Prognostic Significance of Patient-Reported Outcomes in Cancer

Abstract

PURPOSE: Performance status (PS), an established prognostic surrogate of cancer survival, is a physician-synthesized metric of patient symptoms and mobility that is prone to bias and subjectivity. The National Cancer Institute (NCI) Patient-Reported Outcomes Measurement Information System–Cancer (PROMIS-Ca) Bank, a patient-centric patient-reported outcome (PRO) evaluation of physical function (PF), fatigue, depression, anxiety, and pain, shares subject matter with PS and, therefore, may also be prognostic while eliminating physician interpretation. METHODS: Patients at Huntsman Cancer Institute were assessed using the NCI PROMIS-Ca Bank. Using tablets at routine office visits, PF, fatigue, depression, anxiety, and pain scores were collected from patients with advanced melanoma, non–small-cell lung cancer, colorectal cancer, and breast cancer. A PRO score collected at a single time point within 6 months of metastatic diagnosis for each patient was merged with curated clinical outcome data. The association of PROs, overall survival (OS), and hospitalization-free survival (HFS) were assessed in multivariable analysis that included sex and cancer type. RESULTS: Two hundred eighty-two complete sets of patient data were available for analysis. All 5 PRO domains were strongly prognostic of OS and HFS. While the PRO domains were interrelated with moderate to strong correlations (0.40-0.79), multivariable regression suggested that PF was most strongly associated with the clinical outcomes of OS ( P < .001) and HFS ( P < .001). CONCLUSION: NCI PROMIS-Ca PROs may be prognostic of both cancer survival and likelihood of hospitalization. Future prospective studies are needed for all major prognostic factors to fully understand the independent prognostic value of PROs.

Patient‐reported outcomes as a prognostic marker of survival in patients with advanced nonsmall cell lung cancer treated with immunotherapy

“…ECOG-PS is a widely used physician-synthesised assessment of patient symptoms and mobility, and LIPI is an emerging prediction tool reportedly specific for ICIs. [2][3][4]9 Importantly, the present study identi-…”

“…[2][3][4] Patient-reported outcomes (PROs) are commonly used as a secondary outcome in clinical trials, and evidence indicates they are prognostic for a wide range of conventional anticancer treatments. [5][6][7][8][9] There is also emerging evidence that routine collection of PROs, a relatively inexpensive intervention, can enhance quality of life, patient satisfaction and survival. 5,6 To date, however, there has been minimal research on the prognostic significance of PROs for ICI therapy.…”

A systematic review of rehabilitation and exercise recommendations in oncology guidelines

“…A better understanding of the definition of function and improved accuracy of functional assessment can be enhanced by rehabilitation professionals, but more so, can establish the much needed linkage so that providers optimize the use of PROs and functional assessment to enable referrals for services that actually enhance function. 172 Administrative leaders must also understand the existing oncology guidelines, their relevance to comprehensive oncology care, and should seek to remove administrative barriers so that collaborative care models can be developed. Guideline implementation, in general, is challenging and often limited by the dichotomy of real-world clinical practices and theoretical synthesis of optimal evidence-based care.…”

Beyond Performance Status

“…There are other problems too; the score is (predominantly) physician assessed and therefore subjective and prone to bias [ 18 ]. It may vary according to the quality of history taken/provided.…”