Patient-clinician symptom agreement before and after radiotherapy for prostate cancer in the HYPO-RT-PC study

Patient-reported outcome measures are recommended for monitoring treatment-related symptoms during and after radiotherapy (RT) for prostate cancer (PC). However, agreement between patient- and clinician-reported symptoms is often low. Secondary analysis of the phase 3 HYPO-RT-PC study, in Sweden and Denmark evaluated agreement between patient- and clinician-reported symptoms before and after RT for PC. The analysis included 1180 men with PC who were randomized to conventional RT (2.0 Gy x 39 fractions) or ultra-hypofractionated RT (6.1 Gy x 7 fractions) between 2005 and 2015. Urinary, bowel, and sexual symptoms were assessed using the Prostate Cancer Symptom Scale questionnaire at baseline, end of RT, and at 1, 2, and 4 years post-treatment; clinicians evaluated symptoms at the same timepoints 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 symptoms and bowel symptoms, and overrated sexual activity, while results for erectile dysfunction were inconsistent. The authors conclude that agreement between patient- and clinician-reported RT-related symptoms was generally poor. These discrepancies highlight the limitations of relying solely on clinician assessment.