Grading System Designed to Assess Patient Reactions to Radiotherapy

A novel study was designed to assess the effectiveness of different systems used by caregivers to evaluate toxicity for patients receiving radiation therapy.

The study, conducted by researchers from North Shore-Long Island Jewish (LIJ) Health System (New Hyde Park, NY, USA), was presented at the 55th annual meeting of the American Society of Therapeutic Radiation Oncology (ASTRO), held September 2013 in Atlanta (GA, USA).

During the course of radiation therapy, patients may experience reactions to their treatments. Typically, the severity of reactions is assessed by a radiation oncologist and nurse using a formal grading scheme. Research conducted by North Shore-LIJ’s radiation oncologists evaluated the reliability of these grading systems by independent caregivers. The study assessed whether independent caregivers would assign the same grade to the same adverse reaction using a common grading scheme. Images of breasts that had undergone radiation in 30 breast cancer patients on skin care protocols were presented to radiation oncologists and nurses who were asked to assign grades independently based on their evaluation of the images and provide feedback explaining their choices. The assessments were then analyzed and the level of agreement among caregivers was determined using statistical methods.

As presented at ASTRO, the study determined that overall there was a significantly better agreement in the assessments based on the use of the Common-Terminology-Criteria-for-Adverse Events (CTCAE) scale, which was developed by the National Cancer Institute to standardize the assignment of grades across various caregivers. Analysis of the comments provided by the caregivers revealed a reliance on assessment criteria that was not necessarily explicit in the grading definitions.

“Establishing the reliability of the scale used to assess adverse reactions among different caregivers is an important step to enhance uniformity and consistency of the care to our patients,” said Ajay Kapur, PhD, lead author of the study and director of medical physics research and education in the North Shore-LIJ department of radiation medicine. “The specific grading scheme used must demonstrate a high level of reliability amongst various caregivers.”

The study’s senior author and chair of radiation medicine, Louis Potters, MD, said, “In order to deliver the highest quality of care to our patients, we all need to speak the same language. This study enhances our ability to provide Consistent care to all our patients and further validates the CTCAE grading system.”

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North Shore-Long Island Jewish Health System