The level of association between functional performance status measures and patient-reported outcomes in cancer patients: a systematic review.

PURPOSE: The process of assessing patient symptoms and functionality using patient-reported outcomes (PROs) and functional performance status (FPS) is an essential aspect of patient-centered oncology research and care. However, PRO and FPS measures are often employed separately or inconsistently combined. Thus, the purpose of this study was to conduct a systematic review of the level of association between PRO and FPS measures to determine their differential or combined utility. METHODS: A systematic search was conducted using five databases (1966 to February 2014) to identify studies that described an association between PRO and FPS. Studies were excluded if they were non-cancer specific, did not include adults aged 18 or older, or were review articles. Publications were selected for review by consensus among two authors, with a third author arbitrating as needed. RESULTS: A total of 18 studies met inclusion criteria. FPS was primarily assessed by clinicians using the ECOG Performance Status or Karnofsky Performance Status measures. PROs were captured using a variety of measures, with numerous domains assessed (e.g., pain, fatigue, and general health status). Concordance between PROs and FPS measures was widely variable, falling in the low to moderate range (0.09-0.72). CONCLUSIONS: Despite consistency in the method of capture of PROs or FPS, domain capture varied considerably across reviewed studies. Irrespective of the method of capturing PROs or FPS, the quantified level of association between these two areas was moderate at best, providing evidence that FPS and PRO assessments offer unique information to assist clinicians in their decision-making.

A quantitative meta-analysis of neurocognitive sequelae in survivors of pediatric brain tumors.

BACKGROUND: Deficits in neurocognitive functioning are an important area of late effects in survivors of pediatric brain tumors, but a quantitative analysis of the magnitude of these deficits has yet to be conducted. PROCEDURE: The purpose of the current article is to provide a comprehensive meta-analysis of the literature on long-term neurocognitive effects found in these survivors. RESULTS: Results indicated significant deficits in both narrow and broad indices of neurocognitive functioning, and the overall magnitude of the effects across all domains ranged from small to large in magnitude (g = -0.45 to -1.43) with a large mean overall effect size of g = -0.91. CONCLUSIONS: These findings underscore the importance of monitoring the neurocognitive late effects in survivors of pediatric brain tumors, and the need for more consistent consideration of demographic, diagnostic, and treatment-related variables in future research to allow for examination of factors that may moderate these deficits.

Do comorbid anxiety disorders impact treatment planning for outpatients with major depressive disorder?

Research indicates that depressed patients with comorbid anxiety disorders have a poorer long-term course of illness, are less responsive to treatment, and may experience greater deficits in psychosocial functioning, when compared with depressed patients without comorbid anxiety disorders. The objective of this study was to examine, through use of a large, well-characterized clinical database, how clinicians may modify treatment recommendations in depressed outpatients when anxiety disorders are present. A group of 346 case records, derived from the Methods to Improve Diagnostic Assessment and Services (MIDAS) project at Rhode Island Hospital, were examined to determine what treatment recommendations were made immediately after diagnosis. Psychopharmacological and psychotherapeutic treatments were classified to capture differences in recommendations between groups. Demographic and clinical characteristics were compared for patients with (n=248) and without (n=98) comorbid anxiety disorders. Utilizing logistic regression models, we found patients with anxiety disorders had a greater number of psychopharmacological therapies included as part of their initial treatment plan, but no differences were found in initial psychotherapeutic interventions. Our results indicate that practitioners are making unique recommendations based on comorbid anxiety diagnoses, but outcome studies are now needed to determine the most effective treatment methods for this patient population.

Reach of benchmark psychiatric trial results to community-based providers: a case study of CATIE.

OBJECTIVE: To evaluate the familiarity of front-line clinicians with findings from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE), the influence of didactic continuing medical education on provider knowledge about key details of CATIE, and how location-related factors affect rates of pre-event knowledge and intraevent learning about CATIE. METHOD: Data derived from the Massachusetts General Hospital Psychiatry Academy (MGH-PA) semester II live symposia provided in different cities nationally between September and December 2006 were analyzed to evaluate providers' self-assessment of their knowledge about CATIE. In addition, participants were also asked a preactivity and postactivity question to assess learning of material presented during the live event psychosis lecture. Descriptive statistics were utilized to characterize participants' self-assessment of knowledge about CATIE, while parametric and nonparametric statistical tests were used to evaluate the degree of observed learning and the effect of lecture location on the results. RESULTS: 3333 participants (mean attendance: N = 278 per event) attended 1 of the 12 MGH-PA live symposia. Of the subsample of providers who treat schizophrenia, 51% indicated that either they had never heard of CATIE or they were not familiar enough with its results to change their practice. Overall, the proportion of correct answers on the postactivity question was 65%, compared with 24% prior to the lecture (chi(2) = 48.68, df = 1, p < .001). Degree of learning did not differ among symposium locations. CONCLUSION: In this sample, the CATIE study had very limited dissemination to, and impact on, a geographically and occupationally diverse sample of mental health practitioners. Robust learning of a key methodologic detail of this trial was evidenced across symposium locations.