Estimates of Cancer Population Reference Values for PROMIS Patient-Reported Outcome Domains


Key Points

  • PROMIS domains with reference values that were worse among cancer patients vs the general population included pain interference, fatigue, and physical function.
  • Reference values indicated the poorest status for patients with lung cancer and those with ovarian cancer.


As reported in the Journal of Clinical Oncology, Jensen et al have undertaken a study to estimate cancer population–based reference values for patient-reported outcome domains in the Patient-Reported Outcomes Measurement Information System (PROMIS).

Study Details

The study included 5,284 patients newly diagnosed with prostate, colorectal, non–small cell lung, breast, uterine, or cervical cancer or non-Hodgkin lymphoma from 2010 to 2012 recruited through the Surveillance, Epidemiology, and End Results (SEER) program. Patients were mailed surveys 6 to 13 months after diagnosis.

Weighted average PROMIS scores were generated for the domains of pain interference, fatigue, anxiety, depression, sleep disturbance, physical function, ability to participate in social roles, and cognitive function. The scores were standardized to a T-score metric, with a score of 50 representing the general U.S. population mean. A ≥ 3-point difference was defined as a clinically meaningful difference.

Reference Values

Mean reference values among all patients that were worse than the general population norm included pain interference (52.4), fatigue (52.2), and physical function (lower score = worse; 44.1). Reference values were highest (poorest status) in patients with lung cancer (pain interference = 55.5, fatigue = 57.3, depression = 51.4) and those with cervical cancer (anxiety = 53.2, sleep disturbance = 53.4). Reference values for patients aged 65 to 84 years indicated less sleep disturbance, anxiety, and depression and better cognitive function compared with younger patients. Reference values that were poorer among patients with advanced disease compared with limited or no evidence of disease included physical function (41.1 vs 46.6), fatigue (55.8 vs 50.2), and pain interference (55.2 vs 50.9).

The investigators concluded: “In a large, population-based sample of patients with recently diagnosed cancer, we observed symptom severity and functional deficits by age, stage, and cancer type consistent with the expected impact of cancer diagnosis and treatment. These United States cancer reference values can help facilitate interpretation of the PROMIS domain scores in research studies or in clinical applications that measure and evaluate the symptom and functional burden patients with cancer experience after initial treatment.”

The study was supported by grants from the National Institutes of Health.

Roxanne E. Jensen, PhD, of Lombardi Comprehensive Cancer Center, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.