ST. PETERSBURG, Florida—New cancer regimens are sometimes a double-edged sword, offering better survival but also delayed toxicity affecting quality of life. At the Late Effects of Normal Tissues (LENT) IV workshop, an international, multidisciplinary panel tackled the Herculean task of defining, grading, and reporting chronic toxicity. The workshop included representatives from more than 10 countries, including two European organizations.
"It’s not a clear-cut issue like survival—we’re trying to quantitate about 500 different toxicity endpoints in a uniform way," said conference moderator Andy Trotti, MD, associate professor and director of clinical research in radiation oncology, H. Lee Moffitt Cancer Center at the University of South Florida, Tampa. "The delayed effects of cancer treatment are usually far less visible than acute effects, less appreciated even by experienced professionals, and often much harder to measure."
Delayed effects of chemotherapy, radiation therapy, and surgery include chronic fatigue, musculoskeletal atrophy and fibrosis, pain syndromes, limited mobility and exercise intolerance, dry mouth and dental disease, chronic edema, impaired cognitive and sexual functions, chronic intestinal dysfunction, and increased risk of heart disease and stroke.
Reporting and analyzing complications like these has, in the past, often suffered from a hit-or-miss approach: culling random observations hastily scrawled in charts or relying on complaints from patients, who are often reluctant to trouble harried providers.
Over the years, different cooperative oncology groups have developed their own toxicity scales. These groups include the Radiation Therapy Oncology Group (RTOG) and at least four others. However, lack of uniformity among the different scales hinders comparability and interpretation of results.
"Through the hard work of the participants of this workshop, one day in the near future, all of these organizations should be able to speak in a single toxicity language, utilizing a common platform, a common library of definitions, terminology, and severity scaling guided by standardized data collection and reporting techniques," Dr. Trotti said.
His team is comprised of 90 investigators, including surgeons, radiation oncologists, medical oncologists, nurses, research associates, biologists, statisticians, and other specialists; 12 National Cancer Institute (NCI) representatives; and 25 industry sponsors.
