Physicians May Fail to Recognize Symptoms of Toxicity in Breast Cancer Patients

Physicians may fail to recognize symptoms of toxicity in patients with breast cancer undergoing radiotherapy (RT), according to research published in JAMA Oncology.

Researchers discovered physician underrecognition of symptoms for more than half of patients who reported at least 1 substantial symptom during RT.

The risk of underrecognition was higher when the physician was a man and the patient was younger or non-White.

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To investigate underrecognition of symptoms, researchers collected patient-reported outcomes (PROs) of breast cancer patients who underwent RT between January 1, 2012, and March 31, 2020.

The team compared the PROs with physicians’ Common Toxicity Criteria for Adverse Events (CTCAE) assessments for 4 symptoms: moderate/severe pain, pruritis, edema, and fatigue.

The cohort included 13,725 patients who underwent RT after lumpectomy at 29 practices. In all, 72.4% of patients completed at least 1 PRO questionnaire during treatment. PROs were compared with matched physician reports for 9868 patients.

The researchers discovered physician underrecognition of patient-reported moderate or severe pain in 30.9% of cases. Physicians underrecognized frequent bother from pruritus in 36.7% of cases, frequent bother from edema in 51.4% of cases, and substantial fatigue in 18.8% of cases. 

Physician underrecognition was seen at least once in 53.2% of patients who reported at least 1 substantial symptom during RT. 

On multivariate analysis, underrecognition of symptoms was associated with Black race (odds ratio [OR], 1.56; P <.001) or other non-White race (OR, 1.52; P =.01). Underrecognition of symptoms was also associated with younger age, with patients aged 50 years and younger (OR, 1.35; P <.001) and those aged 50 to 59 years (OR, 1.19; P =.02) having a greater risk than patients aged 60 to 69 years. 

Patients treated with conventional fractionation had a higher likelihood of symptom underrecognition (OR, 1.26; P =.002). Patients treated by a male physician also had a greater likelihood of symptom underrecognition (OR, 1.54; P =.002). 

Based on these findings, the researchers suggested that all physicians should inquire about potential toxic effects in detail with all patients to avoid missing symptoms that could be mitigated.

“Improving symptom detection may be a targetable mechanism to reduce disparities in experiences and outcomes,” the researchers concluded. 

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Jagsi R, Griffith KA, Vicini F, et al. Identifying patients whose symptoms are underrecognized during treatment with breast radiotherapy. JAMA Oncol. Published online April 21, 2022. doi: 10.1001/jamaoncol.2022.0114

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