Mayo Clinic College of Medicine, Rochester, MN
Carrie A. Thompson , Neha Mehta-Shah , Christopher Flowers , Gilles A. Salles , Herve Tilly , Neil Sun Chua , René-Olivier Casasnovas , Fiona Miall , Tae Min Kim , Cheng-Hong Tsai , Sunita Dwivedy Nasta , Seung Tae Lee , Veronica Craine , Avrita Campinha-Bacote , Jamie H. Hirata , Calvin Lee , Matthew Dean Sei Sugidono , Jonathan W. Friedberg
Background: The safety profiles of novel agents are mainly based on clinician-reported adverse events (AEs) from clinical trials. Patient-reported outcomes (PROs) may better represent the treatment burden experienced by patients (pts) compared with clinician-reported AEs. Using data from POLARIX, a double-blind, placebo-controlled, randomized Phase 3 international study (NCT03274492), we previously presented PRO and clinician-reported data showing similar rates of neuropathy (Trněný et al. 2022). Here, we evaluate the reporting of other common symptoms using PRO and clinician-reported data in POLARIX. Methods: POLARIX methods were previously described (Tilly et al. 2022); this analysis included all pts with PRO data. PRO and clinician-reported data described the incidence and severity of fatigue, constipation, diarrhea, nausea, and vomiting. Clinician-reported severity grading was based on the NCI Common Terminology Criteria for Adverse Events (NCI-CTCAE) v4.0. PROs were collected using the European Organisation Research and Treatment of Cancer Quality of Life-Core 30 questionnaire (EORTC QLQ-C30), which was administered to pts at clinic visits on Day 1 of Cycles 1 (baseline), 2, 3, and 5, and end of treatment (EOT). PRO severity scores included ‘A little’, ‘Quite a bit’, and ‘Very much’. Results: Overall, 825 pts were evaluable. From baseline to EOT, PROs showed a higher incidence of symptoms compared with clinicians for fatigue (98% vs 27%), constipation (68% vs 29%), diarrhea (56% vs 26%), nausea (58% vs 40%), and vomiting (24% vs 15%). PRO severity scores of ‘Quite a bit’ or ‘Very much’ were reported in 33% of pts for fatigue, 29% for constipation, 17% for diarrhea, 19% for nausea, and 7% for vomiting. Clinicians reported Grade ≥2 symptoms in 11% of pts for fatigue, 11% for constipation, 11% for diarrhea, 14% for nausea, and 6% for vomiting. Conclusions: In POLARIX, pts reported a higher incidence and severity of symptoms compared with clinicians. Although distinct scales were used, the differences in symptom rates reported by pts and clinicians were clinically meaningful. These data may have implications for symptom management, including physician evaluation and communication of symptom expectations for pts. Reporting of symptoms by PROs should be incorporated into clinical trials as an adjunct to standard AE reporting to better characterize the patient experience. Clinical trial information: NCT03274492.
Symptom,* n (%) | Clinician-reported severity,† Grade ≥2 | Patient-reported severity,‡ ‘A little’ | Patient-reported severity,‡ ‘Quite a bit’ | Patient-reported severity,‡ ‘Very much’ |
---|---|---|---|---|
Fatigue | 88 (10.7) | 532 (64.6) | 245 (29.7) | 28 (3.4) |
Constipation | 93 (11.3) | 330 (40.2) | 143 (17.4) | 91 (11.1) |
Diarrhea | 87 (10.5) | 316 (38.4) | 90 (10.9) | 52 (6.3) |
Nausea | 119 (14.4) | 317 (38.5) | 112 (13.6) | 46 (5.6) |
Vomiting | 46 (5.6) | 143 (17.4) | 33 (4.0) | 25 (3.0) |
PRO-evaluable population: n=825. *From baseline to EOT; †Based on NCI-CTCAE v4.0; ‡Based on EORTC QLQ-C30.
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