Development of an Illustrated Scale for Acute Radiation Dermatitis in Breast Cancer Patients

Shumway, Dean A.; Kapadia, Nirav S.; Walker, Eleanor M.; Griffith, Kent A.; Thy, Thy; Feng, Mary; Boike, Thomas; Helfrich, Yolanda; DePalma, Bonnie; Gillespie, Erin F.; Miller, Alexandria; Hayman, James A.; Jagsi, Reshma; Pierce, Lori J.

doi:10.1016/j.prro.2020.09.002

Cited by 12 publications

(6 citation statements)

References 22 publications

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“…Black patients are less likely to receive hypofractionated radiation therapy, an approach less likely to be followed by short-term toxic effects, but the association between race and ethnicity and toxic effects in the current study existed even after controlling for differences in fractionation. Given evidence that clinicians may be less sensitive to pain experienced by Black patients and less likely to prescribe them pain medication, and also given that skin reactions to radiation may be less easily observed in patients with darker skin pigmentation and physicians may be less familiar with the ways radiation dermatitis manifests in patients with darker skin tones, we hypothesized that underrecognition of symptoms would be more likely for individuals of racial and ethnic minority groups. This study’s findings confirmed that hypothesis.…”

Section: Discussionmentioning

confidence: 99%

Identifying Patients Whose Symptoms Are Underrecognized During Treatment With Breast Radiotherapy

et al. 2022

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for the Michigan Radiation Oncology Quality Consortium IMPORTANCE Understanding whether physicians accurately detect symptoms in patients with breast cancer is important because recognition of symptoms facilitates supportive care, and clinical trials often rely on physician assessments using Common Toxicity Criteria for Adverse Events (CTCAE).OBJECTIVE To compare the patient-reported outcomes (PROs) of patients with breast cancer who received radiotherapy from January 1, 2012, to March 31, 2020, with physicians' CTCAE assessments to assess underrecognition of symptoms. DESIGN, SETTING, AND PARTICIPANTSThis cohort study included a total of 29 practices enrolled in the Michigan Radiation Oncology Quality Consortium quality initiative. Of 13 725 patients with breast cancer who received treatment with radiotherapy after undergoing lumpectomy, 9941 patients (72.4%) completed at least 1 PRO questionnaire during treatment with radiotherapy and were evaluated for the study. Of these, 9868 patients (99.3%) were matched to physician CTCAE assessments that were completed within 3 days of the PRO questionnaires.EXPOSURES Patient and physician ratings of 4 symptoms (pain, pruritus, edema, and fatigue) were compared. MAIN OUTCOMES AND MEASURESWe used multilevel multivariable logistic regression to evaluate factors associated with symptom underrecognition, hypothesizing that it would be more common in racial and ethnic minority groups. RESULTSOf 9941 patients, all were female, 1655 (16.6%) were Black, 7925 (79.7%) were White, and 361 (3.6%) had Other race and ethnicity (including American Indian/Alaska Native, Arab/Middle Eastern, and Asian), either as self-reported or as indicated in the electronic medical record. A total of 1595 (16.0%) were younger than 50 years, 2874 (28.9%) were age 50 to 59 years, 3353 (33.7%) were age 60 to 69 years, and 2119 (21.3%) were 70 years or older. Underrecognition of symptoms existed in 2094 of 6781 (30.9%) observations of patient-reported moderate/severe pain, 748 of 2039 observations (36.7%) of patient-reported frequent pruritus, 2309 of 4492 observations (51.4%) of patient-reported frequent edema, and 390 of 2079 observations (18.8%) of patient-reported substantial fatigue. Underrecognition of at least 1 symptom occurred at least once for 2933 of 5510 (53.2%) of those who reported at least 1 substantial symptom. Factors independently associated with underrecognition were younger age (younger than 50 years compared with 60-69 years: odds ratio [

