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Basch E, Reeve BB, Mitchell SA, Clauser SB, Minasian LM, Dueck AC, Mendoza TR, Hay J, Atkinson TM, Abernethy AP, Bruner DW, Cleeland CS, Sloan JA, Chilukuri R, Baumgartner P, Denicoff A, St Germain D, O'Mara AM, Chen A, Kelaghan J, Bennett AV, Sit L, Rogak L, Barz A, Paul DB, Schrag D. Development of the National Cancer Institute's patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE). J Natl Cancer Inst 2014; 106:dju244. [PMID: 25265940 PMCID: PMC4200059 DOI: 10.1093/jnci/dju244] [Citation(s) in RCA: 637] [Impact Index Per Article: 63.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 06/24/2014] [Accepted: 07/01/2014] [Indexed: 12/23/2022] Open
Abstract
The standard approach for documenting symptomatic adverse events (AEs) in cancer clinical trials involves investigator reporting using the National Cancer Institute's (NCI's) Common Terminology Criteria for Adverse Events (CTCAE). Because this approach underdetects symptomatic AEs, the NCI issued two contracts to create a patient-reported outcome (PRO) measurement system as a companion to the CTCAE, called the PRO-CTCAE. This Commentary describes development of the PRO-CTCAE by a group of multidisciplinary investigators and patient representatives and provides an overview of qualitative and quantitative studies of its measurement properties. A systematic evaluation of all 790 AEs listed in the CTCAE identified 78 appropriate for patient self-reporting. For each of these, a PRO-CTCAE plain language term in English and one to three items characterizing the frequency, severity, and/or activity interference of the AE were created, rendering a library of 124 PRO-CTCAE items. These items were refined in a cognitive interviewing study among patients on active cancer treatment with diverse educational, racial, and geographic backgrounds. Favorable measurement properties of the items, including construct validity, reliability, responsiveness, and between-mode equivalence, were determined prospectively in a demographically diverse population of patients receiving treatments for many different tumor types. A software platform was built to administer PRO-CTCAE items to clinical trial participants via the internet or telephone interactive voice response and was refined through usability testing. Work is ongoing to translate the PRO-CTCAE into multiple languages and to determine the optimal approach for integrating the PRO-CTCAE into clinical trial workflow and AE analyses. It is envisioned that the PRO-CTCAE will enhance the precision and patient-centeredness of adverse event reporting in cancer clinical research.
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Affiliation(s)
- Ethan Basch
- : Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Epidemiology and Biostatistics, Health Outcomes Research Group (EB, LS, LR) and Department of Psychiatry and Behavioral Sciences (JH, TMA), Memorial Sloan Kettering Cancer Center, New York, NY; Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences (SAM, SBC), Division of Cancer Prevention (LMM), NCTN Clinical Trials Operations, Cancer Therapy Evaluation Program (AD), Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention (AMO, DSG, JK), and Investigational Drug Branch, Cancer Therapy Evaluation Program (AC), National Cancer institute, Bethesda, MD;Division of Health Sciences Research, College of Medicine, Mayo Clinic - Arizona, Scottsdale, AZ (ACD); Department of Symptom Research, Division of Internal Medicine, The University of Texas Anderson Cancer Center, Houston, TX (TRM, CSC); Patient Advocate, New York, NY (DBP); Department of Medicine, Duke Center for Learning HealthCare, Duke Cancer Research Program, Duke University, Durham, NC (APA); Nell Hodgson Woodruff School of Nursing, Winship Cancer Institute of Emory University, Emory University, Atlanta, GA (DWB); Mayo Clinic - Rochester, Rochester, MN (JAS); SemanticBits LLC, Herndon, VA (RC, PB); Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (AB); Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (DS).
| | - Bryce B Reeve
- : Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Epidemiology and Biostatistics, Health Outcomes Research Group (EB, LS, LR) and Department of Psychiatry and Behavioral Sciences (JH, TMA), Memorial Sloan Kettering Cancer Center, New York, NY; Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences (SAM, SBC), Division of Cancer Prevention (LMM), NCTN Clinical Trials Operations, Cancer Therapy Evaluation Program (AD), Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention (AMO, DSG, JK), and Investigational Drug Branch, Cancer Therapy Evaluation Program (AC), National Cancer institute, Bethesda, MD;Division of Health Sciences Research, College of Medicine, Mayo Clinic - Arizona, Scottsdale, AZ (ACD); Department of Symptom Research, Division of Internal Medicine, The University of Texas Anderson Cancer Center, Houston, TX (TRM, CSC); Patient Advocate, New York, NY (DBP); Department of Medicine, Duke Center for Learning HealthCare, Duke Cancer Research Program, Duke University, Durham, NC (APA); Nell Hodgson Woodruff School of Nursing, Winship Cancer Institute of Emory University, Emory University, Atlanta, GA (DWB); Mayo Clinic - Rochester, Rochester, MN (JAS); SemanticBits LLC, Herndon, VA (RC, PB); Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (AB); Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (DS)
| | - Sandra A Mitchell
- : Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Epidemiology and Biostatistics, Health Outcomes Research Group (EB, LS, LR) and Department of Psychiatry and Behavioral Sciences (JH, TMA), Memorial Sloan Kettering Cancer Center, New York, NY; Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences (SAM, SBC), Division of Cancer Prevention (LMM), NCTN Clinical Trials Operations, Cancer Therapy Evaluation Program (AD), Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention (AMO, DSG, JK), and Investigational Drug Branch, Cancer Therapy Evaluation Program (AC), National Cancer institute, Bethesda, MD;Division of Health Sciences Research, College of Medicine, Mayo Clinic - Arizona, Scottsdale, AZ (ACD); Department of Symptom Research, Division of Internal Medicine, The University of Texas Anderson Cancer Center, Houston, TX (TRM, CSC); Patient Advocate, New York, NY (DBP); Department of Medicine, Duke Center for Learning HealthCare, Duke Cancer Research Program, Duke University, Durham, NC (APA); Nell Hodgson Woodruff School of Nursing, Winship Cancer Institute of Emory University, Emory University, Atlanta, GA (DWB); Mayo Clinic - Rochester, Rochester, MN (JAS); SemanticBits LLC, Herndon, VA (RC, PB); Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (AB); Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (DS)
