Patient-Reported Symptom Assessments and Early Chemotherapy Discontinuation in Routine Gastrointestinal Cancer Care
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Background
Early chemotherapy (CTh) discontinuation in gastrointestinal (GI) cancer patients can compromise treatment effectiveness and worsen outcomes. Clinical trials show that monitoring and addressing patient-reported symptoms may reduce early discontinuation and improve outcomes. However, evidence from routine care settings where patients are treated in standard clinical practice, especially on the dose-response relationship between number of completed assessments and risk of discontinuation, remains limited.
Methods
This retrospective cohort study included adult patients with GI cancers who received CTh at Mass General Brigham between 01/2019 and 01/2024. The Patient-Reported Outcome version of the Common Terminology Criteria for Adverse Events assessed 12 CTh-related symptoms at CTh initiation and at days 30, 60, and 90. All patients completed baseline assessment. The primary outcome was early discontinuation due to toxicity within 90 days of initiation. Using the Fine-Gray model to account for competing risks of death and progression, we examined the association between early discontinuation and number of completed assessments over time. We also tested whether this association differed across prognostic groups. To address time-varying bias from disease severity, treatment, and prior completion, we applied inverse probability weighting.
Results
Among 1,178 patients, the most common cancers were colorectal (35%) and pancreatic (31%), and 45% had stage IV disease. Overall, 784 (67%) completed symptom assessments at CTh initiation and during follow-up. After adjusting for demographic and clinical covariates and time-varying bias, completing post-initiation assessments was associated with a lower cumulative risk of early discontinuation (SHR: 0.70 [95% CI: 0.44–1.12]). Results were generally consistent across prognostic groups.
Conclusion
More frequent completion of patient-reported symptom assessment post CTh initiation was associated with a lower risk of early discontinuation in practice.
