Development of the Pediatric Neuro-Oncology Rating of Treatment Intensity (PNORTI)

Abstract

Measures of treatment intensity for childhood cancer are needed in research in order to control for variability in treatments. Existing measures of treatment intensity for childhood cancers do not reflect the complexities of treatment protocols for central nervous system (CNS) tumors. This paper describes the development of the Pediatric Neuro-Oncology Rating of Treatment Intensity (PNORTI). PNORTI development occurred in three phases. Phase 1: five experts in pediatric neuro-oncology created a 5-point scale of treatment intensity and 42 pediatric neuro-oncology providers completed a three-part online questionnaire to evaluate the classification system and apply the rating system to 16 sample patients. Validity was determined by respondents classifying therapy modalities into intensity levels. Inter-rater reliability was calculated from ratings of the 16 sample patients. Phase 2: three experts revised the PNORTI based on survey results and 18 pediatric neuro-oncology providers evaluated the classification system. Phase 3: ten experts in pediatric neuro-oncology refined and finalized the PNORTI and rated 10 sample patients using the PNORTI. Agreement between median ratings of the survey respondents and criterion raters for chemotherapy intensity (r's = .82 and 1.0) and overall treatment intensity level (r's = .91 and .94) were high in Phases 1 and 2. Inter-rater reliability also was very high when using the PNORTI to classify the 16 sample patients in Phase 1 (median agreement of r = .93 and rICC = .99) and the 10 sample patients in Phase 3 (median agreement of r = .92 and rICC = .98). The PNORTI is a valid and reliable method for classifying the intensity of different treatment modalities used in pediatric neuro-oncology.

A prospective study of social competence in survivors of pediatric brain and solid tumors

“…Post hoc analyses were conducted for survivors of pediatric brain tumors to contextualize the unexpected, crossed interaction between baseline irony and empathy and social skills and peer relationships over time. We examined whether the crossed interactions varied as a function of time‐since‐diagnosis, the intensity of treatment using the Pediatric Neuro‐Oncology Rating of Treatment Intensity (PNORTI) 21 and treatment risk factors using the Neurological Predictor Scale (NPS) 22 . Results showed that the three‐way interaction between time, irony and empathy, and time‐since‐diagnosis was significant ( b = −0.04, se = 0.01, t = − 2.76, P = 0.011), with simple slopes demonstrating an increase in the crossed interaction between time and irony and empathy with an increase in time‐since‐diagnosis.…”

A Prospective Study of Social Competence in Survivors of Pediatric Brain Tumors

“…Post hoc analyses were conducted for the BT group to help contextualize the unexpected, crossed interaction between baseline Irony & Empathy and social skills and peer relationships over time. We examined whether the crossed interactions varied as a function of time-since-diagnosis, the intensity of treatment using the Pediatric Neuro-Oncology Rating of Treatment Intensity (PNORTI) [20] and treatment risk factors using the Neurological Predictor Scale (NPS) [21]. Results showed that the 3-way interaction between time, Irony & Empathy and time-since-diagnosis was significant (b = -0.04, se = 0.01, t = -2.76, p = .011), with simple slopes demonstrating an increase in the crossed interaction between time and Irony & Empathy with an increase in time-since-diagnosis.…”

Nutritional Status in Childhood Cancer Survivors with Solid Tumors: A Longitudinal Study

“…Data was collected on the following characteristics: demographic (age at diagnosis, gender, race, ethnicity), clinical (type of cancer and Intensity of Treatment Rating scale (ITR-3) 28 and treatment (RDN NA). Treatment intensity was assigned using ITR-3, a validated, standardized rating scale taking into account types of treatment patient will receive based on diagnosis.…”

“…The ITR scale has four levels of treatment intensity: 1 (least), 2 (moderately), 3 (very) and 4 (most). 28 Diagnoses were recoded into four categories based on tumor type and treatment: retinoblastoma, neuroblastoma, renal/hepatic tumors, sarcoma/other solid tumors. Age group at diagnosis were < 2 years and [?]…”

“…The percentage of patients who were overweight doubled from diagnosis compared to their initial CSP visit, 6.9% and 15.2%, respectively. An increase was observed in patients' BMI (>20 years age) at EOT to the initial CSP visit, 22.8 to 25.3 (range [20][21][22][23][24][25][26][27][28][29][30][31][32][33].…”