Patient-clinician symptom agreement before and after radiotherapy for prostate cancer: results from the randomized HYPO-RT-PC study.

Abstract

Patient-reported outcome measures are recommended for monitoring treatment-related symptoms during radiotherapy (RT) for prostate cancer (PC). However, agreement between patient- and clinician-reported symptoms is often low. This study aimed to evaluate agreement between patient- and clinician-reported symptoms before and after radiotherapy for prostate cancer. This sub-study of the HYPO-RT-PC trial included 1,180 men with PC randomized to conventional (2.0 Gy × 39 fx) or ultra-hypofractionated (6.1 Gy × 7 fx) RT between 2005 and 2015. Urinary, bowel, and sexual symptoms were assessed using the Prostate Cancer Symptom Scale questionnaire at baseline, at the end of RT, and at 1, 2, and 4 years post-treatment; clinicians evaluated symptoms at the same intervals using the Radiation Therapy Oncology Group scale. At each follow-up, 580-910 paired assessments were analyzed. Spearman's correlation between patient and clinician ratings ranged from -0.091 to 0.750. Clinicians consistently underrated urinary and bowel symptoms, overrated sexual activity, but results for erectile dysfunction were inconsistent. Agreement between patient- and clinician-reported RT-related symptoms was generally poor. These discrepancies highlight the limitations of relying solely on clinician assessment. They also underscore the need to integrate patient-reported outcome measures systematically into clinical practice and research to ensure accurate symptom monitoring and patient-centered care.