title: Measuring performance status in pediatric patients with brain tumors--experience of the HIT-GBM-C protocol.
abstract: BACKGROUND
  Measuring the quality of life or performance status in pediatric neurooncology has proven a challenge. Here, we report in a treatment protocol for pediatric patients with high-grade glioma and diffuse intrinsic pontine glioma.
  
  
  METHODS
  The Fertigkeitenskala Münster-Heidelberg (FMH) is a 56-item quantitative measure of health status. The number of yes answers is transformed to age-dependent percentiles. Physicians were also asked the patients' health status by their own judgment on a 1-5 scale: normal, mild handicap, age-normal activity severely reduced but patient not in bed, in bed, and in ICU.
  
  
  RESULTS
  Assessments were available from 50 of 97 eligible patients. For 22 patients both questionnaire and the physicians score obtained. At the beginning of the treatment, only 5 patients scored over 40 FMH%, and 4 of these survived. Of 16 patients who initially scored less than 40 FMH%, 15 died. During later assessments, most FMH measures became gradually worse. FMH scores improved in three patients. The physician's judgment was documented at diagnosis and during treatment (n = 50). Per physician, 22% of the patients were normal before chemotherapy, decreasing to 16% in the middle of the protocol. At diagnosis only 16% of patients had severely reduced activity, which increased to 30.6% in the middle of the protocol. The FMH% correlated well with the physicians' judgments (P < 0.005).
  
  
  CONCLUSIONS
  The FMH scale is easily obtained and provides a valid assessment of health status. Patients with poor performance at diagnosis had a poorer prognosis.
authors.affiliation: Division of Pediatrics, Section of Pediatric Neuro-oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. jwolff@mdanderson.org
authors.forename: Johannes E A
authors.initials: JE
authors.lastname: Wolff
authors.forename: Kamran
authors.initials: K
authors.lastname: Mohiuddin
authors.forename: Norbert
authors.initials: N
authors.lastname: Jorch
authors.forename: Norbert
authors.initials: N
authors.lastname: Graf
authors.forename: Sabine
authors.initials: S
authors.lastname: Wagner
authors.forename: Tribahwan
authors.initials: T
authors.lastname: Vats
authors.forename: Astrid
authors.initials: A
authors.lastname: Gnekow
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D001932:Brain Neoplasms / Q000503:physiopathology*; D020295:Brain Stem Neoplasms / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005910:Glioma / Q000503:physiopathology*; D006304:Health Status; D006801:Humans; D008297:Male; D011788:Quality of Life; D011795:Surveys and Questionnaires