Capturing acute toxicity data during lung radiotherapy by using a patient-reported assessment tool

Background: Comprehensive and accurate assessment of symptoms experienced by patients undergoing lung radiotherapy (RT) is challenging. This study aims to evaluate the feasibility and utility of collecting acute toxicity information by using a patient-reported instrument, the Thoracic Symptom Self-Assessment Tool (TSSAT).

Methods: The TSSAT is based on the CTCAE v3.0(Common Toxicity Criteria of Adverse Events). All patients undergoing lung RT at our center from May 2008 to April 2009 were asked to complete the TSSAT on day 1 and weekly during RT. TSSAT scores were compared with clinician reporting of the same symptoms. Descriptive statistics and weighted kappa values were calculated to measure the agreement between patient- and clinician-reported acute toxicity.

Results: Of 300 consecutive patients approached, 49% (148/300) completed the TSSAT at least once. Patient participation and compliance were associated with treatment intent; radical (87%) vs. palliative (25%); P = <.0001. The average data completion rate by patients was 72%, and the average toxicity documentation rate by clinicians was 67%. Agreement between patients and clinicians was fair to moderate for most symptoms; the majority (>79%) of the differences were within one grade. Patients reported greater severity than clinicians for subjective symptoms. Clinicians graded greater severity than patients for the more observable symptoms.

Conclusions: The TSSAT has been shown to be feasible and accepted by patients receiving radical dose RT. Patient-reported assessments may improve acute symptom management in the future.