| | - Steven B Clauser
- : Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Epidemiology and Biostatistics, Health Outcomes Research Group (EB, LS, LR) and Department of Psychiatry and Behavioral Sciences (JH, TMA), Memorial Sloan Kettering Cancer Center, New York, NY; Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences (SAM, SBC), Division of Cancer Prevention (LMM), NCTN Clinical Trials Operations, Cancer Therapy Evaluation Program (AD), Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention (AMO, DSG, JK), and Investigational Drug Branch, Cancer Therapy Evaluation Program (AC), National Cancer institute, Bethesda, MD;Division of Health Sciences Research, College of Medicine, Mayo Clinic - Arizona, Scottsdale, AZ (ACD); Department of Symptom Research, Division of Internal Medicine, The University of Texas Anderson Cancer Center, Houston, TX (TRM, CSC); Patient Advocate, New York, NY (DBP); Department of Medicine, Duke Center for Learning HealthCare, Duke Cancer Research Program, Duke University, Durham, NC (APA); Nell Hodgson Woodruff School of Nursing, Winship Cancer Institute of Emory University, Emory University, Atlanta, GA (DWB); Mayo Clinic - Rochester, Rochester, MN (JAS); SemanticBits LLC, Herndon, VA (RC, PB); Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (AB); Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (DS)
| | - Lori M Minasian
- : Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Epidemiology and Biostatistics, Health Outcomes Research Group (EB, LS, LR) and Department of Psychiatry and Behavioral Sciences (JH, TMA), Memorial Sloan Kettering Cancer Center, New York, NY; Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences (SAM, SBC), Division of Cancer Prevention (LMM), NCTN Clinical Trials Operations, Cancer Therapy Evaluation Program (AD), Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention (AMO, DSG, JK), and Investigational Drug Branch, Cancer Therapy Evaluation Program (AC), National Cancer institute, Bethesda, MD;Division of Health Sciences Research, College of Medicine, Mayo Clinic - Arizona, Scottsdale, AZ (ACD); Department of Symptom Research, Division of Internal Medicine, The University of Texas Anderson Cancer Center, Houston, TX (TRM, CSC); Patient Advocate, New York, NY (DBP); Department of Medicine, Duke Center for Learning HealthCare, Duke Cancer Research Program, Duke University, Durham, NC (APA); Nell Hodgson Woodruff School of Nursing, Winship Cancer Institute of Emory University, Emory University, Atlanta, GA (DWB); Mayo Clinic - Rochester, Rochester, MN (JAS); SemanticBits LLC, Herndon, VA (RC, PB); Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (AB); Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (DS)
| | - Amylou C Dueck
- : Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Epidemiology and Biostatistics, Health Outcomes Research Group (EB, LS, LR) and Department of Psychiatry and Behavioral Sciences (JH, TMA), Memorial Sloan Kettering Cancer Center, New York, NY; Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences (SAM, SBC), Division of Cancer Prevention (LMM), NCTN Clinical Trials Operations, Cancer Therapy Evaluation Program (AD), Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention (AMO, DSG, JK), and Investigational Drug Branch, Cancer Therapy Evaluation Program (AC), National Cancer institute, Bethesda, MD;Division of Health Sciences Research, College of Medicine, Mayo Clinic - Arizona, Scottsdale, AZ (ACD); Department of Symptom Research, Division of Internal Medicine, The University of Texas Anderson Cancer Center, Houston, TX (TRM, CSC); Patient Advocate, New York, NY (DBP); Department of Medicine, Duke Center for Learning HealthCare, Duke Cancer Research Program, Duke University, Durham, NC (APA); Nell Hodgson Woodruff School of Nursing, Winship Cancer Institute of Emory University, Emory University, Atlanta, GA (DWB); Mayo Clinic - Rochester, Rochester, MN (JAS); SemanticBits LLC, Herndon, VA (RC, PB); Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (AB); Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (DS)
| | - Tito R Mendoza
- : Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Epidemiology and Biostatistics, Health Outcomes Research Group (EB, LS, LR) and Department of Psychiatry and Behavioral Sciences (JH, TMA), Memorial Sloan Kettering Cancer Center, New York, NY; Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences (SAM, SBC), Division of Cancer Prevention (LMM), NCTN Clinical Trials Operations, Cancer Therapy Evaluation Program (AD), Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention (AMO, DSG, JK), and Investigational Drug Branch, Cancer Therapy Evaluation Program (AC), National Cancer institute, Bethesda, MD;Division of Health Sciences Research, College of Medicine, Mayo Clinic - Arizona, Scottsdale, AZ (ACD); Department of Symptom Research, Division of Internal Medicine, The University of Texas Anderson Cancer Center, Houston, TX (TRM, CSC); Patient Advocate, New York, NY (DBP); Department of Medicine, Duke Center for Learning HealthCare, Duke Cancer Research Program, Duke University, Durham, NC (APA); Nell Hodgson Woodruff School of Nursing, Winship Cancer Institute of Emory University, Emory University, Atlanta, GA (DWB); Mayo Clinic - Rochester, Rochester, MN (JAS); SemanticBits LLC, Herndon, VA (RC, PB); Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (AB); Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (DS)
| | - Jennifer Hay
- : Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Epidemiology and Biostatistics, Health Outcomes Research Group (EB, LS, LR) and Department of Psychiatry and Behavioral Sciences (JH, TMA), Memorial Sloan Kettering Cancer Center, New York, NY; Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences (SAM, SBC), Division of Cancer Prevention (LMM), NCTN Clinical Trials Operations, Cancer Therapy Evaluation Program (AD), Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention (AMO, DSG, JK), and Investigational Drug Branch, Cancer Therapy Evaluation Program (AC), National Cancer institute, Bethesda, MD;Division of Health Sciences Research, College of Medicine, Mayo Clinic - Arizona, Scottsdale, AZ (ACD); Department of Symptom Research, Division of Internal Medicine, The University of Texas Anderson Cancer Center, Houston, TX (TRM, CSC); Patient Advocate, New York, NY (DBP); Department of Medicine, Duke Center for Learning HealthCare, Duke Cancer Research Program, Duke University, Durham, NC (APA); Nell Hodgson Woodruff School of Nursing, Winship Cancer Institute of Emory University, Emory University, Atlanta, GA (DWB); Mayo Clinic - Rochester, Rochester, MN (JAS); SemanticBits LLC, Herndon, VA (RC, PB); Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (AB); Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (DS)
