Under-Recognition of Symptoms Common in Patients With Breast Cancer


Younger and Black patients are more likely to experience breast cancer symptom under-recognition.

Under-recognition of symptoms in patients with breast cancer receiving radiotherapy is common, according to data presented at the 2020 San Antonio Breast Cancer Symposium.

Underrecognized symptoms include pain, pruritus, edema, and fatigue. Younger and Black patients were more likely to have radiotherapy symptoms go unrecognized.

Investigators looked at patient-reported outcomes from 9868 patients who were treated with radiotherapy for breast cancer after lumpectomy, according to the study. Patients were drawn from 29 practices across Michigan that are enrolled in the Michigan Radiation Oncology Quality Consortium. Patients and physician ratings of 4 symptoms, breast pain, pruritus, edema, and fatigue, were collected independently and compared.

According to the study, 30.9% of patients reported under-recognition of pain, 36.7% reported under-recognition of pruritis, 51.4% reported under-recognition of edema, and 18.8% reported under-recognition of fatigue. Of the 9868 patients, 5510 reported at least 1 substantial symptom during radiotherapy, 53.2% reported under-recognition of at least 1 of the 4 symptoms.

Compared with patients ages 60-69 years, patients younger than 50 years had 35% increased odds in symptom under-recognition and those between the ages of 50-59 years had a 21% increased chance, according to the study. Black patients had 92% increased odds of symptom under-recognition. Patients of races other than Black and Asian have 82% increased odds of symptom under-recognition, according to the study.

"It is possible that there is a misconception among medical professionals about the pain tolerance of patients based on age and race," said Reshma Jagsi, MD, DPhil, the Newman Family professor and deputy chair of the Department of Radiation Oncology and director of the Center for Bioethics and Social Sciences in Medicine at the University of Michigan, in a press release. "Our study identifies some concerning patterns that need to be evaluated in future research, along with opportunities for intervention to improve the quality and equity of cancer care delivery.”

Study limitations include its observational nature. According to the study authors, improving symptom detection can help improve patient experiences and outcomes.


Under-recognition of symptoms may be common in breast cancer patients receiving radiation [News Release] December 9, 2020; San Antonio, TX. Accessed December 9, 2020. https://www.eurekalert.org/pub_releases/2020-12/aafc-uos120720.php.

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