患者报告的结局可改善功能状态评估：一项试点研究。
Patient reported outcomes can improve performance status assessment: a pilot study.
作者信息
Broderick Joan E, May Marcella, Schwartz Joseph E, Li Ming, Mejia Aaron, Nocera Luciano, Kolatkar Anand, Ueno Naoto T, Yennu Sriram, Lee Jerry S H, Hanlon Sean E, Cozzens Philips Frankie A, Shahabi Cyrus, Kuhn Peter, Nieva Jorge
机构信息
Dornsife Center for Self-Report Science, University of Southern California, 635 Downey Way, Los Angeles, CA, 90089-3332, USA.
Department of Psychiatry, Stony Brook University, Stony Brook, USA.
出版信息
J Patient Rep Outcomes. 2019 Jul 16;3(1):41. doi: 10.1186/s41687-019-0136-z.
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.
背景
患者表现状态在肿瘤学中常规用于评估身体功能，这是临床治疗决策和临床试验资格的一个重要因素。然而，表现状态评分的有效性和可靠性数据并不理想。本研究招募了即将开始接受致吐性姑息或辅助化疗以治疗实体瘤的肿瘤患者。我们采用活动记录仪作为身体活动水平的金标准。检查了活动记录仪与肿瘤学家和患者的表现状态评分之间的对应关系，并与活动记录仪和几个患者报告结局（PROs）的对应关系进行了比较。该研究旨在确定测量方法的可行性以及PROs是否能提高表现状态评估的准确性。
方法
肿瘤学家和患者在第1次就诊时进行表现状态评分。患者佩戴活动记录仪，并在智能手机应用程序上每周输入PROs。分析第1次就诊后第1 - 14天的数据。进行病历审查以列出第1 - 150天所有意外医疗事件。
结果
肿瘤学家和患者的表现状态评分均不能预测每小时步数（活动记录仪测量）。PROMIS®身体功能PRO（第1、7、14天的平均值）在高（男性）和中（女性）水平与每小时步数相关；PROMIS®疲劳PRO预测男性的步数，但不能预测女性的步数。57%的患者发生了意外医疗事件。仅女性患者的体重可预测事件；肿瘤学家和患者的表现状态评分、每小时步数及其他PROs均不能预测。
结论
PROMIS®身体功能和疲劳PROs与每小时步数显示出良好的对应关系，使其成为肿瘤学家改善表现状态评估的简便、有用工具，尤其是对男性患者。女性患者每小时步数低于男性，且预测指标之间的相关性较低，这表明需要进一步开展工作以改善女性患者的表现状态评估。在评估当前身体功能和疲劳PROs的同时评估病前久坐行为，可能有助于更有效地确定疾病相关的活动水平和表现状态。
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