Importance of Low- and Moderate-Grade Adverse Events in Patients’ Treatment Experience and Treatment Discontinuation: An Analysis of the E1912 Trial

Nathaniel S. O’Connell*, Fengmin Zhao, Ju Whei Lee, Edward H. Ip, John Devin Peipert, Noah Graham, Mary Lou Smith, Ilana F. Gareen, Ruth C. Carlos, Samilia Obeng-Gyasi, Joseph A. Sparano, Tait D. Shanafelt, Mary L. Thomas, David Cella, Lynne I. Wagner, Robert Gray

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


PURPOSE Despite defined grades of 1 to 5 for adverse events (AEs) on the basis of Common Terminology Criteria for Adverse Events criteria, mild (G1) and moderate (G2) AEs are often not reported in phase III trials. This under-reporting may inhibit our ability to understand patient toxicity burden. We analyze the relationship between the grades of AEs experienced with patient side-effect bother and treatment discontinuation. METHODS We analyzed a phase III Eastern Cooperative Oncology Group-American College of Radiology Imaging Network trial with comprehensive AE data. The Likert response Functional Assessment of Cancer Therapy-GP5 item, “I am bothered by side effects of treatment” was used to define side-effect bother. Bayesian mixed models were used to assess the impact of G1 and G2 AE counts on patient side-effect bother and treatment discontinuation. AEs were further analyzed on the basis of symptomatology (symptomatic or asymptomatic). The results are given as odds ratios (ORs) and 95% credible interval (CrI). RESULTS Each additional G1 and G2 AEs experienced during a treatment cycle increased the odds of increased self-reported patient side-effect bother by 13% (95% CrI, 1.06 to 1.21) and 35% (95% CrI, 1.19 to 1.54), respectively. Furthermore, only AEs defined as symptomatic were associated with increased side-effect bother, with asymptomatic AEs showing no association regardless of grade. Count of G2 AEs increased the odds of treatment discontinuation by 59% (95% CrI, 1.32 to 1.95), with symptomatic G2 AEs showing a stronger association (OR, 1.75; 95% CrI, 1.28 to 2.39) relative to asymptomatic G2 AEs (OR, 1.45; 95% CrI, 1.12 to 1.89). CONCLUSION Low- and moderate-grade AEs are related to increased odds of increased patient side-effect bother and treatment discontinuation, with symptomatic AEs demonstrating greater magnitude of association than asymptomatic. Our findings suggest that limiting AE capture to grade 31 misses important contributors to treatment side-effect bother and discontinuation.

Original languageEnglish (US)
Pages (from-to)266-272
Number of pages7
JournalJournal of Clinical Oncology
Issue number3
StatePublished - Jan 20 2024

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


Dive into the research topics of 'Importance of Low- and Moderate-Grade Adverse Events in Patients’ Treatment Experience and Treatment Discontinuation: An Analysis of the E1912 Trial'. Together they form a unique fingerprint.

Cite this