Quality of Life Department, European Organization for Research and Treatment of Cancer Headquarters, Brussels, Belgium.
J Natl Cancer Inst. 2011 Dec 21;103(24):1851-8. doi: 10.1093/jnci/djr485. Epub 2011 Dec 7.
The National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI-CTCAE) reporting system is widely used by clinicians to measure patient symptoms in clinical trials. The European Organization for Research and Treatment of Cancer's Quality of Life core questionnaire (EORTC QLQ-C30) enables cancer patients to rate their symptoms related to their quality of life. We examined the extent to which patient and clinician symptom scoring and their agreement could contribute to the estimation of overall survival among cancer patients.
We analyzed baseline data regarding six cancer symptoms (pain, fatigue, vomiting, nausea, diarrhea, and constipation) from a total of 2279 cancer patients from 14 closed EORTC randomized controlled trials. In each trial that was selected for retrospective pooled analysis, both clinician and patient symptom scoring were reported simultaneously at study entry. We assessed the extent of agreement between clinician vs patient symptom scoring using the Spearman and kappa correlation statistics. After adjusting for age, sex, performance status, cancer severity, and cancer site, we used Harrell concordance index (C-index) to compare the potential for clinician-reported and/or patient-reported symptom scores to improve the accuracy of Cox models to predict overall survival. All P values are from two-sided tests.
Patient-reported scores for some symptoms, particularly fatigue, did differ from clinician-reported scores. For each of the six symptoms that we assessed at baseline, both clinician and patient scorings contributed independently and positively to the predictive accuracy of survival prognostication. Cox models of overall survival that considered both patient and clinician scores gained more predictive accuracy than models that considered clinician scores alone for each of four symptoms: fatigue (C-index = .67 with both patient and clinician data vs C-index = .63 with clinician data only; P <.001), vomiting (C-index = .64 vs .62; P = .01), nausea (C-index = .65 vs .62; P < .001), and constipation (C-index = .62 vs .61; P = .01).
Patients provide a subjective measure of symptom severity that complements clinician scoring in predicting overall survival.
美国国立癌症研究所的不良事件通用术语标准（NCI-CTCAE）报告系统被临床医生广泛用于临床试验中测量患者症状。欧洲癌症研究与治疗组织的生活质量核心问卷（EORTC QLQ-C30）使癌症患者能够对与生活质量相关的症状进行评分。我们研究了患者和临床医生症状评分及其一致性在多大程度上有助于估计癌症患者的总生存率。
我们分析了来自 14 项 EORTC 随机对照试验的 2279 例癌症患者的 6 种癌症症状（疼痛、疲劳、呕吐、恶心、腹泻和便秘）的基线数据。在每个被选择进行回顾性汇总分析的试验中，同时报告了临床医生和患者的症状评分。我们使用 Spearman 和 kappa 相关统计来评估临床医生与患者症状评分之间的一致性程度。在调整年龄、性别、表现状态、癌症严重程度和癌症部位后，我们使用 Harrell 一致性指数（C 指数）来比较临床医生报告和/或患者报告的症状评分对改善 Cox 模型预测总生存率的准确性的潜力。所有 P 值均来自双侧检验。
患者对某些症状（尤其是疲劳）的评分与临床医生的评分不同。在我们评估的 6 种基线症状中，临床医生和患者的评分都独立且积极地提高了生存预后预测的准确性。对于我们评估的四个症状（疲劳、呕吐、恶心和便秘），考虑患者和临床医生评分的 Cox 总体生存模型比仅考虑临床医生评分的模型具有更高的预测准确性（C 指数：疲劳为 0.67（同时考虑患者和临床医生数据）与 0.63（仅考虑临床医生数据）；P<0.001）；呕吐为 0.64（同时考虑患者和临床医生数据）与 0.62（仅考虑临床医生数据）；P=0.01）；恶心为 0.65（同时考虑患者和临床医生数据）与 0.62（仅考虑临床医生数据）；P<0.001）；便秘为 0.62（同时考虑患者和临床医生数据）与 0.61（仅考虑临床医生数据）；P=0.01）。
患者提供了症状严重程度的主观衡量标准，与临床医生评分一起预测总生存率。
