients in a busy clinic often does not allow for a complete survey of all symptoms that may be affecting a given patient. This is true in all subspecialties caring for patients with breast cancer. The current analysis comparing patient-reported outcomes (PROs) with radiation oncologists' assessments of common symptoms of breast radiotherapy (pain, pruritis, edema, and fatigue) brings this issue to the fore.
Nearly 10,000 patients from across radiation oncology 29 practices were included, of whom 17% were Black and 80% were white. More than 50% of patients experienced acute toxicity related to radiation therapy that went underrecognized by physicians. Factors independently associated with underreporting included younger patient age (< 50 years vs. 60–69 years: odds ratio, 1.35; 50–59 years vs. 60–69 years: OR, 1.19), patient race (Black vs. white: OR, 1.56; “Other” race and ethnicity vs. white: OR, 1.52), conventional radiation fractionation (OR, 1.26), male physician (OR, 1.54), and receipt of 2-field radiotherapy without supraclavicular field (OR, 0.80).
These results add to previous evidence of discordance between PROs and physician assessments of toxicities. Another important and troubling finding is that adverse side effects experienced by Black patients and patients of other underrepresented racial and ethnic groups were more often underreported or minimized by clinicians compared with those of white patients. Previous studies suggest that physicians may be less willing to prescribe pain medications to Black patients and may have more difficulty recognizing skin toxicity due to radiation therapy in Black patients (J Pain 2009; 10:1187). Although the current data speak to side effects experienced during radiation therapy, their broader implication is that unconscious bias, or at a minimum lack of awareness, may result in disparities in care for certain populations of patients.
Jagsi R et al.
Title: Identifying patients whose symptoms are underrecognized during treatment with breast radiotherapy.
Source: JAMA Oncol 2022 Apr 21; [e-pub]. (Abstract/FREE Full Text)