Abstract / Summary
We previously evaluated the predictive factors for reduced radiotherapy intensity based on radiation oncologist experience. In this study, we evaluated the appropriateness of the treatment intensity selection based on radiation and medical oncologists’ experience from a patient-reported outcome (PRO) perspective. We prospectively enrolled patients with non-metastatic cancer (≥ 70 years) between November 2020 and February 2022. Reduced treatment intensity implied changes to the irradiation field, radiotherapy schedule, and/or concurrent chemotherapy from the standard based on primary tumor guidelines. PRO was assessed using the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire scores before radiotherapy and at 3–5 and 8–16 weeks post-radiotherapy. A clinically relevant change was defined as a difference of ≥ 10 points. Overall, 294 of 317 enrolled patients were eligible for analysis. Treatment policies were modified in 72 patients (24%), and 43 patients (15%) experienced grade ≥ 3 acute adverse events. None of the observed differences between before and after radiotherapy were ≥ 10 points in the standard and reduced-intensity treatment groups. Significant differences were observed in physical and role functioning, and dyspnea (p = 0.015, 0.003, and 0.010, respectively) in patients with grade ≥ 3 adverse events, which deteriorated by ≥ 10 points. Our results indicate that the treatment intensity was appropriately selected from a PRO perspective. Nevertheless, it is necessary to pay attention to the deterioration of quality of life after radiotherapy for older patients with grade ≥ 3 adverse events. This study was registered in the University Hospital Medical Information Network (UMIN) under the number UMIN 000042473. We assessed the appropriateness of treatment intensity selection in cancer patients aged ≥ 70 years using PRO. Of 294 patients, 24% received reduced-intensity treatment and 15% experienced grade ≥ 3 adverse events. Quality of life changes were minimal, indicating appropriate treatment selection; however, a significant decline occurred in severe adverse events.