Abstract 989: Do physician-reported toxicities accurately reflect patient-reported symptom burden? An analysis of ESAS and CTCAE for patients with lung cancer
Authors: Savla Bansi , Dilling Thomas , Naqvi Syeda Mahrukh , Lee Jae K. , Yu Hsiang-Hsuan M. 
Published: July 2017

Purpose/Objectives: Symptom adverse events can be quantitatively monitored by oncologists with the U.S. National Cancer Institute’s Common Terminology Criteria for Adverse Events (CTCAE). Symptoms can also be reported by patients through the Edmonton Symptom Assessment Scale (ESAS). There is increasing recognition of the importance of assessing patient-reported symptoms as part of clinical care. The aim of this study is to examine correlation between patient-reported and physician-graded symptoms in patients with lung cancer who underwent external beam thoracic radiotherapy, in an attempt to identify gaps between these parameters.

Materials/Methods: Between August 2015 and July 2016, 265 patients with diagnosis of lung cancer had completed ESAS and CTCAE data obtained during weekly clinic visit while undergoing thoracic radiotherapy.The following stratification for symptom severity was used: ESAS (none, 0; mild 1-3, moderate 4-6, severe 7-10) and CTCAE scores (none, 0; mild, 1; moderate, 2; and severe, 3-4). Five associated symptoms were compared: tiredness, nausea, shortness of breath, and other (cough and dysphagia) from ESAS and fatigue, nausea, dyspnea, cough and esophagitis from CTCAE. Frequency tables and boxplots combined with the scatter plots were used to assess the distribution, correlation and to identify possible outliers. Spearman correlation coefficients were analyzed to evaluate rank-associated correlations between associated ESAS domains and CTCAE toxicities.

Results: Statistical analysis showed that the associated ESAS symptoms and CTCAE toxicity pairs (tiredness/fatigue, nausea, shortness of breath/dyspnea, dysphagia/esophagitis, cough) were highly correlated (p&lt;0.05), However, analysis showed that ESAS reported by patients screens for more severe symptoms than the toxicities graded by physicians using the CTCAE; this includes fatigue (16.1% as opposed to 0.5%), nausea (5.0% as opposed to 0.0%), dyspnea (11.8% as opposed to 2.4%), cough (2.1% as opposed to 0.2%), and esophagitis (1.5% as opposed to 0.5%). ESAS collected additional symptom domains including overall wellbeing symptoms, depression, anxiety, and spiritual wellbeing, which are not included on CTCAE. ESAS detected 6.2% of patients reporting severe depression, 8.3% with severe anxiety, 9.7% marking severe for poor overall wellbeing, and 8.3% marking severe for poor spiritual wellbeing.

Conclusion: This studied demonstrated that while ESAS and CTCAE reports are correlated, patients reported more severe symptoms through ESAS compared to physician-graded toxicities from CTCAE in this group of lung cancer patients who underwent thoracic radiotherapy. Systematic acquisition of patient-reported symptoms is important to optimize clinical care and symptom management.

Citation Format: Bansi Savla, Thomas Dilling, Syeda Mahrukh Naqvi, Jae K. Lee, Hsiang-Hsuan M. Yu. Do physician-reported toxicities accurately reflect patient-reported symptom burden? An analysis of ESAS and CTCAE for patients with lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 989. doi:10.1158/1538-7445.AM2017-989