| | - Thomas M Atkinson
- : Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Epidemiology and Biostatistics, Health Outcomes Research Group (EB, LS, LR) and Department of Psychiatry and Behavioral Sciences (JH, TMA), Memorial Sloan Kettering Cancer Center, New York, NY; Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences (SAM, SBC), Division of Cancer Prevention (LMM), NCTN Clinical Trials Operations, Cancer Therapy Evaluation Program (AD), Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention (AMO, DSG, JK), and Investigational Drug Branch, Cancer Therapy Evaluation Program (AC), National Cancer institute, Bethesda, MD;Division of Health Sciences Research, College of Medicine, Mayo Clinic - Arizona, Scottsdale, AZ (ACD); Department of Symptom Research, Division of Internal Medicine, The University of Texas Anderson Cancer Center, Houston, TX (TRM, CSC); Patient Advocate, New York, NY (DBP); Department of Medicine, Duke Center for Learning HealthCare, Duke Cancer Research Program, Duke University, Durham, NC (APA); Nell Hodgson Woodruff School of Nursing, Winship Cancer Institute of Emory University, Emory University, Atlanta, GA (DWB); Mayo Clinic - Rochester, Rochester, MN (JAS); SemanticBits LLC, Herndon, VA (RC, PB); Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (AB); Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (DS)
| | - Amy P Abernethy
- : Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Epidemiology and Biostatistics, Health Outcomes Research Group (EB, LS, LR) and Department of Psychiatry and Behavioral Sciences (JH, TMA), Memorial Sloan Kettering Cancer Center, New York, NY; Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences (SAM, SBC), Division of Cancer Prevention (LMM), NCTN Clinical Trials Operations, Cancer Therapy Evaluation Program (AD), Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention (AMO, DSG, JK), and Investigational Drug Branch, Cancer Therapy Evaluation Program (AC), National Cancer institute, Bethesda, MD;Division of Health Sciences Research, College of Medicine, Mayo Clinic - Arizona, Scottsdale, AZ (ACD); Department of Symptom Research, Division of Internal Medicine, The University of Texas Anderson Cancer Center, Houston, TX (TRM, CSC); Patient Advocate, New York, NY (DBP); Department of Medicine, Duke Center for Learning HealthCare, Duke Cancer Research Program, Duke University, Durham, NC (APA); Nell Hodgson Woodruff School of Nursing, Winship Cancer Institute of Emory University, Emory University, Atlanta, GA (DWB); Mayo Clinic - Rochester, Rochester, MN (JAS); SemanticBits LLC, Herndon, VA (RC, PB); Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (AB); Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (DS)
| | - Deborah W Bruner
- : Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Epidemiology and Biostatistics, Health Outcomes Research Group (EB, LS, LR) and Department of Psychiatry and Behavioral Sciences (JH, TMA), Memorial Sloan Kettering Cancer Center, New York, NY; Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences (SAM, SBC), Division of Cancer Prevention (LMM), NCTN Clinical Trials Operations, Cancer Therapy Evaluation Program (AD), Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention (AMO, DSG, JK), and Investigational Drug Branch, Cancer Therapy Evaluation Program (AC), National Cancer institute, Bethesda, MD;Division of Health Sciences Research, College of Medicine, Mayo Clinic - Arizona, Scottsdale, AZ (ACD); Department of Symptom Research, Division of Internal Medicine, The University of Texas Anderson Cancer Center, Houston, TX (TRM, CSC); Patient Advocate, New York, NY (DBP); Department of Medicine, Duke Center for Learning HealthCare, Duke Cancer Research Program, Duke University, Durham, NC (APA); Nell Hodgson Woodruff School of Nursing, Winship Cancer Institute of Emory University, Emory University, Atlanta, GA (DWB); Mayo Clinic - Rochester, Rochester, MN (JAS); SemanticBits LLC, Herndon, VA (RC, PB); Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (AB); Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (DS)
| | - Charles S Cleeland
- : Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Epidemiology and Biostatistics, Health Outcomes Research Group (EB, LS, LR) and Department of Psychiatry and Behavioral Sciences (JH, TMA), Memorial Sloan Kettering Cancer Center, New York, NY; Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences (SAM, SBC), Division of Cancer Prevention (LMM), NCTN Clinical Trials Operations, Cancer Therapy Evaluation Program (AD), Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention (AMO, DSG, JK), and Investigational Drug Branch, Cancer Therapy Evaluation Program (AC), National Cancer institute, Bethesda, MD;Division of Health Sciences Research, College of Medicine, Mayo Clinic - Arizona, Scottsdale, AZ (ACD); Department of Symptom Research, Division of Internal Medicine, The University of Texas Anderson Cancer Center, Houston, TX (TRM, CSC); Patient Advocate, New York, NY (DBP); Department of Medicine, Duke Center for Learning HealthCare, Duke Cancer Research Program, Duke University, Durham, NC (APA); Nell Hodgson Woodruff School of Nursing, Winship Cancer Institute of Emory University, Emory University, Atlanta, GA (DWB); Mayo Clinic - Rochester, Rochester, MN (JAS); SemanticBits LLC, Herndon, VA (RC, PB); Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (AB); Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (DS)
| | - Jeff A Sloan
- : Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Epidemiology and Biostatistics, Health Outcomes Research Group (EB, LS, LR) and Department of Psychiatry and Behavioral Sciences (JH, TMA), Memorial Sloan Kettering Cancer Center, New York, NY; Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences (SAM, SBC), Division of Cancer Prevention (LMM), NCTN Clinical Trials Operations, Cancer Therapy Evaluation Program (AD), Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention (AMO, DSG, JK), and Investigational Drug Branch, Cancer Therapy Evaluation Program (AC), National Cancer institute, Bethesda, MD;Division of Health Sciences Research, College of Medicine, Mayo Clinic - Arizona, Scottsdale, AZ (ACD); Department of Symptom Research, Division of Internal Medicine, The University of Texas Anderson Cancer Center, Houston, TX (TRM, CSC); Patient Advocate, New York, NY (DBP); Department of Medicine, Duke Center for Learning HealthCare, Duke Cancer Research Program, Duke University, Durham, NC (APA); Nell Hodgson Woodruff School of Nursing, Winship Cancer Institute of Emory University, Emory University, Atlanta, GA (DWB); Mayo Clinic - Rochester, Rochester, MN (JAS); SemanticBits LLC, Herndon, VA (RC, PB); Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (AB); Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (DS)
| | - Ram Chilukuri
- : Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Epidemiology and Biostatistics, Health Outcomes Research Group (EB, LS, LR) and Department of Psychiatry and Behavioral Sciences (JH, TMA), Memorial Sloan Kettering Cancer Center, New York, NY; Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences (SAM, SBC), Division of Cancer Prevention (LMM), NCTN Clinical Trials Operations, Cancer Therapy Evaluation Program (AD), Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention (AMO, DSG, JK), and Investigational Drug Branch, Cancer Therapy Evaluation Program (AC), National Cancer institute, Bethesda, MD;Division of Health Sciences Research, College of Medicine, Mayo Clinic - Arizona, Scottsdale, AZ (ACD); Department of Symptom Research, Division of Internal Medicine, The University of Texas Anderson Cancer Center, Houston, TX (TRM, CSC); Patient Advocate, New York, NY (DBP); Department of Medicine, Duke Center for Learning HealthCare, Duke Cancer Research Program, Duke University, Durham, NC (APA); Nell Hodgson Woodruff School of Nursing, Winship Cancer Institute of Emory University, Emory University, Atlanta, GA (DWB); Mayo Clinic - Rochester, Rochester, MN (JAS); SemanticBits LLC, Herndon, VA (RC, PB); Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (AB); Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (DS)
| | - Paul Baumgartner
- : Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Epidemiology and Biostatistics, Health Outcomes Research Group (EB, LS, LR) and Department of Psychiatry and Behavioral Sciences (JH, TMA), Memorial Sloan Kettering Cancer Center, New York, NY; Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences (SAM, SBC), Division of Cancer Prevention (LMM), NCTN Clinical Trials Operations, Cancer Therapy Evaluation Program (AD), Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention (AMO, DSG, JK), and Investigational Drug Branch, Cancer Therapy Evaluation Program (AC), National Cancer institute, Bethesda, MD;Division of Health Sciences Research, College of Medicine, Mayo Clinic - Arizona, Scottsdale, AZ (ACD); Department of Symptom Research, Division of Internal Medicine, The University of Texas Anderson Cancer Center, Houston, TX (TRM, CSC); Patient Advocate, New York, NY (DBP); Department of Medicine, Duke Center for Learning HealthCare, Duke Cancer Research Program, Duke University, Durham, NC (APA); Nell Hodgson Woodruff School of Nursing, Winship Cancer Institute of Emory University, Emory University, Atlanta, GA (DWB); Mayo Clinic - Rochester, Rochester, MN (JAS); SemanticBits LLC, Herndon, VA (RC, PB); Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (AB); Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (DS)
| | - Andrea Denicoff
- : Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Epidemiology and Biostatistics, Health Outcomes Research Group (EB, LS, LR) and Department of Psychiatry and Behavioral Sciences (JH, TMA), Memorial Sloan Kettering Cancer Center, New York, NY; Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences (SAM, SBC), Division of Cancer Prevention (LMM), NCTN Clinical Trials Operations, Cancer Therapy Evaluation Program (AD), Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention (AMO, DSG, JK), and Investigational Drug Branch, Cancer Therapy Evaluation Program (AC), National Cancer institute, Bethesda, MD;Division of Health Sciences Research, College of Medicine, Mayo Clinic - Arizona, Scottsdale, AZ (ACD); Department of Symptom Research, Division of Internal Medicine, The University of Texas Anderson Cancer Center, Houston, TX (TRM, CSC); Patient Advocate, New York, NY (DBP); Department of Medicine, Duke Center for Learning HealthCare, Duke Cancer Research Program, Duke University, Durham, NC (APA); Nell Hodgson Woodruff School of Nursing, Winship Cancer Institute of Emory University, Emory University, Atlanta, GA (DWB); Mayo Clinic - Rochester, Rochester, MN (JAS); SemanticBits LLC, Herndon, VA (RC, PB); Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (AB); Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (DS)
| | - Diane St Germain
- : Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Epidemiology and Biostatistics, Health Outcomes Research Group (EB, LS, LR) and Department of Psychiatry and Behavioral Sciences (JH, TMA), Memorial Sloan Kettering Cancer Center, New York, NY; Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences (SAM, SBC), Division of Cancer Prevention (LMM), NCTN Clinical Trials Operations, Cancer Therapy Evaluation Program (AD), Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention (AMO, DSG, JK), and Investigational Drug Branch, Cancer Therapy Evaluation Program (AC), National Cancer institute, Bethesda, MD;Division of Health Sciences Research, College of Medicine, Mayo Clinic - Arizona, Scottsdale, AZ (ACD); Department of Symptom Research, Division of Internal Medicine, The University of Texas Anderson Cancer Center, Houston, TX (TRM, CSC); Patient Advocate, New York, NY (DBP); Department of Medicine, Duke Center for Learning HealthCare, Duke Cancer Research Program, Duke University, Durham, NC (APA); Nell Hodgson Woodruff School of Nursing, Winship Cancer Institute of Emory University, Emory University, Atlanta, GA (DWB); Mayo Clinic - Rochester, Rochester, MN (JAS); SemanticBits LLC, Herndon, VA (RC, PB); Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (AB); Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (DS)
| | - Ann M O'Mara
- : Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Epidemiology and Biostatistics, Health Outcomes Research Group (EB, LS, LR) and Department of Psychiatry and Behavioral Sciences (JH, TMA), Memorial Sloan Kettering Cancer Center, New York, NY; Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences (SAM, SBC), Division of Cancer Prevention (LMM), NCTN Clinical Trials Operations, Cancer Therapy Evaluation Program (AD), Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention (AMO, DSG, JK), and Investigational Drug Branch, Cancer Therapy Evaluation Program (AC), National Cancer institute, Bethesda, MD;Division of Health Sciences Research, College of Medicine, Mayo Clinic - Arizona, Scottsdale, AZ (ACD); Department of Symptom Research, Division of Internal Medicine, The University of Texas Anderson Cancer Center, Houston, TX (TRM, CSC); Patient Advocate, New York, NY (DBP); Department of Medicine, Duke Center for Learning HealthCare, Duke Cancer Research Program, Duke University, Durham, NC (APA); Nell Hodgson Woodruff School of Nursing, Winship Cancer Institute of Emory University, Emory University, Atlanta, GA (DWB); Mayo Clinic - Rochester, Rochester, MN (JAS); SemanticBits LLC, Herndon, VA (RC, PB); Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (AB); Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (DS)
| | - Alice Chen
- : Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Epidemiology and Biostatistics, Health Outcomes Research Group (EB, LS, LR) and Department of Psychiatry and Behavioral Sciences (JH, TMA), Memorial Sloan Kettering Cancer Center, New York, NY; Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences (SAM, SBC), Division of Cancer Prevention (LMM), NCTN Clinical Trials Operations, Cancer Therapy Evaluation Program (AD), Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention (AMO, DSG, JK), and Investigational Drug Branch, Cancer Therapy Evaluation Program (AC), National Cancer institute, Bethesda, MD;Division of Health Sciences Research, College of Medicine, Mayo Clinic - Arizona, Scottsdale, AZ (ACD); Department of Symptom Research, Division of Internal Medicine, The University of Texas Anderson Cancer Center, Houston, TX (TRM, CSC); Patient Advocate, New York, NY (DBP); Department of Medicine, Duke Center for Learning HealthCare, Duke Cancer Research Program, Duke University, Durham, NC (APA); Nell Hodgson Woodruff School of Nursing, Winship Cancer Institute of Emory University, Emory University, Atlanta, GA (DWB); Mayo Clinic - Rochester, Rochester, MN (JAS); SemanticBits LLC, Herndon, VA (RC, PB); Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (AB); Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (DS)
| | - Joseph Kelaghan
- : Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Epidemiology and Biostatistics, Health Outcomes Research Group (EB, LS, LR) and Department of Psychiatry and Behavioral Sciences (JH, TMA), Memorial Sloan Kettering Cancer Center, New York, NY; Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences (SAM, SBC), Division of Cancer Prevention (LMM), NCTN Clinical Trials Operations, Cancer Therapy Evaluation Program (AD), Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention (AMO, DSG, JK), and Investigational Drug Branch, Cancer Therapy Evaluation Program (AC), National Cancer institute, Bethesda, MD;Division of Health Sciences Research, College of Medicine, Mayo Clinic - Arizona, Scottsdale, AZ (ACD); Department of Symptom Research, Division of Internal Medicine, The University of Texas Anderson Cancer Center, Houston, TX (TRM, CSC); Patient Advocate, New York, NY (DBP); Department of Medicine, Duke Center for Learning HealthCare, Duke Cancer Research Program, Duke University, Durham, NC (APA); Nell Hodgson Woodruff School of Nursing, Winship Cancer Institute of Emory University, Emory University, Atlanta, GA (DWB); Mayo Clinic - Rochester, Rochester, MN (JAS); SemanticBits LLC, Herndon, VA (RC, PB); Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (AB); Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (DS)
| | - Antonia V Bennett
- : Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Epidemiology and Biostatistics, Health Outcomes Research Group (EB, LS, LR) and Department of Psychiatry and Behavioral Sciences (JH, TMA), Memorial Sloan Kettering Cancer Center, New York, NY; Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences (SAM, SBC), Division of Cancer Prevention (LMM), NCTN Clinical Trials Operations, Cancer Therapy Evaluation Program (AD), Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention (AMO, DSG, JK), and Investigational Drug Branch, Cancer Therapy Evaluation Program (AC), National Cancer institute, Bethesda, MD;Division of Health Sciences Research, College of Medicine, Mayo Clinic - Arizona, Scottsdale, AZ (ACD); Department of Symptom Research, Division of Internal Medicine, The University of Texas Anderson Cancer Center, Houston, TX (TRM, CSC); Patient Advocate, New York, NY (DBP); Department of Medicine, Duke Center for Learning HealthCare, Duke Cancer Research Program, Duke University, Durham, NC (APA); Nell Hodgson Woodruff School of Nursing, Winship Cancer Institute of Emory University, Emory University, Atlanta, GA (DWB); Mayo Clinic - Rochester, Rochester, MN (JAS); SemanticBits LLC, Herndon, VA (RC, PB); Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (AB); Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (DS)
| | - Laura Sit
- : Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Epidemiology and Biostatistics, Health Outcomes Research Group (EB, LS, LR) and Department of Psychiatry and Behavioral Sciences (JH, TMA), Memorial Sloan Kettering Cancer Center, New York, NY; Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences (SAM, SBC), Division of Cancer Prevention (LMM), NCTN Clinical Trials Operations, Cancer Therapy Evaluation Program (AD), Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention (AMO, DSG, JK), and Investigational Drug Branch, Cancer Therapy Evaluation Program (AC), National Cancer institute, Bethesda, MD;Division of Health Sciences Research, College of Medicine, Mayo Clinic - Arizona, Scottsdale, AZ (ACD); Department of Symptom Research, Division of Internal Medicine, The University of Texas Anderson Cancer Center, Houston, TX (TRM, CSC); Patient Advocate, New York, NY (DBP); Department of Medicine, Duke Center for Learning HealthCare, Duke Cancer Research Program, Duke University, Durham, NC (APA); Nell Hodgson Woodruff School of Nursing, Winship Cancer Institute of Emory University, Emory University, Atlanta, GA (DWB); Mayo Clinic - Rochester, Rochester, MN (JAS); SemanticBits LLC, Herndon, VA (RC, PB); Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (AB); Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (DS)
| | - Lauren Rogak
- : Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Epidemiology and Biostatistics, Health Outcomes Research Group (EB, LS, LR) and Department of Psychiatry and Behavioral Sciences (JH, TMA), Memorial Sloan Kettering Cancer Center, New York, NY; Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences (SAM, SBC), Division of Cancer Prevention (LMM), NCTN Clinical Trials Operations, Cancer Therapy Evaluation Program (AD), Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention (AMO, DSG, JK), and Investigational Drug Branch, Cancer Therapy Evaluation Program (AC), National Cancer institute, Bethesda, MD;Division of Health Sciences Research, College of Medicine, Mayo Clinic - Arizona, Scottsdale, AZ (ACD); Department of Symptom Research, Division of Internal Medicine, The University of Texas Anderson Cancer Center, Houston, TX (TRM, CSC); Patient Advocate, New York, NY (DBP); Department of Medicine, Duke Center for Learning HealthCare, Duke Cancer Research Program, Duke University, Durham, NC (APA); Nell Hodgson Woodruff School of Nursing, Winship Cancer Institute of Emory University, Emory University, Atlanta, GA (DWB); Mayo Clinic - Rochester, Rochester, MN (JAS); SemanticBits LLC, Herndon, VA (RC, PB); Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (AB); Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (DS)
| | - Allison Barz
- : Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Epidemiology and Biostatistics, Health Outcomes Research Group (EB, LS, LR) and Department of Psychiatry and Behavioral Sciences (JH, TMA), Memorial Sloan Kettering Cancer Center, New York, NY; Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences (SAM, SBC), Division of Cancer Prevention (LMM), NCTN Clinical Trials Operations, Cancer Therapy Evaluation Program (AD), Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention (AMO, DSG, JK), and Investigational Drug Branch, Cancer Therapy Evaluation Program (AC), National Cancer institute, Bethesda, MD;Division of Health Sciences Research, College of Medicine, Mayo Clinic - Arizona, Scottsdale, AZ (ACD); Department of Symptom Research, Division of Internal Medicine, The University of Texas Anderson Cancer Center, Houston, TX (TRM, CSC); Patient Advocate, New York, NY (DBP); Department of Medicine, Duke Center for Learning HealthCare, Duke Cancer Research Program, Duke University, Durham, NC (APA); Nell Hodgson Woodruff School of Nursing, Winship Cancer Institute of Emory University, Emory University, Atlanta, GA (DWB); Mayo Clinic - Rochester, Rochester, MN (JAS); SemanticBits LLC, Herndon, VA (RC, PB); Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (AB); Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (DS)
| | - Diane B Paul
- : Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Epidemiology and Biostatistics, Health Outcomes Research Group (EB, LS, LR) and Department of Psychiatry and Behavioral Sciences (JH, TMA), Memorial Sloan Kettering Cancer Center, New York, NY; Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences (SAM, SBC), Division of Cancer Prevention (LMM), NCTN Clinical Trials Operations, Cancer Therapy Evaluation Program (AD), Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention (AMO, DSG, JK), and Investigational Drug Branch, Cancer Therapy Evaluation Program (AC), National Cancer institute, Bethesda, MD;Division of Health Sciences Research, College of Medicine, Mayo Clinic - Arizona, Scottsdale, AZ (ACD); Department of Symptom Research, Division of Internal Medicine, The University of Texas Anderson Cancer Center, Houston, TX (TRM, CSC); Patient Advocate, New York, NY (DBP); Department of Medicine, Duke Center for Learning HealthCare, Duke Cancer Research Program, Duke University, Durham, NC (APA); Nell Hodgson Woodruff School of Nursing, Winship Cancer Institute of Emory University, Emory University, Atlanta, GA (DWB); Mayo Clinic - Rochester, Rochester, MN (JAS); SemanticBits LLC, Herndon, VA (RC, PB); Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (AB); Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (DS)
| | - Deborah Schrag
- : Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC (EB, BBR, AVB); Department of Epidemiology and Biostatistics, Health Outcomes Research Group (EB, LS, LR) and Department of Psychiatry and Behavioral Sciences (JH, TMA), Memorial Sloan Kettering Cancer Center, New York, NY; Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences (SAM, SBC), Division of Cancer Prevention (LMM), NCTN Clinical Trials Operations, Cancer Therapy Evaluation Program (AD), Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention (AMO, DSG, JK), and Investigational Drug Branch, Cancer Therapy Evaluation Program (AC), National Cancer institute, Bethesda, MD;Division of Health Sciences Research, College of Medicine, Mayo Clinic - Arizona, Scottsdale, AZ (ACD); Department of Symptom Research, Division of Internal Medicine, The University of Texas Anderson Cancer Center, Houston, TX (TRM, CSC); Patient Advocate, New York, NY (DBP); Department of Medicine, Duke Center for Learning HealthCare, Duke Cancer Research Program, Duke University, Durham, NC (APA); Nell Hodgson Woodruff School of Nursing, Winship Cancer Institute of Emory University, Emory University, Atlanta, GA (DWB); Mayo Clinic - Rochester, Rochester, MN (JAS); SemanticBits LLC, Herndon, VA (RC, PB); Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (AB); Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (DS)
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Reeve BB, Mitchell SA, Dueck AC, Basch E, Cella D, Reilly CM, Minasian LM, Denicoff AM, O'Mara AM, Fisch MJ, Chauhan C, Aaronson NK, Coens C, Bruner DW. Recommended patient-reported core set of symptoms to measure in adult cancer treatment trials. J Natl Cancer Inst 2014; 106:dju129. [PMID: 25006191 PMCID: PMC4110472 DOI: 10.1093/jnci/dju129] [Citation(s) in RCA: 203] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 04/01/2014] [Accepted: 04/11/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The National Cancer Institute's Symptom Management and Health-Related Quality of Life Steering Committee held a clinical trials planning meeting (September 2011) to identify a core symptom set to be assessed across oncology trials for the purposes of better understanding treatment efficacy and toxicity and to facilitate cross-study comparisons. We report the results of an evidence-synthesis and consensus-building effort that culminated in recommendations for core symptoms to be measured in adult cancer clinical trials that include a patient-reported outcome (PRO). METHODS We used a data-driven, consensus-building process. A panel of experts, including patient representatives, conducted a systematic review