2977 - Patient- and Physician-Reported Symptom Profile for Severe Radiation-Induced Dermatitis in Black Women with Fitzpatrick Skin Type IV-VI Undergoing Adjuvant Radiotherapy for Breast Cancer

Purpose/Objective(s):

Studies suggest that Black women undergoing radiation therapy (RT) for breast cancer may experience worse RT-induced skin toxicity (RIST). However, symptoms assessed in toxicity scoring tools may not adequately capture the grade of RIST in Black women to guide supportive management. The objective of this study was to determine the patient- and physician-reported symptoms associated with severe RIST in Black women with Fitzpatrick skin types IV-VI.

Materials/Methods:

Black women planned for adjuvant RT for BC were enrolled prospectively in Zimbabwe. Patient and physician-reported Fitzpatrick scoring and skin toxicity assessments were completed weekly during RT, then at 2,6- and 12-weeks post-RT using validated tools (Skin Dex 16, Patient reported CTCAE and Modified QLQ BR23 for patient-reported and CTCAE v 3 and v5 for physician-reported). Symptoms representative of severe RIST were evaluated from each tool using Chi square or Fisher’s exact test. Level of agreement between patient- and physician-reported symptoms were examined using kappa statistics.

Results:

56 patients were enrolled and the most common physician and patient reported skin type was type V at 65% and 85% respectively . The overall incidence of patient-reported severe RIST at any time point based on all the 3 tools was 27%, however for each tool it was as follows:10.7% , Skin Dex 16; 21.4% on Modified QLQ BR23, and 25% on PRO CTCAE. The incidence of physician- reported severe RIST was 13%, which were all recorded on the CTCAE v5; severe RIST was not reported using the CTCAE v3. There was a low level of agreement between the patient and physician reported severe RIST with a concordance of 65%, kappa= -0.08 (-0.31, 0.14).

The symptoms contributing to the patient-reported severe RIST scores included pain on radiotherapy field 100% (p=.001), increased sensitivity 100% (p=<.001), burning or stinging 100% (p=<.001), skin changes 100% (p=<.001), dry skin 100% (p=<.001),itchy skin 100%(p=<.001), skin discoloration 100%(p=<.001) and redder skin 53% (p=<0.001). Dry skin 67% (p=.001) was the only physician-reported severe RIST symptom.

Conclusion:

Poor concordance was observed between physician- and patient-reported incidence of severe RIST and in the RIST symptom profile. Modification of existing physician scoring tools is needed to include the unique symptom profile of severe RIST among Black women to facilitate early and appropriate intervention.