Perini Family Survivor's Center, Dana-Farber Cancer Institute, Boston, Massachusetts.
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Cancer. 2021 Oct 1;127(19):3691-3697. doi: 10.1002/cncr.33683. Epub 2021 Jul 1.
The objective of this study was to validate the Patient-Reported Outcomes Measurement Information System Short Form v1.0-Anxiety 8a (PROMIS-A-SF) against a structured diagnostic interview in order to determine its accuracy and the most appropriate cutoff score for identifying anxiety disorders in young adult cancer survivors (YACSs).
Two hundred forty-nine YACSs aged 18 to 40 years (50% male) completed the PROMIS-A-SF and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID). The SCID was used to determine whether participants met the criteria for an anxiety diagnosis. Receiving operator characteristic analyses were performed to determine the concordance of the PROMIS-A-SF and the SCID as well as cutoff scores with sensitivity (≥0.85) and specificity (≥0.75) appropriate for an anxiety screening measure.
The PROMIS-A-SF was determined to have good overall discrimination in comparison with the SCID (area under the curve, 0.84). A PROMIS-A-SF t-score cutoff ≥ 53.2 (total predictive value, 67.9%) came closest to meeting the study criteria with a sensitivity of 88%, but the specificity was only 65%. In a hypothetical screening example, this cutoff led to moderate levels of missed cases (14%) and a significant proportion of clinical referrals that were unnecessary by SCID criteria (35%). Of the survivors referred for services according to these criteria, less than one-third (29%) would have a SCID anxiety diagnosis.
The PROMIS-A-SF demonstrated moderately strong concordance with anxiety disorders measured by the SCID, but cutoff scores did not meet study criteria for clinical screening. Although it may not be appropriate as a standalone screener, the PROMIS-A-SF may be useful for assessing anxiety in YACSs when it is incorporated into clinical practice or when it is combined with other measures.
本研究旨在通过结构诊断访谈验证患者报告结局测量信息系统简表 1.0 版焦虑量表（PROMIS-A-SF），以确定其识别青年癌症幸存者（YACS）焦虑障碍的准确性和最佳截断分数。
249 名年龄在 18 至 40 岁之间（50%为男性）的 YACS 完成了 PROMIS-A-SF 和精神障碍诊断与统计手册第四版（DSM-IV）结构临床访谈（SCID）。SCID 用于确定参与者是否符合焦虑症诊断标准。进行接收者操作特征分析，以确定 PROMIS-A-SF 与 SCID 以及截断分数的一致性，同时具有适当的敏感性（≥0.85）和特异性（≥0.75），以作为焦虑筛查措施。
与 SCID 相比，PROMIS-A-SF 总体具有良好的区分度（曲线下面积为 0.84）。PROMIS-A-SF t 评分截断值≥53.2（总预测值为 67.9%）最接近满足研究标准，敏感性为 88%，但特异性仅为 65%。在假设的筛查示例中，该截断值导致错过病例（14%）的比例适中，且根据 SCID 标准，不必要的临床转诊比例显著（35%）。根据这些标准转诊服务的幸存者中，不到三分之一（29%）将被 SCID 诊断为焦虑症。
PROMIS-A-SF 与 SCID 测量的焦虑症具有中等强度的一致性，但截断分数不符合研究的临床筛查标准。尽管它可能不适合作为独立筛查工具，但当它纳入临床实践或与其他措施结合使用时，PROMIS-A-SF 可能对评估 YACS 的焦虑症有用。
