Expert Point of View: Therese Marie Mulvey, MD, FASCO

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Therese Marie Mulvey, MD, FASCO, Director of Quality Safety and Value at the Massachusetts General Hospital North Shore Cancer Center, Boston, told The ASCO Post that this “provocative and elegant” study underscores the importance of listening to patients.

“Baseline patient-reported symptoms are probably better at predicting outcomes than how we currently assess patients,” said Dr. Mulvey. “Performance status should be reported by the patient, but, in reality, it’s what the doctor’s perception is, and we’ve known for a long time that doctors overestimate performance status.”

Why Were Patients Fatigued?

According to Dr. Mulvey, although a patient-reported symptom such as fatigue is important in determining side effects to treatments and ultimate outcome, the study was unable to capture why patients were fatigued in the first place, which could have been due to problems other than advanced cancer.

Therese Marie Mulvey, MD, FASCO

Therese Marie Mulvey, MD, FASCO

“This population of patients with lung and prostate cancers may have been enriched for other problems such as cardiovascular disease or obstructive sleep apnea,” said Dr. Mulvey. She noted that the vast majority of patients in the study were men and were generally older. “We’re presuming the fatigue is directly related to the cancer, but we don’t know that for sure.”

Fatigue may also be different in men and women or even other cancers, she added.

“Fatigue may not be a good surrogate in breast cancer, a disease that has a long trajectory with multiple lines of therapy over a period of many years, and it might not be a good surrogate in pediatric cancers either,” said Dr. Mulvey. “We just don’t know where the fatigue is from.”

Fatigue may not the “be-all and end-all,” Dr. Mulvey continued, but it’s clearly an important surrogate for performance status. Some combination of objective and subjective measures is needed to predict how patients are going to do.

The Patient Voice

“I want to see that the patient voice in clinical trials and in standard of care is used much more routinely than it is now,” said Dr. Mulvey. “What patients tell us should not be relegated to the back page or to soft science.”

“We know patient-reported outcomes or patient-reported symptoms have a real role, upfront, in managing patients,” she concluded. “This is one more study with evidence showing we have to listen to patients.” 

DISCLOSURE: Dr. Mulvey reported no conflicts of interest.


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