Professional-patient discrepancies in assessing lung cancer radiotherapy symptoms: An international multicentre study.
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Aguado-Barrera Miguel E, Lopez-Pleguezuelos Carlos, Gómez-Caamaño Antonio, Calvo-Crespo Patricia, Taboada-Valladares Begoña, Azria David, Boisselier Pierre, Briers Erik, Chan Clara, Chang-Claude Jenny, Coedo-Costa Carla, Crujeiras-González Ana, Cuaron John J, Defraene Gilles, Elliott Rebecca M, Faivre-Finn Corinne, Franceschini Marzia, Fuentes-Rios Olivia, Galego-Carro Javier, Gutiérrez-Enríquez Sara, Heumann Philipp, Higginson Daniel S, Johnson Kerstie, Lambrecht Maarten, Lang Philippe, Lievens Yolande, Mollà Meritxell, Ramos Mónica, Rancati Tiziana, Rattay Tim, Rimner Andreas, Rosenstein Barry S, Sangalli Claudia, Seibold Petra, Sperk Elena, Stobart Hilary, Symonds Paul, Talbot Christopher J, Vandecasteele Katrien, Veldeman Liv, Ward Tim, Webb Adam, Woolf David, de Ruysscher Dirk, West Catharine M L, Vega Ana, REQUITE Consortium
Аннотация
MATERIALS AND METHODS: Data from 515 participants in the REQUITE study were analysed. Five symptoms (cough, dyspnoea, bronchopulmonary haemorrhage, chest wall pain, dysphagia) were evaluated both before and after radiotherapy. Agreement between healthcare professionals and people with lung cancer was quantified using Gwet's-AC2 coefficient. The influence of clinical variables, comorbidities, and quality-of-life outcomes on agreement was examined through stratified analyses.
RESULTS: We found varying levels of agreement between healthcare professionals and people with lung cancer. Bronchopulmonary haemorrhage and dysphagia exhibited very good agreement (meanAC2 > 0.81), while cough and chest wall pain showed substantial agreement (meanAC2 = 0.64 and 0.76, respectively). Dyspnoea had the lowest agreement (meanAC2 = 0.59), with prior chemotherapy significantly reducing agreement levels. Chronic obstructive pulmonary disease (COPD) and early cancer stages also contributed to discrepancies in dyspnoea assessments. Regarding quality-of-life, the most relevant factor was fatigue, which reduced agreement in the assessment of dyspnoea (AC2 = 0.55 vs 0.70), dysphagia (AC2 = 0.48 vs 0.69), cough (AC2 = 0.58 vs 0.82), and chest wall pain (AC2 = 0.77 vs 0.91).
CONCLUSIONS: Our findings indicate strong alignment between healthcare professionals' and people with lung cancer evaluations of observable treatment-related symptoms, but less consistency for subjective symptoms such as dyspnoea. Factors such as prior chemotherapy, COPD, and cancer stage should be considered when interpreting symptom assessments. Furthermore, our study underscores the importance of integrating quality-of-life considerations, particularly fatigue, into symptom evaluations to mitigate potential biases in symptom perception.