title: Postradiotherapy morbidity in long-term survivors after locally advanced cervical cancer: how well do physicians' assessments agree with those of their patients?
abstract: OBJECTIVE
  Descriptions of late morbidity after radiotherapy in cervical cancer survivors (CCSs) are usually based on observations made by physicians, and rarely by patients themselves. We describe and compare physician-assessed morbidity with patient-rated symptoms more than 5 years after pelvic radiotherapy.
  
  
  METHODS
  In 147 CCSs treated between 1994 and 1999 at The Norwegian Radiumhospital, morbidity data were regularly documented by physicians at least for 5 years after radiotherapy. Information on patient-rated symptoms was collected by a questionnaire from 91 (62%) of the 147 survivors after a median follow-up time of 96 months (65-131 months). The results were compared with physician-assessed morbidity scores recorded at 5 years, and to selected normative data using descriptive statistics. Physician-assessed morbidity data were modeled using Kaplan-Meier method. Agreement between physician data and patient data was expressed using weighted kappa statistics.
  
  
  RESULTS
  The 5-year Kaplan-Meier estimates of physician-assessed intestinal, bladder, and vaginal morbidity Grade 3-4 were 15%, 13%, and 23%, respectively. The prevalence of patient-rated severe symptoms from these organs was much higher (intestines 45%, bladder 23%, and 58% vaginal discomfort among sexually active CCSs). Poor agreement was confirmed by low values of kappa: For bladder the concordance was slight (kappa = 0.16) and for intestine it was fair (kappa = 0.27). Stress incontinence, diarrhea, nausea, and sexual problems were significantly (p < 0.001) more prevalent when compared with a control sample from the general female population.
  
  
  CONCLUSIONS
  Morbidity is common after pelvic radiotherapy. However, our data indicate that physicians underreport patients symptoms. It is important to incorporate patient-reported outcomes in the evaluation of treatment-related morbidity.
authors: Department of Gynecology, Sorlandet Hospital HF, Kristiansand, Norway. ingvild.vistad@sshf.no
authors: Ingvild
authors: I
authors: Vistad
authors: Milada
authors: M
authors: Cvancarova
authors: Sophie Dorothea
authors: SD
authors: Fosså
authors: Gunnar B
authors: GB
authors: Kristensen
mesh_terms: D000328:Adult; D000368:Aged; D003967:Diarrhea / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007422:Intestines / Q000528:radiation effects; D008875:Middle Aged; D009325:Nausea / Q000175:diagnosis; D015588:Observer Variation; D009774:Obstetrics; D011832:Radiation Injuries / Q000150:complications* / Q000175:diagnosis; D018787:Radiation Oncology; D011879:Radiotherapy Dosage; D012007:Rectum / Q000528:radiation effects; D012720:Severity of Illness Index; D019529:Sexuality; D017741:Survivors; D001743:Urinary Bladder / Q000528:radiation effects; D001745:Urinary Bladder Diseases / Q000175:diagnosis; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D014621:Vagina / Q000528:radiation effects