of the literature (2001-2011) and analyzed six large datasets. Results were reviewed at a multistakeholder meeting, and a final set was derived emphasizing symptom prevalence across diverse cancer populations, impact on health outcomes and quality of life, and attribution to either disease or anticancer treatment. RESULTS We recommend that a core set of 12 symptoms--specifically fatigue, insomnia, pain, anorexia (appetite loss), dyspnea, cognitive problems, anxiety (includes worry), nausea, depression (includes sadness), sensory neuropathy, constipation, and diarrhea--be considered for inclusion in clinical trials where a PRO is measured. Inclusion of symptoms and other patient-reported endpoints should be well justified, hypothesis driven, and meaningful to patients. CONCLUSIONS This core set will promote consistent assessment of common and clinically relevant disease- and treatment-related symptoms across cancer trials. As such, it provides a foundation to support data harmonization and continued efforts to enhance measurement of patient-centered outcomes in cancer clinical trials and observational studies.
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Affiliation(s)
- Bryce B Reeve
- Affiliations of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (BBR, EB); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (SAM); Division of Cancer Prevention, National Cancer Institute, Bethesda, MD (LMM and AMO); Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD (AMD); Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (ACD); Feinberg School of Medicine, Northwestern University, Chicago, IL (DC); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA (CMR, DWB); Department of General Oncology, MD Anderson Cancer Center, Houston, TX (MJF); Mayo Clinic Breast SPORE, Rochester, MN (CCh); Department of Psychological Research, The Netherlands Cancer Institute, Amsterdam, The Netherlands (NKA); Quality of Life Department, European Organization for the Research and Treatment of Cancer, Brussels, Belgium (CCo).
| | - Sandra A Mitchell
- Affiliations of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (BBR, EB); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (SAM); Division of Cancer Prevention, National Cancer Institute, Bethesda, MD (LMM and AMO); Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD (AMD); Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (ACD); Feinberg School of Medicine, Northwestern University, Chicago, IL (DC); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA (CMR, DWB); Department of General Oncology, MD Anderson Cancer Center, Houston, TX (MJF); Mayo Clinic Breast SPORE, Rochester, MN (CCh); Department of Psychological Research, The Netherlands Cancer Institute, Amsterdam, The Netherlands (NKA); Quality of Life Department, European Organization for the Research and Treatment of Cancer, Brussels, Belgium (CCo)
| | - Amylou C Dueck
- Affiliations of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (BBR, EB); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (SAM); Division of Cancer Prevention, National Cancer Institute, Bethesda, MD (LMM and AMO); Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD (AMD); Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (ACD); Feinberg School of Medicine, Northwestern University, Chicago, IL (DC); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA (CMR, DWB); Department of General Oncology, MD Anderson Cancer Center, Houston, TX (MJF); Mayo Clinic Breast SPORE, Rochester, MN (CCh); Department of Psychological Research, The Netherlands Cancer Institute, Amsterdam, The Netherlands (NKA); Quality of Life Department, European Organization for the Research and Treatment of Cancer, Brussels, Belgium (CCo)
| | - Ethan Basch
- Affiliations of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (BBR, EB); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (SAM); Division of Cancer Prevention, National Cancer Institute, Bethesda, MD (LMM and AMO); Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD (AMD); Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (ACD); Feinberg School of Medicine, Northwestern University, Chicago, IL (DC); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA (CMR, DWB); Department of General Oncology, MD Anderson Cancer Center, Houston, TX (MJF); Mayo Clinic Breast SPORE, Rochester, MN (CCh); Department of Psychological Research, The Netherlands Cancer Institute, Amsterdam, The Netherlands (NKA); Quality of Life Department, European Organization for the Research and Treatment of Cancer, Brussels, Belgium (CCo)
| | - David Cella
- Affiliations of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (BBR, EB); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (SAM); Division of Cancer Prevention, National Cancer Institute, Bethesda, MD (LMM and AMO); Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD (AMD); Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (ACD); Feinberg School of Medicine, Northwestern University, Chicago, IL (DC); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA (CMR, DWB); Department of General Oncology, MD Anderson Cancer Center, Houston, TX (MJF); Mayo Clinic Breast SPORE, Rochester, MN (CCh); Department of Psychological Research, The Netherlands Cancer Institute, Amsterdam, The Netherlands (NKA); Quality of Life Department, European Organization for the Research and Treatment of Cancer, Brussels, Belgium (CCo)
| | - Carolyn Miller Reilly
- Affiliations of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (BBR, EB); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (SAM); Division of Cancer Prevention, National Cancer Institute, Bethesda, MD (LMM and AMO); Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD (AMD); Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (ACD); Feinberg School of Medicine, Northwestern University, Chicago, IL (DC); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA (CMR, DWB); Department of General Oncology, MD Anderson Cancer Center, Houston, TX (MJF); Mayo Clinic Breast SPORE, Rochester, MN (CCh); Department of Psychological Research, The Netherlands Cancer Institute, Amsterdam, The Netherlands (NKA); Quality of Life Department, European Organization for the Research and Treatment of Cancer, Brussels, Belgium (CCo)
| | - Lori M Minasian
