Frequency and severity of skin reactions in patients with breast cancer undergoing adjuvant radiotherapy, the usefulness of two assessment instruments - a pilot study.

Acute radiation skin reactions (ARSR) are a major problem in curative radiotherapy (RT). A number of studies have failed to show a positive effect of different skin care products to reduce or prevent ARSR. The aims for this study were to describe frequency and severity of ARSR in patients with breast cancer undergoing adjuvant RT and to test the suitability in clinical use of two assessment instruments. A majority (93%) of the 93 patients with breast cancer included in this study developed ARSR, most of them mild reactions. Low scores for pain and itching (VAS) were reported. ARSR were assessed using the modified version of RTOG/EORTC acute radiation morbidity scoring criteria and the World Health Organisation (WHO) grading system for acute and subacute toxicity by two independent observers after the completion of RT. The percentages of discordant assessment between the two observers were 21% for the WHO scale and 32% for the RTOG/EORTC. Severe ARSR, classified as grades 2-4 on both instruments resulted in good agreement between the two instruments. However, the assessments using RTOG/EORTC resulted in an almost 10% higher proportion of severe ARSR. Comparisons of health related quality of life and sleep revealed no statistically significant differences between patients with mild or severe ARSR assessed by the RTOG/EORTC scale with the exception of cognitive functioning. The use of assessment instruments to describe treatment-related symptoms is complicated and clinical experience is not always enough. More research is needed to validate these instruments to guarantee sound and precise assessments.