Published on December 18, 2020
Research Says Severity of Breast Cancer Symptoms is Often Underestimated
Healthcare providers often under-recognize the severity of the symptoms their patients with breast cancer report, including pain, pruritus, edema, and fatigue, according to data presented at the 2020 San Antonio Breast Cancer Symposium (SABCS) held earlier this month.
In addition, they are more likely to miscalculate the severity of symptoms in patients who are younger and in patients who are Black.
Miscalculating the severity of symptoms can lead to a reduced quality of life, said Dr. Reshma Jagsi, Newman Family Professor, deputy chair of the Department of Radiation Oncology and director of the Center for Bioethics and Social Sciences in Medicine at the University of Michigan.
“Recognizing side effects is necessary for physicians to provide supportive care to help patients manage their symptoms,” she said in a press release announcing the findings.
For the study, researchers compared patient-reported outcome (PRO) evaluations with physician Common Terminology Criteria for Adverse Events (CTCAE) assessments among 9,868 patients with breast cancer. CTCAE is a set of criteria for the standardized classification of adverse effects of drugs used in cancer therapy. It uses grades of 0 to 5, with grade 0 referring to an absent symptom and grade 5 referring to death related to the symptom. All of the patients in the study had been treated with radiotherapy after a lumpectomy, at 29 sites in Michigan.
The research team collected and compared patient and physician ratings of four symptoms: breast pain, pruritus (itchy skin), edema (swelling) and fatigue.
Patients were deemed to have substantial symptoms if they reported moderate or severe pain; if they were bothered often or all the time by itching or swelling; or if they had significant fatigue most of the time or always.
- In terms of pain: Healthcare providers were deemed to under-recognize pain when patients reported moderate pain that their doctors recorded as grade 0 or severe pain that was recorded as less than or equal to grade 1.
- In terms of pruritus or edema: Healthcare providers were deemed to under-recognize pruritus or edema when they recorded these symptoms as grade 0 and patients reported the symptoms bothered them often or all the time.
- In terms of fatigue: Healthcare providers were deemed to under-recognize fatigue when they recorded the symptom as grade 0 and patients reported having significant fatigue most of the time or always.
- Under-recognition of pain, pruritis, edema and fatigue was found in 30.9%, 36.7%, 51.4% and 18.8% of reports in patients having substantial symptoms, respectively.
- Among the 5,510 patients who reported at least one substantial symptom during radiotherapy, 53.2% had under-recognition of at least one of the four symptoms.
- Compared with patients age 60-69, patients younger than age 50 and patients age 50-59 had 35% and 21% increased odds of symptom under-recognition.
- Compared with white patients, Black patients had 92% increased odds of symptom under-recognition; patients of races other than Black or Asian had 82% increased odds of symptom under-recognition.
“It is possible that there is a misconception among medical professionals about the pain tolerance of patients based on age and race,” Dr. Jagsi noted. “Improving symptom detection is a potential way to reduce disparities in cancer treatment experiences and outcomes, at least in the setting of breast radiation therapy.”
What You Can Do: Keep track of your side effects and the severity. The American Cancer Society has worksheets you can use to communicate better with your healthcare team. Don’t be shy or feel weak for telling your doctor how much a symptom is bothering you. Otherwise, he or she may think it isn’t a big deal. If you still don’t feel like your concerns are being taken seriously, you may want to consider seeking a second opinion.
Read the full press release and abstract of the study here.
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