Journal of Clinical Oncology, 2007 ASCO Annual Meeting Proceedings (Post-Meeting Edition).
Vol 25, No 18S (June 20 Supplement), 2007: 6524
© 2007 American Society of Clinical Oncology

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Abstract

Patient-centered validation of 11 symptom indices to evaluate response to chemotherapy for advanced cancer

Evanston Northwestern Healthcare, Evanston, IL; Duke University Medical Center, Durham, NC; University of South Florida Moffitt Cancer Center, Tampa, FL; National Comprehensive Cancer Network, Jenkintown, PA; Fred Hutchinson Cancer Research Center, Seattle, WA; Northwestern Univ Med/RHLCCC, Chicago, IL

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Background: Symptom burden in advanced disease has relevance both for clinical practice and in evaluating the efficacy of new chemotherapeutic agents. This study aimed to identify patients’ highest priority symptoms for 11 advanced cancers, compare priority ratings with those obtained from clinicians, and construct brief symptom indices based on their combined input. Methods: 534 patients with advanced bladder, brain, breast, colorectal, head/neck, hepatobiliary/pancreatic, kidney, lung, lymphoma, ovarian or prostate cancer from a subset of National Comprehensive Cancer Network (NCCN) member institutions and 4 Cancer Health Alliance of Metropolitan Chicago organizations completed a survey of priority symptoms and concerns and a disease-specific FACT QOL measure. 112 physicians at NCCN institutions completed a rating of whether symptoms and concerns were considered disease- or treatment-related. Symptoms endorsed more often than chance probability were retained. Expert clinician and patient ratings were equally weighted in item selection. Responses to symptom index items drawn from the QOL questionnaires allowed for validation analyses. Results: Items comprising 2 to 3 subscales (up to 20 items in length) were retained for each of the 11 disease-specific symptom indices. Content-determined subscales consisted of symptoms and concerns that were 1) exclusively or predominantly disease-related symptoms (DRS); 2) exclusively or predominantly treatment side effects (TSE); and 3) descriptive of general function or well-being (F/WB). For example, the NCCN/FACT Breast Cancer Symptom Index (FBSI) contains 17 items: 8 DRS, 4 TSE and 5 F/WB. Data on 14 of 17 FBSI items showed good internal consistency (a=.89). Correlations between FBSI and FACT-B scores were high for physical well-being, functional well-being and breast cancer subscales (r = 0.83, 0.77, and 0.61 respectively). Correlation with emotional well-being subscale was 0.55. FBSI scores differed across PSR groups in the appropriate direction (p<0.0001). Conclusions: NCCN/FACT disease-specific questionnaires have been transformed into brief, patient-centered symptom indices that can be used as stand-alone measures in oncology research and practice.

No significant financial relationships to disclose.

Abstract presentation from the 2007 ASCO Annual Meeting