Main Session
Sep
29
PQA 06 - Genitourinary Cancer, Gynecological Cancer, and Health Care Access and Engagement
Presenter(s)
Caroline Kernell, MD, BS - Hospital of the University of Pennsylvania, Philadelphia, PA
C. Kernell1, E. Toye2, S. O'Neill3, A. Aggarwal3, M. Gurram2, R. Ketlametswe4, and S. Grover4,5; 1UT Southwestern Medical Center, Dallas, TX, 2University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 3London School of Hygiene & Tropical Medicine, London, United Kingdom, 4Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, 5Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
Purpose/Objective(s):
Botswana has a high incidence of locally advanced cervical cancer which requires radiotherapy for cure. CTCAE toxicity reporting in this setting has been difficult; patients often lack the health literacy required to accurately report radiation toxicities. The aim of this study is to utilize a validated and patient-designed GI toxicity survey (ALERT-B) to quantify toxicities experienced by patients after pelvic radiotherapy for cervical cancer in Botswana and validate the study’s use as a patient-centered alternative reporting system in this population.Materials/Methods:
The ALERT-B GI toxicity questionnaire and a GI-specific CTCAE toxicity questionnaire were administered from July 2024 to May 2025 to cervical cancer patients who completed curative radiotherapy through the GYN/MDT Clinic at Princess Marina Hospital in Gaborone, Botswana. Administration ranged from 6-18 months after treatment completion.Results:
The median age of patients (n=93) was 53 ± 10.7 yrs, and 54.8% patients were HIV positive. FIGO Stages IB-IVB were represented, with most patients presenting at Stage II (n=36) or Stage III (n=34), followed by Stage I (n=13) and Stage IV (n=10). Treatment regimens included chemoradiotherapy (CRT) (n=60), radiotherapy (RT) (n=22), surgery + CRT (n=6), chemotherapy + CRT (n=3), and surgery + RT (n=2). A total of 21 and 15 patients reported GI toxicities with Alert B and CTCAE, respectively. The most reported Alert B symptom was nocturnal defecation urge (n=12), followed by fecal incontinence (n=8), rectal bleeding (n=7), and impact on daily life (n=4). The most reported CTCAE symptom was diarrhea (n=8), followed by rectal bleeding (n=5), fecal incontinence (n=2), rectal pain (n=1), and pelvic pain (n=1). Patients reported a maximum toxicity level of Grade 2 in nocturnal defecation urge (n=1) and Alert B rectal bleeding (n=1). All other patients reported Grade 1 toxicities. The Alert-B survey reports a 61.9% chance of detecting a toxicity that is reported on the CTCAE survey. If a toxicity is not reported on the CTCAE survey, there is a 97.4% chance the ALERT-B survey agrees. The ALERT-B and CTCAE questionnaires were not statistically different in sensitivity/specificity of reporting patient toxicity outcomes (p=0.11).Conclusion:
GI toxicities in this patient population are underreported. We demonstrated equivalence between the patient-centered ALERT-B survey and the medically focused CTCAE survey. In the context of an LMIC like Botswana where follow up and toxicity reporting can be inconsistent, ALERT-B offers an alternative path to GI toxicity data collection that improves efficiency and data volume collected. With these benefits, toxicities can be detected earlier and interventions started sooner, improving the quality of life for the patient. Future work includes application of similar surveys for other tumor types (cervical) as well as M-Health apps.