The level of association between functional performance status measures and patient-reported outcomes in cancer patients: a systematic review

Abstract

Purpose The process of assessing patient symptoms and functionality using patient-reported outcomes (PROs) and functional performance status (FPS) is an essential aspect of patient-centered oncology research and care. However, PRO and FPS measures are often employed separately or inconsistently combined. Thus, the purpose of this study was to conduct a systematic review of the level of association between PRO and FPS measures to determine their differential or combined utility. Methods A systematic search was conducted using five databases (1966 to February 2014) to identify studies that described an association between PRO and FPS. Studies were excluded if they were non-cancer specific, did not include adults aged 18 or older, or were review articles. Publications were selected for review by consensus among two authors, with a third author arbitrating as needed. Results A total of 18 studies met inclusion criteria. FPS was primarily assessed by clinicians using the ECOG Performance Status or Karnofsky Performance Status measures. PROs were captured using a variety of measures, with numerous domains assessed (e.g., pain, fatigue, and general health status). Concordance between PROs and FPS measures was widely variable, falling in the low to moderate range (0.09–0.72). Conclusions Despite consistency in the method of capture of PROs or FPS, domain capture varied considerably across reviewed studies. Irrespective of the method of capturing PROs or FPS, the quantified level of association between these two areas was moderate at best, providing evidence that FPS and PRO assessments offer unique information to assist clinicians in their decision-making.

Impact of cutaneous adverse events on the quality of life in patients receiving anticancer agents: Results from an observational, cross-sectional study

“…In our study, we assessed patient overall QoL using FACT-G questionnaire, as it is an effective scale that has been validated for use with cancer patients and it is one of the most widely used measures of cancer-speci c health-related QoL. Patient perceiving of QoL was assessed using PRO measures related to cutaneous adverse events, such as DLQI, Skindex-16, and FACT-EGFRI-18 [16][17][18][19][20][21][22][23][24][25][26][27][28][29].…”

“…The main study variable was the impact of cutaneous adverse effects of anticancer drugs on (QoL). Different QoL questionnaires were selected according to previous clinical experience [16][17][18][19][20][21][22][23][24][25][26][27][28].…”

Toward a National Initiative in Cancer Rehabilitation: Recommendations From a Subject Matter Expert Group

“…Ideally, the application of objective measures alongside PROMs provides broader perspective on total functioning of the individual. 78 …”

“…90 The consistent use of valid, reliable, performance measures is rare in the oncologic clinical setting outside of rudimentary scales, such as The Eastern Cooperative Oncology Group or the Karnofsky Performance Scale, both of which fall short of portraying an individual's discrete functional capabilities. 78,91 The Karnofsky Performance Scale is a predictor of overall survival, but it is inadequately sensitive to identify clinically meaningful improvement in function over time. Recent evidence highlights the potential for the geriatric assessment, as described by Elsawy and Higgins, 92 to be a more sensitive screening tool for the identification of treatment-related toxicities.…”

Frailty: the missing piece of the pre- hematopoietic cell transplantation assessment?

“…[36][37][38] There is only moderate correlation between physician and patient reported performance status, with patients scoring themselves more pessimistically than their physicians. [39][40][41] In cancer patients, discordance between physician assessed and patient assessed performance status is associated with worse survival. 42,43 These factors decrease the sensitivity of performance status scores in predicting adverse health outcomes.…”