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Worth Attention Breast quality-of-life

Patients with documented fatigue were less likely to complete electronic symptom surveys after breast RT

Patients with clinician-documented fatigue had 39% lower odds of completing electronic fatigue assessments, exposing an important limitation of PRO-only monitoring.

RadOncToday · ·2 min read

KEY POINTS

  • This retrospective study included 756 patients with breast cancer treated at a multisite academic center from 2019–2023. Median age was 57 years; 442 patients (58.5%) received whole-breast RT, 261 (34.5%) regional nodal irradiation or postmastectomy RT, and 53 (7.0%) accelerated partial-breast irradiation. Median treatment length was 17 fractions.
  • Patients received electronic PRO-CTCAE fatigue assessments 2 and 4 weeks after RT, but only 463 of 756 patients (61%) completed at least one survey. English language preference was strongly associated with completion (OR 7.19, 95% CI 3.17–18.61; p<0.001), while non-Hispanic White patients were also more likely to respond (OR 1.61, 95% CI 1.09–2.35; p=0.02).
  • The most clinically concerning finding was that patients with fatigue already documented by clinicians were less likely to complete the electronic survey: OR 0.61 (95% CI 0.43–0.87; p=0.006). In other words, relying only on portal-based PRO collection could preferentially lose patients with greater symptom burden.
  • Patient- and clinician-reported fatigue behaved differently. Each additional RT fraction was associated with greater patient-reported fatigue severity (OR 1.09 per fraction, 95% CI 1.04–1.15; p=0.001), while whole-breast RT was associated with lower post-treatment patient-reported fatigue than partial-breast RT (OR 0.49, 95% CI 0.25–0.98; p=0.04).
  • Clinician-documented fatigue instead tracked strongly with treatment volume: compared with partial-breast irradiation, the odds were substantially higher with whole-breast RT (OR 9.21, 95% CI 4.27–21.82) and regional nodal/postmastectomy RT (OR 8.11, 95% CI 3.34–21.23), both p<0.001. The authors caution that clinician and patient assessments were collected at different timepoints and therefore cannot be treated as a direct concordance comparison.
  • Baseline exercise data were available for only 125 patients. Meeting the guideline of ≥150 minutes/week of moderate-to-vigorous activity showed a borderline association with less clinician-documented fatigue (OR 0.39, 95% CI 0.15–1.02; p=0.054) but no association with patient-reported fatigue (OR 1.14, 95% CI 0.48–2.75; p=0.76).
  • Important limitations include the retrospective single-center design, an English-only PRO instrument, differences in timing between clinician and patient fatigue assessments, and incomplete capture of potentially relevant factors such as depression and anemia. The study therefore supports multimodal symptom monitoring rather than showing that one assessment method is superior.

CLINICAL TAKEAWAY

Electronic PROs can improve fatigue monitoring, but this study identifies an important failure mode: patients already experiencing fatigue may be less likely to complete them. For breast RT programs using digital symptom surveillance, non-response should not automatically be interpreted as absence of toxicity; clinician assessment and alternative outreach remain important.

SOURCE

Technical Innovations & Patient Support in Radiation Oncology