In a systematic review and meta-analysis reported in JAMA Oncology, Huang et al found that patient-reported outcomes (PROs) provide prognostic information for overall survival in patients with cancer.
Study Details
A systematic review of studies published between January 2000 and June 2024 was performed to identify eligible randomized clinical trials enrolling adults with cancer that included at least one baseline PRO measure, reported overall survival as an outcome, and conducted multivariate analyses adjusting for clinical and disease-related confounders. The primary outcome measure was the association between baseline PROs and overall survival using pooled hazard ratios (HRs) and 95% confidence intervals (CIs).
Key Findings
A total of 69 randomized clinical trials were included in the systematic review, with 31 (44.9%) meeting criteria for the meta-analysis.
Each one-point improvement in global health status/quality-of-life score was associated with improved overall survival (HR = 0.99, 95% CI = 0.98–0.99).
Physical functioning (HR = 0.94, 95% CI = 0.92–0.96) and role functioning scores (HR = 0.96, 95% CI = 0.94–0.98) were associated with improved overall survival. No significant association with overall survival was observed for cognitive (HR = 0.96, 95% CI = 0.92–1.00), social (HR = 1.01, 95% CI = 0.97–1.05), or emotional functioning (HR = 1.04, 95% CI = 0.99–1.10). Pooling of functional scales showed that improved functioning was associated with improved overall survival (HR = 0.97, 95% CI = 0.95–0.98).
Worse nausea/vomiting (HR = 1.12, 95% CI = 1.04–1.21), fatigue (HR = 1.05, 95% CI = 1.00–1.10), and pain scores (HR = 1.07, 95% CI = 1.05–1.10) were associated with poorer overall survival. Pooling of all symptom scales showed that increasing symptom severity was associated with worse overall survival (HR = 1.07, 95% CI = 1.05–1.10).
The investigators concluded: “This systematic review and meta-analysis found that PROs offer independent prognostic information for cancer survival. These findings support the integration of PRO assessments into clinical decision-making and risk stratification in oncology.”
Srinivas Raman, MD, of BC Cancer Vancouver, Vancouver, Canada, is the corresponding author of the JAMA Oncology article.
Disclosure: For full disclosures of all study authors, visit jamanetwork.com.
