• Chantal Quinten, John Maringwa, Carolyn C Gotay, Francesca Martinelli, Corneel Coens, Bryce B Reeve, Henning Flechtner, Eva Greimel, Madeleine King, David Osoba, Charles Cleeland, Jolie Ringash, Joseph Schmucker-Von Koch, Martin J B Taphoorn, Joachim Weis, and Andrew Bottomley.
• Quality of Life Department, European Organization for Research and Treatment of Cancer Headquarters, Brussels, Belgium. chantal.quinten@eortc.be
• J. Natl. Cancer Inst. 2011 Dec 21;103(24):1851-8.

BackgroundThe National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI-CTCAE) reporting system is widely used by clinicians to measure patient symptoms in clinical trials. The European Organization for Research and Treatment of Cancer's Quality of Life core questionnaire (EORTC QLQ-C30) enables cancer patients to rate their symptoms related to their quality of life. We examined the extent to which patient and clinician symptom scoring and their agreement could contribute to the estimation of overall survival among cancer patients.MethodsWe analyzed baseline data regarding six cancer symptoms (pain, fatigue, vomiting, nausea, diarrhea, and constipation) from a total of 2279 cancer patients from 14 closed EORTC randomized controlled trials. In each trial that was selected for retrospective pooled analysis, both clinician and patient symptom scoring were reported simultaneously at study entry. We assessed the extent of agreement between clinician vs patient symptom scoring using the Spearman and kappa correlation statistics. After adjusting for age, sex, performance status, cancer severity, and cancer site, we used Harrell concordance index (C-index) to compare the potential for clinician-reported and/or patient-reported symptom scores to improve the accuracy of Cox models to predict overall survival. All P values are from two-sided tests.ResultsPatient-reported scores for some symptoms, particularly fatigue, did differ from clinician-reported scores. For each of the six symptoms that we assessed at baseline, both clinician and patient scorings contributed independently and positively to the predictive accuracy of survival prognostication. Cox models of overall survival that considered both patient and clinician scores gained more predictive accuracy than models that considered clinician scores alone for each of four symptoms: fatigue (C-index = .67 with both patient and clinician data vs C-index = .63 with clinician data only; P <.001), vomiting (C-index = .64 vs .62; P = .01), nausea (C-index = .65 vs .62; P < .001), and constipation (C-index = .62 vs .61; P = .01).ConclusionPatients provide a subjective measure of symptom severity that complements clinician scoring in predicting overall survival.

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