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Section: Discussionmentioning

confidence: 99%

Identifying Patients Whose Symptoms Are Underrecognized During Treatment With Breast Radiotherapy

et al. 2022

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“…Considering the variable manifestations of RD that may not be well captured using a singular clinician-rated scoring system developed primarily for patients with lighter phototypes, and variation in rates of acute RD in patients with different skin types, a diverse battery of clinician-rated and PRO measures is needed to ensure accurate and equitable measurement of acute RD across a diverse patient population. 3,46 While skin phototype was not collected at baseline in the present study, a future clinical trial will assess patient-reported Fitzpatrick skin type to better understand and account for the interaction between skin type, acute RD and treatment effect. 47,48 Another important finding of this study is that exploratory analyses of agreement between clinician-rated and patientreported measures of acute RD identified substantial discordance.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…2 Its early manifestations differ between skin tone types: erythema in patients with lighter skin tones and hyperpigmentation in patients with more pigmented skin types, the latter of which is not well captured in commonly used RD grading scales. [3][4][5][6] Further progression of RD can manifest as dry or moist desquamation (i.e., moderate RD) to oedema, bleeding, ulceration or necrosis (i.e., severe RD).…”

Section: Introductionmentioning

confidence: 99%

Keratin-based topical cream for radiation dermatitis during head and neck radiotherapy: a randomised, open-label pilot study

Hughes,

Levine,

Frizzell

et al. 2024

J Radiother Pract

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Introduction: Radiation dermatitis (RD) is a frequent toxicity during radiotherapy (RT) for head and neck cancer (HNC). We report the first use of KeraStat® Cream (KC), a topical, keratin-based wound dressing, in patients with HNC receiving RT. Methods: This pilot study randomized HNC patients treated with definitive or postoperative RT (≥60 Gy) to KC or standard of care (SOC), applied at least twice daily during and for 1-month after RT. Outcomes of interest included adherence to the assigned regimen (at least 10 applications per week of treatment), clinician- and patient-reported RD, and skin-related quality of life. Results: 24 patients were randomized and completed the study. Most patients had stage III-IV disease and oropharynx cancer. Median RT dose was 68 Gy; the bilateral neck was treated in 19 patients, and 18 patients received concurrent chemotherapy. Complete adherence was observed in 7/12 (SOC) vs. 10/12 (KC, p = 0.65). Adherence by patient-week was 61/68 versus 64/67, respectively (p = 0.20). No differences in RD were observed between groups. Conclusion: A randomized trial of KC versus SOC in HNC patients treated with RT is feasible with good adherence to study agent. An adequately powered randomized study is warranted to test the efficacy of KC in reducing RD.

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“…Tagliaferri et al reviewed cosmetic assessment in brachytherapy for breast cancer and did not report on a PRO measure used to evaluate MD [ 20 ]. Shumway et al recently published a study describing the development of an illustrated scale for acute radiation dermatitis in breast cancer patients [ 21 ]. This study evaluated acute radiation dermatitis using PRO, clinician-reported outcomes, and photographic evaluations by clinicians.…”

Section: Discussionmentioning

confidence: 99%

Validation of a Patient-Reported Outcome Measure for Moist Desquamation among Breast Radiotherapy Patients

et al. 2022

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There has been an increasing interest in patient-reported outcome (PRO) measures in both the clinical and research settings to improve the quality of life among patients and to identify when clinical intervention may be needed. The primary purpose of this prospective study was to validate an acute breast skin toxicity PRO measure across a broad sample of patient body types undergoing radiation therapy. Between August 2018 and September 2019, 134 women undergoing adjuvant breast radiotherapy (RT) consented to completing serial PRO measures both during and post-RT treatment and to having their skin assessed by trained trial radiation therapists. There was high patient compliance, with 124 patients (92.5%) returning to the clinic post-RT for at least one staff skin assessment. Rates of moist desquamation (MD) in the infra-mammary fold (IMF) by PRO were compared with skin assessments completed by trial radiation therapists. There was high sensitivity (86.5%) and good specificity (79.4%) between PRO and staff-reported presence of MD in the IMF, and there was a moderate correlation between the peak severity of the MD reported by PRO and assessed by staff (rho = 0.61, p < 0.001). This prospective study validates a new PRO measure to monitor the presence of MD in the IMF among women receiving breast RT.

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Development of an Illustrated Scale for Acute Radiation Dermatitis in Breast Cancer Patients

Cited by 12 publications

References 22 publications

Identifying Patients Whose Symptoms Are Underrecognized During Treatment With Breast Radiotherapy

Identifying Patients Whose Symptoms Are Underrecognized During Treatment With Breast Radiotherapy

Keratin-based topical cream for radiation dermatitis during head and neck radiotherapy: a randomised, open-label pilot study

Validation of a Patient-Reported Outcome Measure for Moist Desquamation among Breast Radiotherapy Patients

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