- Affiliations of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (BBR, EB); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (SAM); Division of Cancer Prevention, National Cancer Institute, Bethesda, MD (LMM and AMO); Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD (AMD); Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (ACD); Feinberg School of Medicine, Northwestern University, Chicago, IL (DC); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA (CMR, DWB); Department of General Oncology, MD Anderson Cancer Center, Houston, TX (MJF); Mayo Clinic Breast SPORE, Rochester, MN (CCh); Department of Psychological Research, The Netherlands Cancer Institute, Amsterdam, The Netherlands (NKA); Quality of Life Department, European Organization for the Research and Treatment of Cancer, Brussels, Belgium (CCo)
| | - Andrea M Denicoff
- Affiliations of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (BBR, EB); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (SAM); Division of Cancer Prevention, National Cancer Institute, Bethesda, MD (LMM and AMO); Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD (AMD); Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (ACD); Feinberg School of Medicine, Northwestern University, Chicago, IL (DC); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA (CMR, DWB); Department of General Oncology, MD Anderson Cancer Center, Houston, TX (MJF); Mayo Clinic Breast SPORE, Rochester, MN (CCh); Department of Psychological Research, The Netherlands Cancer Institute, Amsterdam, The Netherlands (NKA); Quality of Life Department, European Organization for the Research and Treatment of Cancer, Brussels, Belgium (CCo)
| | - Ann M O'Mara
- Affiliations of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (BBR, EB); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (SAM); Division of Cancer Prevention, National Cancer Institute, Bethesda, MD (LMM and AMO); Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD (AMD); Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (ACD); Feinberg School of Medicine, Northwestern University, Chicago, IL (DC); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA (CMR, DWB); Department of General Oncology, MD Anderson Cancer Center, Houston, TX (MJF); Mayo Clinic Breast SPORE, Rochester, MN (CCh); Department of Psychological Research, The Netherlands Cancer Institute, Amsterdam, The Netherlands (NKA); Quality of Life Department, European Organization for the Research and Treatment of Cancer, Brussels, Belgium (CCo)
| | - Michael J Fisch
- Affiliations of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (BBR, EB); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (SAM); Division of Cancer Prevention, National Cancer Institute, Bethesda, MD (LMM and AMO); Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD (AMD); Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (ACD); Feinberg School of Medicine, Northwestern University, Chicago, IL (DC); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA (CMR, DWB); Department of General Oncology, MD Anderson Cancer Center, Houston, TX (MJF); Mayo Clinic Breast SPORE, Rochester, MN (CCh); Department of Psychological Research, The Netherlands Cancer Institute, Amsterdam, The Netherlands (NKA); Quality of Life Department, European Organization for the Research and Treatment of Cancer, Brussels, Belgium (CCo)
| | - Cynthia Chauhan
- Affiliations of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (BBR, EB); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (SAM); Division of Cancer Prevention, National Cancer Institute, Bethesda, MD (LMM and AMO); Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD (AMD); Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (ACD); Feinberg School of Medicine, Northwestern University, Chicago, IL (DC); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA (CMR, DWB); Department of General Oncology, MD Anderson Cancer Center, Houston, TX (MJF); Mayo Clinic Breast SPORE, Rochester, MN (CCh); Department of Psychological Research, The Netherlands Cancer Institute, Amsterdam, The Netherlands (NKA); Quality of Life Department, European Organization for the Research and Treatment of Cancer, Brussels, Belgium (CCo)
| | - Neil K Aaronson
- Affiliations of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (BBR, EB); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (SAM); Division of Cancer Prevention, National Cancer Institute, Bethesda, MD (LMM and AMO); Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD (AMD); Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (ACD); Feinberg School of Medicine, Northwestern University, Chicago, IL (DC); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA (CMR, DWB); Department of General Oncology, MD Anderson Cancer Center, Houston, TX (MJF); Mayo Clinic Breast SPORE, Rochester, MN (CCh); Department of Psychological Research, The Netherlands Cancer Institute, Amsterdam, The Netherlands (NKA); Quality of Life Department, European Organization for the Research and Treatment of Cancer, Brussels, Belgium (CCo)
| | - Corneel Coens
- Affiliations of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (BBR, EB); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (SAM); Division of Cancer Prevention, National Cancer Institute, Bethesda, MD (LMM and AMO); Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD (AMD); Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (ACD); Feinberg School of Medicine, Northwestern University, Chicago, IL (DC); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA (CMR, DWB); Department of General Oncology, MD Anderson Cancer Center, Houston, TX (MJF); Mayo Clinic Breast SPORE, Rochester, MN (CCh); Department of Psychological Research, The Netherlands Cancer Institute, Amsterdam, The Netherlands (NKA); Quality of Life Department, European Organization for the Research and Treatment of Cancer, Brussels, Belgium (CCo)
| | - Deborah Watkins Bruner
- Affiliations of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (BBR, EB); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (SAM); Division of Cancer Prevention, National Cancer Institute, Bethesda, MD (LMM and AMO); Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD (AMD); Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ (ACD); Feinberg School of Medicine, Northwestern University, Chicago, IL (DC); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA (CMR, DWB); Department of General Oncology, MD Anderson Cancer Center, Houston, TX (MJF); Mayo Clinic Breast SPORE, Rochester, MN (CCh); Department of Psychological Research, The Netherlands Cancer Institute, Amsterdam, The Netherlands (NKA); Quality of Life Department, European Organization for the Research and Treatment of Cancer, Brussels, Belgium (CCo)
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