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Radiation dermatitis assessment tools used in breast cancer: A systematic review of measurement properties

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Abstract

Purpose

This review aimed to assess the quality and efficacy of tools currently used in breast cancer patients to score radiation dermatitis (RD), a common debilitating side effect of radiotherapy (RT).

Methods

A search was conducted through Ovid Medline, Embase, and Cochrane Central Register of Controlled Trials databases on 14 February 2020. English articles that evaluated an instrument’s use in assessing RD among breast cancer patients receiving external beam RT were included. Studies that reported on the reliability, validity, or concordance of items between assessment tools were included in accordance with the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) criteria.

Results

Twelve studies were included in this review, with a total of 13 skin toxicity assessment tools discussed. Tools that assessed clinician-reported outcomes (CROs) mostly reported moderate correlation with biophysical parameter (BP) measurements and low correlation with patient-reported outcomes (PROs). Traditionally used CRO scoring tools demonstrated moderate inter-rater reliability between clinicians, likely due to the subjective nature of items on the grading scales. Most commonly used tools were found to be either insufficient or indeterminate in their measurement properties.

Conclusions

Current standardized tools that measure CROs are subject to clinician interpretation and fail to represent the patient experience. Tools designed to assess PROs are promising in their assessments of the impact of RT on patient quality of life; however, most PRO tools are generic to all skin conditions and require further validation for use in breast cancer. Among tools that measure CROs, PROs, and BPs, there is insufficient evidence on their measurement properties to establish a “gold standard” for the assessment of RD in breast cancer patients.

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Authors and Affiliations

  1. Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

    Tara Behroozian, Lauren T. Milton, Erin McKenzie, Yasmeen Razvi, Irene Karam, Henry Lam, Emily Lam & Edward Chow

  2. Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

    Neil H. Shear & Kucy Pon

Authors
  1. Tara Behroozian
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Correspondence to Edward Chow.

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Conflict of interest

Dr. Neil H Shear is a consultant (honoraria) to AbbVie, Celgene, Sanofi-Genzyme, Novartis, Lilly, Leo Pharma, UCB, Galderma, Janssen, and Otsuka US. Ms. Tara Behroozian, Ms. Lauren Milton, Ms. Erin McKenzie, Ms. Yasmeen Razvi, Dr. Irene Karam, Dr. Kucy Pon, Mr. Henry Lam, Ms. Emily Lam, and Dr. Edward Chow declare that they have no conflict of interest.

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Behroozian, T., Milton, L.T., Shear, N.H. et al. Radiation dermatitis assessment tools used in breast cancer: A systematic review of measurement properties. Support Care Cancer 29, 2265–2278 (2021). https://doi.org/10.1007/s00520-020-05889-w

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