title: Patient-reported outcomes and survivorship in radiation oncology: overcoming the cons.
abstract: OBJECTIVE
  Although patient-reported outcomes (PROs) have become a key component of clinical oncology trials, many challenges exist regarding their optimal application. The goal of this article is to methodically review these barriers and suggest strategies to overcome them. This review will primarily focus on radiation oncology examples, will address issues regarding the "why, how, and what" of PROs, and will provide strategies for difficult problems such as methods for reducing missing data. This review will also address cancer survivorship because it closely relates to PROs.
  
  
  METHODS
  Key articles focusing on PROs, quality of life, and survivorship issues in oncology trials are highlighted, with an emphasis on radiation oncology clinical trials. Publications and Web sites of various governmental and regulatory agencies are also reviewed.
  
  
  RESULTS
  The study of PROs in clinical oncology trials has become well established. There are guidelines provided by organizations such as the US Food and Drug Administration that clearly indicate the importance of and methodology for studying PROs. Clinical trials in oncology have repeatedly demonstrated the value of studying PROs and suggested ways to overcome some of the key challenges. The Radiation Therapy Oncology Group (RTOG) has led some of these efforts, and their contributions are highlighted. The current state of cancer survivorship guidelines is also discussed.
  
  
  CONCLUSIONS
  The study of PROs presents significant benefits in understanding and treating toxicities and enhancing quality of life; however, challenges remain. Strategies are presented to overcome these hurdles, which will ultimately improve cancer survivorship.
authors.affiliation: Farzan Siddiqui and Benjamin Movsas, Henry Ford Health System, Detroit, MI; Arthur K. Liu, University of Colorado, Aurora, CO; and Deborah Watkins-Bruner, Emory University, Atlanta, GA.
authors.forename: Farzan
authors.initials: F
authors.lastname: Siddiqui
authors.affiliation: Farzan Siddiqui and Benjamin Movsas, Henry Ford Health System, Detroit, MI; Arthur K. Liu, University of Colorado, Aurora, CO; and Deborah Watkins-Bruner, Emory University, Atlanta, GA.
authors.forename: Arthur K
authors.initials: AK
authors.lastname: Liu
authors.affiliation: Farzan Siddiqui and Benjamin Movsas, Henry Ford Health System, Detroit, MI; Arthur K. Liu, University of Colorado, Aurora, CO; and Deborah Watkins-Bruner, Emory University, Atlanta, GA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Watkins-Bruner
authors.affiliation: Farzan Siddiqui and Benjamin Movsas, Henry Ford Health System, Detroit, MI; Arthur K. Liu, University of Colorado, Aurora, CO; and Deborah Watkins-Bruner, Emory University, Atlanta, GA. bmovsas1@hfhs.org.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Movsas
mesh_terms: D006801:Humans; D009369:Neoplasms / Q000523:psychology / Q000532:radiotherapy*; D018787:Radiation Oncology / Q000379:methods*; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D057566:Self Report; D015996:Survival Rate; D016896:Treatment Outcome
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