Abstract
Purpose
Dermatologic adverse events (dAEs) occur frequently in hospitalized patients and can significantly reduce quality of life. Physicians grade dAEs using the Common Terminology Criteria of Adverse Events (CTCAE). However, they often underestimate symptom frequency and severity. The patient-reported outcomes (PRO) version of the CTCAE (PRO-CTCAE) was developed to assess symptoms from the patient's perspective. In this study, we assessed the patient-reported burden of dAEs via the PRO-CTCAE questionnaire and compared results with dAE assessment by treating oncologists and dermatologists.
Methods
Patients admitted to Memorial Sloan Kettering Cancer Center from 6/1/2018 to 4/30/2019 and received a dermatology consultation were eligible. Once enrolled, participants completed a PRO-CTCAE questionnaire on 14 dermatologic symptoms. CTCAE grades assigned by oncology and dermatology were obtained from clinical notes, and kappa statistics were calculated to evaluate the level of agreement between physician and patient evaluations.
Results
A total of 100 patients (mean age 59.4, 55% male) were prospectively enrolled. The most common patient-reported dAEs were rash (72%), swelling (67%), pruritus (64%), bruising (53%), and hives (37%). Oncologists and dermatologists underreported dAEs except for rash (median kappa values 0.3 [0.02-0.84] and 0.32 [0.02-0.87], respectively). Oncologists and dermatologists were concordant with each other’s documented assessment of dAEs (median kappa value 0.985 [0.55-1]).
Conclusion
Oncology patient-reported dAEs in a tertiary academic oncologic referral center were under-recognized by providers. PRO-CTCAE may be a useful tool to optimize inpatient dermatologic care for cancer patients by detecting and allowing management of patient-reported dAEs.
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Data Availability
The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable de-indentified request. Data are located in controlled access data storage at Memorial Sloan Kettering Cancer Center.
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Funding
This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748. Dr. Christian Menzer is supported by a fellowship from the German Research Foundation (DFG) (ME 5482/1–1).
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SG and CM wrote the manuscript and SD prepared the figure and performed the statistical analyses. CP was involved in enrolling patients and data collection. AM, MEL and JH conceived of the study, participated in its design, and contributed to the manuscript. All authors read and approved the final manuscript.
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This is an observational study. The MSK Research Ethics Committee has confirmed that no ethical approval is required.
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Informed consent was obtained from all individual patients included in this study.
Competing interests
AM receives research funding from Incyte Corporation and Amryt Pharma; consults for ADC Therapeutics, Alira Health, Protagonist Therapeutics, OnQuality, and Janssen; and receives royalties from UpToDate. MEL has a consultant role with Johnson and Johnson, Novocure, Janssen, Novartis, Deciphera, Kintara, RBC/La Roche Posay, Trifecta, Genentech, Loxo, Seattle Genetics, Lutris, OnQuality, Roche, Oncoderm, Apricity. MEL also receives research funding from Lutris, Paxman, Novocure, OQL, Novartis and AZ, and is funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.
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Reviewed and approved by the Memorial Sloan Kettering Cancer Center IRB#14-236.
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Gu, S., Menzer, C., Hay, J.L. et al. PRO-CTCAE reveals under-recognition of dermatologic symptom burden in hospitalized cancer patients. Support Care Cancer 31, 337 (2023). https://doi.org/10.1007/s00520-023-07793-5
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DOI: https://doi.org/10.1007/s00520-023-07793-5