TOPLINE:

Patient-reported outcomes (PROs), which assess symptoms, functional status, and quality of life, had independent prognostic value for overall survival in patients with cancer, according to a meta-analysis of 31 clinical trials. Better physical and role functioning, in particular, were associated with improved survival.

METHODOLOGY:

• In oncology, PROs provide critical insights into patients’ subjective experiences throughout their treatment journey. Although studies have found associations between those patient reports and overall survival, PROs are not widely used in clinical decision-making, partly due to uncertainty around which specific outcomes are most relevant.
• To help clarify the significance of PROs, researchers conducted a systematic review of 69 randomized clinical trials (n = 44,030), of which 31 were pooled in a meta-analysis. Eligible studies enrolled adult patients with cancer, collected one or more baseline PROs, and reported on overall survival.
• The primary outcome was the association between baseline PROs and overall survival. The researchers also evaluated the prognostic significance of specific PRO domains — including symptoms and measures of patients’ daily functioning, overall health, and quality of life.
• The trials spanned multiple countries, primarily the US (32%), France (16%), and Belgium (13%). The most common cancer types were lung (20%), head and neck (12%), pancreatic (12%), colorectal (10%), and prostate (10%).

TAKEAWAY:

• Patient-reported physical functioning was the most consistent prognostic factor, being significantly associated with overall survival in 27 studies (39%). Higher physical functioning scores were associated with improved survival (hazard ratio [HR], 0.94), as were higher role functioning scores (HR, 0.96) — which reflect patients’ ability to fulfill their daily responsibilities at work and home.
• Higher scores for global health status and quality of life were also associated with improved overall survival, with each 1-point increase in the score for global health status associated with a 1% reduction in the risk for mortality (HR, 0.99).
• Looking at patient-reported symptoms, nausea and vomiting (HR, 1.12), fatigue (HR, 1.05), and pain (HR, 1.07) — as well as increasing severity of individual symptoms (HR, 1.03) — were all associated with worse overall survival. Similarly, appetite loss (HR, 1.04) and dyspnea (HR, 1.03) were linked to worse survival, but constipation and insomnia showed no significant association.

IN PRACTICE:

The results highlighted the “unique prognostic value” of PROs, over and above traditional clinical and disease-related factors, the study authors wrote. An invited commentary called such patient reports “the missing variable” in both routine care and clinical trials. “These data highlight the importance of the patient’s voice, while supporting increasing efforts to develop, test, and implement baseline clinical decision support tools that integrate PROs to enhance survival prediction and inform clinical trial enrollment and routine care,” wrote Jamie Takayesu, MD, and Erin F. Gillespie, MD, MPH, of the University of Washington, Seattle.

SOURCE:

The study, led by Ryan Huang, MSc, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada, was published online in JAMA Oncology.

LIMITATIONS:

Variability in design, populations, and cancer types could have led to heterogeneity in findings. Selective populations of randomized controlled trials might limit the applicability of these prognostic associations. The study could not rank prognostic strength across PRO domains due to overlapping HR CIs.

DISCLOSURES:

The authors did not disclose any funding information. Some authors reported receiving grants or personal fees and having ties with various sources. Full disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.