Patient reported outcomes can improve performance status assessment: a pilot study

Abstract

Background Patient performance status is routinely used in oncology to estimate physical functioning, an important factor in clinical treatment decisions and eligibility for clinical trials. However, validity and reliability data for ratings of performance status have not been optimal. This study recruited oncology patients who were about to begin emetogenic palliative or adjuvant chemotherapy for treatment of solid tumors. We employed actigraphy as the gold standard for physical activity level. Correspondences between actigraphy and oncologists’ and patients’ ratings of performance status were examined and compared with the correspondences of actigraphy and several patient reported outcomes (PROs). The study was designed to determine feasibility of the measurement approaches and if PROs can improve the accuracy of assessment of performance status. Methods Oncologists and patients made performance status ratings at visit 1. Patients wore an actigraph and entered weekly PROs on a smartphone app. Data for days 1–14 after visit 1 were analyzed. Chart reviews were conducted to tabulate all unexpected medical events across days 1–150. Results Neither oncologist nor patient ratings of performance status predicted steps/hour (actigraphy). The PROMIS® Physical Function PRO (average of Days 1, 7, 14) was associated with steps/hour at high (for men) and moderate (for women) levels; the PROMIS® Fatigue PRO predicted steps for men, but not for women. Unexpected medical events occurred in 57% of patients. Only body weight in female patients predicted events; oncologist and patient performance status ratings, steps/hour, and other PROs did not. Conclusions PROMIS® Physical Function and Fatigue PROs show good correspondence with steps/hour making them easy, useful tools for oncologists to improve their assessment of performance status, especially for male patients. Female patients had lower levels of steps/hour than males and lower correlations among the predictors, suggesting the need for further work to improve performance status assessment in women. Assessment of pre-morbid sedentary behavior alongside current Physical Functioning and Fatigue PROs may allow for a more valid determination of disease-related activity level and performance status.

Inter-rater reliability in performance status assessment between clinicians and patients: a systematic review and meta-analysis

“…Five studies calculated concordance statistics for both KPS and ECOG. Two studies (Conill et al 21 and de Borja et al 25) reported higher inter-rater agreement for KPS, and three studies (Taylor et al 22; Schnadig et al 27; Collins et al 34) reported similarly for ECOG.…”

“…Thirty-two articles were identified for inclusion in level 2 screening, after which 16 articles underwent data extraction. Ultimately, 14 articles21–34 were included in our review (figure 1).…”

“…Given that seven (Schnadig et al 27; Lee et al 28; Basch et al 29; Malalasekera et al 31; Leal et al 32; Popovic et al 33; Collins et al 34) of fourteen studies included in the narrative synthesis reported fair inter-rater concordance of performance status tools, it may be difficult to interchange clinician performance status scores for patient self-reported scores into prognostic modelling developed originally with clinician scores. Furthermore, inter-rater disagreement between patients and clinicians is greater than disagreement between healthcare professionals, and thereby a step backwards when finding a tool with high concordance 3…”

Web-Based Patient Self-Reported Outcome After Radiotherapy in Adolescents and Young Adults With Cancer: Survey on Acceptance of Digital Tools

“…Convincing studies were performed by Basch et al [ 8 ] and Denis et al [ 9 ], which suggest that regular contact between patient and HCP via eHealth tools also improves overall survival. Furthermore, Broderick et al [ 10 ] reported that the performance status assessment can be improved before initiation of oncologic treatment by PRO. In the literature review by Anatchkova et al [ 11 ] regarding PRO use, it became apparent that PRO is still not commonly used in clinical practice.…”

Pediatric lymphoma patients in Malawi present with poor health-related quality of life at diagnosis, and improve throughout treatment and follow-up across all Pediatric PROMIS-25 domains.

“…2,22,45,46,48 Further, emerging data from HICs suggest PROs offer superior assessment of performance status when compared to traditional physician-reported measures. 49 We observed significantly increased mortality risk and worse survival in our cohort among patients with physician-reported LPS [?] 70 and patient-reported Pain Intensity of 10 at diagnosis.…”