title: Patient self-reports of symptoms and clinician ratings as predictors of overall cancer survival.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  Patients provide a subjective measure of symptom severity that complements clinician scoring in predicting overall survival.
authors.affiliation: Quality of Life Department, European Organization for Research and Treatment of Cancer Headquarters, Brussels, Belgium. chantal.quinten@eortc.be
authors.forename: Chantal
authors.initials: C
authors.lastname: Quinten
authors.forename: John
authors.initials: J
authors.lastname: Maringwa
authors.forename: Carolyn C
authors.initials: CC
authors.lastname: Gotay
authors.forename: Francesca
authors.initials: F
authors.lastname: Martinelli
authors.forename: Corneel
authors.initials: C
authors.lastname: Coens
authors.forename: Bryce B
authors.initials: BB
authors.lastname: Reeve
authors.forename: Henning
authors.initials: H
authors.lastname: Flechtner
authors.forename: Eva
authors.initials: E
authors.lastname: Greimel
authors.forename: Madeleine
authors.initials: M
authors.lastname: King
authors.forename: David
authors.initials: D
authors.lastname: Osoba
authors.forename: Charles
authors.initials: C
authors.lastname: Cleeland
authors.forename: Jolie
authors.initials: J
authors.lastname: Ringash
authors.forename: Joseph
authors.initials: J
authors.lastname: Schmucker-Von Koch
authors.forename: Martin J B
authors.initials: MJ
authors.lastname: Taphoorn
authors.forename: Joachim
authors.initials: J
authors.lastname: Weis
authors.forename: Andrew
authors.initials: A
authors.lastname: Bottomley
mesh_terms: D000328:Adult; D000368:Aged; D002986:Clinical Trials as Topic; D015986:Confounding Factors, Epidemiologic; D003248:Constipation / Q000209:etiology; D003967:Diarrhea / Q000209:etiology; D005060:Europe / Q000453:epidemiology; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D009369:Neoplasms / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D010146:Pain / Q000209:etiology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D057566:Self Report; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013534:Survival; D016019:Survival Analysis; D009626:Terminology as Topic; D014481:United States / Q000453:epidemiology; D014839:Vomiting / Q000209:etiology