title: Avoiding harmful palliative chemotherapy treatment in the end of life: development of a brief patient-completed questionnaire for routine assessment of performance status.
abstract: BACKGROUND
  Earlier studies have shown that up to 43% of patients with incurable cancer are treated with palliative chemotherapy in the last month of their lives. Although pretreatment blood tests are acceptable, the patient's general condition may not permit further palliative chemotherapy treatment (PCT). Presently, there is no patient self-assessment tool available to monitor performance status during PCT.
  
  
  OBJECTIVE
  To describe the development process of the Performance Status in Palliative Chemotherapy (PSPC) questionnaire, and the testing of its psychometric properties.
  
  
  METHODS
  The questionnaire was developed by the authors based on the Eastern Cooperative Oncology Group Performance Status Rating (ECOG PSR) scale as well as their clinical experience with PCT. Adult patients who were diagnosed with epithelial cancers (n = 118) were enrolled to test the PSPC questionnaire for reliability, sensitivity for change, and validity.
  
  
  RESULTS
  After stepwise modifications of the PSPC questionnaire, psychometric tests revealed acceptable values for reliability (via a test-retest method), sensitivity for change (via a comparison of patients with progressive disease over time), and validity (via a comparison of the PSPC vs the Edmonton Symptom Assessment System [ESAS]).
  
  
  CONCLUSIONS
  At this stage of questionnaire development, we are unable to conclude whether the PSPC is superior to the conventional ECOG PSR in the evaluation of performance status and the prediction of chemotherapy response.
  
  
  CONCLUSIONS
  Psychometric tests suggest that the PSPC questionnaire may be a useful patient-completed tool in the late stages of cancer disease to routinely monitor performance status in palliative chemotherapy treatments so as to minimize the risk of inflicting more harm than good.
authors.affiliation: Department of Radiation Sciences, Umeå University, Sweden. ulla.nappa@jll.se
authors.forename: Ulla
authors.initials: U
authors.lastname: Näppä
authors.forename: Olav
authors.initials: O
authors.lastname: Lindqvist
authors.forename: Bertil
authors.initials: B
authors.lastname: Axelsson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods* / Q000523:psychology*; D011594:Psychometrics; D011788:Quality of Life; D015203:Reproducibility of Results; D012647:Self-Assessment; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods*
chemical_list: D000970:Antineoplastic Agents