EORTC study emphasizes value of patient-reported symptoms

Symptoms reported by patients participating in cancer clinical trials are assessed by their doctors using a standardized scoring system. These scores help the physicians choose the best treatment for the patients and can help predict overall survival.

There is, however, growing recognition for the use of patient-reported assessments of adverse events to complement doctor-reported assessments, and the EORTC QLQ-C30 is just such a quality of life questionnaire that enables cancer patients to assess symptoms related to their quality of life. An EORTC analysis was already instrumental in showing that such an assessment can be successfully used to help predict survival. However the question remained whether there would be added value in using patient assessment alongside physician-reported assessment to improve estimates of overall survival in cancer patients.

An EORTC analysis has now shown that patients provide information that complements that of their doctors in predicting overall survival. The research, conducted by an international group of scientists engaged in quality of life research, included assessments from 2279 cancer patients selected from 14 different EORTC trials. In each trial the physician’s as well as the patient’s assessments were reported when the patient entered the trial.

Chantal Quinten, lead author of this study, says “It is accepted that well know established socio-demographic variables like age and gender and clinical variables such as metastasis and performance status allow doctors to have a better idea about the survival prognosis of patients. Also, the symptom burden recorded by the doctors can contribute to accuracy in survival prediction. Analyses like this raise awareness among doctors that symptom assessment by patients provides valuable information, independently or complementary, for predicting survival of cancer patients, since patients themselves rate their own symptom burden caused by their disease or treatment differently than their doctors. Quality of life researchers merely want to demonstrate that patient symptom assessment broadens the spectrum of the patient’s symptom burden, symptoms that are sometimes not objectively known to the doctor.”

The researchers focused on six cancer symptoms: pain, fatigue, vomiting, nausea, diarrhea, and con­stipation, and found that for each of these symptoms the patient-reported and physician-reported assessments indepen­dently and positively affected the accuracy of the prognosis for survival.

Corneel Coens, biostatistician for this study, says, “From a methodological point of view, this was a complicated project, because we were combining data from diverse studies that were designed to evaluate treatments and not necessarily quality of life. The data set may not be representative of a ‘typical’ cancer population, if such a population even exists, but there is no denying the added value gained by adding the patient perspective to the clinical outcomes.”

The EORTC analysis concludes that patient-reported symptoms are a valuable assessment outcome that can be combined with physician-reported symptoms in models predicting overall survival. The EORTC study was orchestrated by the EORTC Quality of Life Department under the PROBE project and provides further evidence supporting the systematic review by Gotay et al which demonstrated the added value of QOL assessment which cannot be underestimated. Ideally QOL should be routinely assessed in all patients entered in clinical trials.

This analysis was featured as one of “87 studies having the greatest potential impact on patients’ lives” in ASCO’s Annual Report on Progress Against 2012.

John Bean
EORTC, Medical Science Writer


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