ESTRO 2022 - Abstract Book

S158

Abstract book

ESTRO 2022

Supported by the Danish Cancer Society, the Danish Breast Cancer Group Center and Clinic for Late Effects (DCCL) was established in 2018. A core aim was to develop and evaluate a smartphone-based application for collecting national PRO data on late effects after breast cancer treatment (DCCL-PRO). Patients are asked to download the DCCL-PRO app and complete a baseline questionnaire prior to surgery. Based on their personal treatment plan, patients are then prompted to complete questions on treatment-specific and general symptoms and late effects at various intervals throughout their treatment and follow-up trajectory. DCCL-PRO includes individual questions and validated scales assessing (a) sociodemographic data, (b) health behaviors, physical function, and comorbidity, (c) loco-regional and general physical symptoms (e.g., lymphedema, menopausal symptoms, pain, neuropathies), (d) general symptoms and late effects (e.g., fatigue, depression, anxiety, fear of cancer recurrence, insomnia, cognitive function, sexual adjustment, and body image), (e) work-related difficulties, and (f) emotional and informational support and self-efficacy for managing symptoms. The DCCL-PRO is personalized, ensuring that patients and survivors are only presented with relevant questions and scales, minimizing respondent burden. DCCL-PRO is also interactive. Based on pre-defined clinical cut-offs, patients and survivors are given feedback and advice on how to cope with their symptoms and when to seek help. Finally, prior to consultations, an accompanying DCCL-PRO Clinician App provides clinicians with an overview of the collected PRO data for each patient, together with information about late effects and examples of relevant advice. The DCCL-PRO has been pilot tested, and qualitative interviews with 30 patients revealed high levels of satisfaction with the project and the app, its content, the feedback, and the interactive user interface. The app is currently being stepwise implemented in departments across Denmark. Challenges include regional differences in consultation and treatment schedules, opportunities for recruiting and informing patients about the app, and the resources available for helping patients download and access the app. When DCCL-PRO is successfully implemented, the perspectives are manifold: First, we aim to integrate the data collected with DCCL-PRO with the DBCG clinical database, thereby delivering on the goal of the Danish National Cancer Plan IV to ensure integration of PRO data in the national clinical cancer databases. Second, such data will provide researchers with the population-based data needed to develop AI-based models predicting who is at heightened risk of developing late effects. Third, the accompanying DCCL-PRO Clinician App makes continuously updated information available to clinicians about late effects experienced by their patients, thereby informing the consultation. Fourth, a nationally implemented DCCL-PRO will deliver population-based high-quality longitudinal data informing randomized controlled trials of interventions to prevent and treat late effects after cancer and cancer treatment. Finally, the knowledge obtained will guide the development of national guidelines on late effects after cancer and identify areas where more research is needed. Abstract Text Radiation oncology has a long-standing tradition of morbidity research as treatment-related symptoms are used to model dose planning aims with a trade-off in maintaining tumor control while minimizing organ at risk (OAR) damage [1]. Especially in curative treatment approaches with favorable disease outcomes and rare severe or life-threatening morbidity, patient- reported symptoms and their impact on quality of life (QoL) are in the focus of attention, as cancer survivors have to face potential impairments for a long time. The EMBRACE I and II studies on MRI-based image-guided adaptive brachytherapy (IGABT) in locally advanced cervical cancer (LACC) have prospectively collected physician-assessed and patient-reported symptoms for over 14 years, in >2800 patients within an international multi-center framework [2]. With the longitudinal assessment of regular follow-ups, the EMBRACE studies offer a unique opportunity to explore different methods for assessing, analyzing, and reporting symptoms after radiotherapy within this large scale collection of both Common Toxicity Criteria for Adverse Events (CTCAE from NCI, National Cancer Institute) and Patient-Reported Outcomes (QoL Questionnaires from the EORTC, European Organisation for Research and Treatment of Cancer) [3]. The majority of symptoms in the EMBRACE studies are G1 and G2, which are often fluctuating over time [4]. With the aim of assessing long-term burden of symptoms, a new method has been integrated to select patients with late, persistent, substantial and treatment-related symptoms (LAPERS) [5]. It is defined if a symptom is reported above a pre-defined threshold in at least half of the late follow-ups and with progression beyond baseline. The method reflects symptom burden over time and informs patients of the risk for transient versus persistent symptoms. It provides reliable estimates to the most commonly asked question by symptomatic patients: “Will this side-effect go away or will I have to live with it?” [6] Furthermore, it has been successfully applied to establish predictive models, including volumetric, dosimetric, and clinical risk factors [7,8,9,10]. With this approach, the impact of persisting long-term symptoms on functional aspects of daily life (physical, role, emotional, cognitive, social functioning) and global health status / general QoL has been investigated. Any persisting symptom shows a significant reduction in all aspects of QoL, but the impact varied substantially between symptoms. In contrary to common expectations, treatment-related symptoms caused by damage to the organs at risk (gastro-intestinal and genito-urinary symptoms) showed less reduction in QoL aspects, compared to more unspecific symptoms, such as fatigue syndrome (weakness, exhaustion and tiredness), insomnia and pain [11]. SP-0190 Large-scale collection of PRO from patients treated with radiation for gynaecological malignancy K. Kirchheiner 1 1 Medical University Vienna, Radiation Oncology, Vienna, Austria

This QoL evaluation of patients with or without single persisting long-term symptoms is an exploratory univariate approach. However, cancer survivors´ reality and narratives are much more complex: The impact of symptoms on functional aspects of daily life strongly depends on individual life circumstances, expectations and coping strategies. Moreover, the cause-