Are PROMs sufficient to record late outcome of breast cancer patients treated with radiotherapy? A comparison between patient and clinician reported outcome through an outpatient clinic after 10years of follow up.

AIM: To investigate whether breast cancer patients' visits to an outpatient clinic for late outcome (OCLO) can be replaced by patient reported outcome measures (PROMs), by comparing late toxicity scored at the OCLO with PROMs. METHODS: All breast cancer patients treated in our institute with adjuvant radiotherapy 10-11years ago were invited to visit the OCLO, and for filling out PROM-questionnaires. Concordance rate between PROMs and OCLO-reported outcome and the percentage of patients with ≥2 degrees difference in toxicity level between patient and clinician was assessed. RESULTS: 686 of 1029 patients were still alive. 249 patients visited the OCLO, and 341 patients returned a questionnaire. At a group level, patients reported higher toxicity rates than clinicians. The mean concordance for individual patients was 58% between patient and clinician reported outcome. In 2.8%, the clinician reported ≥2 degrees higher toxicity than the patients did, whereas in 6.8% patients reported ≥2 degrees higher toxicity. CONCLUSION: PROMs do not underestimate late side-effects at a group level. In spite of the low concordance rate, PROMS can be used to identify patients who experience a heavy burden of side-effects, requiring specific attention. Therefore, patients can be spared a visit to the OCLO.

Sensitivity to spatiotemporal combined luminance and chromaticity contrast.

Contrast-detection thresholds for various combinations of chromaticity and luminance differences were obtained for spatiotemporal square-wave modulation of a yellow field. The results are expressed in terms of excitation of the Vos-Walraven R,G primaries. For every spatiotemporal frequency the thresholds can be approximated by an ellipse in the red-green plane. Large variations were found in the orientation, magnitude, and eccentricity of the discrimination ellipses. It seems that a simple threshold function appears to be sufficient to describe the experimental data. Although the eye does not perceive hue contrast for high spatial frequencies, its sensitivity is not governed mainly by summation of the red and green channels.

Influence of the target size on the deterction threshold for luminance and chromaticity contrast.

The effect of the target size on the detecton of luminance and chromaticity flicker and gratings was studied. Discrimination ellipses in a luminance-chromaticity plane were determined with square test areas subtending from 1/4 degree to 1 degree. Pure luminance modulation thresholds and pure chromaticity modualtion thresholds were obtained from square targets subtending from 1/16 degree to 2 degree. Square-wave stimuli were presented on a color television monitor; the mean color of the screen was yellow, the average retinal illuminance was 350 td. The main effect of enlarging the field size is that the threshold for any luminance-chromaticity combination decreases monotonically except when spatial frequencies are high. The summation area for detecting a fine bar pattern is at least 8 x 8 periods; the integration area for detecting flicker is more than 1 degree x 1 degree. This holds for any luminance-chromaticity mixture. For a fixed spatial or a fixed temporal frequency the change in sensitivity sometimes depends strongly on the ratio of luminance modulation to chromaticity modulation. The main conclusion of this study is that if a target is predominantly yellow the target size has similar influence on the sensitivity to both luminance and chromaticity contrast.