title: Longitudinal patterns of cancer patient reported outcomes in end of life care predict survival.
abstract: OBJECTIVE
  Patients with advanced cancer typically demonstrate sharp deterioration in physical function and psychological status during the last months of life. This study evaluates the relationship between survival in patients with advanced cancer and longitudinal assessment of anxiety, depression, fatigue, pain interference, and/or physical function using the US National Institute of Health Patient Reported Outcomes Information System.
  
  
  METHODS
  Mixed-effects models were used to evaluate patient-reported outcome trajectories over time among patients with advanced loco-regional or metastatic cancer receiving care in a hospital-based palliative care clinic. Cox regression analysis was used to assess the statistical significance of differences in the probability of survival associated with patient-reported outcome scores.
  
  
  RESULTS
  A total of 472 patients completed 1992 assessments during the 18-month study period. Longitudinal scores for fatigue, pain interference, and physical function demonstrated statistically significant non-linear trajectories. Scores for depression, fatigue, pain interference, and physical function were highly statistically significant predictors of survival (p < 0.01). Clinically meaningful differences in the probability of survival were demonstrated between patients with scores at the 25th vs. 75th percentiles, with absolute differences in survival at 6 and 12 months after assessment from 10 to 18 percentage points.
  
  
  CONCLUSIONS
  Patient-reported outcomes can be used to reliably estimate where patients are along the trajectory of deteriorating health status leading toward the end of life, and for identifying patients with declining symptoms in need of referral to palliative care or more aggressive symptom management.
authors.affiliation: Department of Public Health Sciences, University of Virginia School of Medicine, P.O. Box 800717, Charlottesville, VA, 22908-0821, USA. gstukenborg@virginia.edu.
authors.forename: George J
authors.initials: GJ
authors.lastname: Stukenborg
authors.affiliation: Department of Medicine, University of Virginia School of Medicine, P.O. Box 800717, Charlottesville, VA, 22908-0821, USA.
authors.forename: Leslie J
authors.initials: LJ
authors.lastname: Blackhall
authors.affiliation: Department of Public Health Sciences, University of Virginia School of Medicine, P.O. Box 800717, Charlottesville, VA, 22908-0821, USA.
authors.forename: James H
authors.initials: JH
authors.lastname: Harrison
authors.affiliation: Department of Medicine, University of Virginia School of Medicine, P.O. Box 800717, Charlottesville, VA, 22908-0821, USA.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Dillon
authors.affiliation: Department of Radiation Oncology, University of Virginia School of Medicine, P.O. Box 800717, Charlottesville, VA, 22908-0821, USA.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Read
mesh_terms: D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality* / Q000523:psychology*; D010166:Palliative Care; D063868:Patient Outcome Assessment; D011788:Quality of Life / Q000523:psychology*; D016019:Survival Analysis; D013727:Terminal Care / Q000523:psychology*
keywords: Cancer; EHR; PROMIS