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Patient-Reported Outcomes

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Principles and Practice of Clinical Trials
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Abstract

Patient-reported outcomes (PROs) are defined as any report that comes directly from a patient. Their use as key outcomes in clinical trials has increased significantly, especially during the last decade. PROs encompass a variety of measurements including health-related quality of life (HRQOL), symptoms, functional status, safety, utilities, and satisfaction ratings. Selection of the PRO in a trial will depend on a variety of factors including the trial’s objectives, study population, disease or condition, as well as the type of treatment or intervention. PROs can be used to inform clinical care and to support drug approval and labeling claims. This chapter will provide an overview of the different types of PROs with examples and their role in healthcare within the context of clinical trials. Summaries of important regulatory documents including the FDA PRO guidance and recommendations (SPIRIT and CONSORT PRO extensions) will also be provided. Considerations when designing clinical trials are described in the last section, highlighting important issues and topics that are unique to PROs. Many methodologic and analytic features of PROs are similar to those of any outcomes used in clinical trials; thus they require the same methodological rigor with special attention to missing data. This chapter is written with a focus on the use of PROs in interventional trials in the United States, although most information can be applied to any context. Information presented in this chapter is relevant to clinicians, researchers, policy makers, regulatory and funding agencies, as well as patients. When used appropriately, PROs can generate high-quality data about the effects of a particular intervention on a patient’s physical, psychological, functional, and symptomatic experience.

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References

  • Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–376

    Article  Google Scholar 

  • Atkinson TM, Stover AM, Storfer DF, Saracino RM, D’Agostino TA, Pergolizzi D, Matsoukas K, Li Y, Basch E (2017) Patient-reported physical function measures in cancer clinical trials. Epidemiol Rev 39(1):59–70

    Article  Google Scholar 

  • Banta D (2003) The development of health technology assessment. Health Policy 63(2):121–132

    Article  Google Scholar 

  • Basch E (2010) The missing voice of patients in drug-safety reporting. New England Journal of Medicine 362(10):865–869

    Google Scholar 

  • Basch (2012) Beyond the FDA PRO Guidance: Steps toward Integrating Meaningful Patient-Reported Outcomes into Regulatory Trials and US Drug Labels Value in Health 15(3):401–403

    Google Scholar 

  • Basch E (2018) Patient-reported outcomes: an essential component of oncology drug development and regulatory review. The lancet Oncology 19(5):595–597

    Google Scholar 

  • 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, Germain DS, O’Mara AM, Chen A, Kelaghan J, Bennett AV, Sit L, Rogak L, Barz A, Paul DB, Schrag D (2014) 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 106(9):dju244. https://doi.org/10.1093/jnci/dju244. PMID: 25265940; PMCID: PMC4200059

  • Basch E, Rogak LJ, Dueck AC (2016) Methods for implementing and reporting patient-reported outcome (PRO) measures of symptomatic adverse events in cancer clinical trials. Clin Ther 38(4):821–830

    Article  Google Scholar 

  • Basch E, Deal AM, Dueck AC, Scher HI, Kris MG, Hudis C, Schrag D (2017a) Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment overall survival for patient-reported symptom monitoring in routine cancer treatment letters. JAMA 318(2):197–198

    Article  Google Scholar 

  • Basch E, Dueck AC, Rogak LJ, Minasian LM, Kelly WK, O’Mara AM, Denicoff AM, Seisler D, Atherton PJ, Paskett E, Carey L, Dickler M, Heist RS, Himelstein A, Rugo HS, Sikov WM, Socinski MA, Venook AP, Weckstein DJ, Lake DE, Biggs DD, Freedman RA, Kuzma C, Kirshner JJ, Schrag D (2017b) Feasibility assessment of patient reporting of symptomatic adverse events in multicenter cancer clinical trials patient reporting of symptomatic adverse events in multicenter cancer trials patient reporting of symptomatic adverse events in multicenter cancer trials. JAMA Oncol 3(8):1043–1050

    Article  Google Scholar 

  • Calvert M, Blazeby J, Altman DG, Revicki DA, Moher D, Brundage MD (2013) Reporting of patient-reported outcomes in randomized trials: the CONSORT PRO extension. JAMA 309(8):814–822

    Article  Google Scholar 

  • Calvert M, Kyte D, Mercieca-Bebber R, Slade A, Chan A-W, King MT, a. t. S.-P. Group (2018) Guidelines for inclusion of patient-reported outcomes in clinical trial protocols: the SPIRIT-PRO extension guidelines for inclusion of patient-reported outcomes in clinical trial protocols guidelines for inclusion of patient-reported outcomes in clinical trial protocols. JAMA 319(5):483–494

    Article  Google Scholar 

  • Calvert M, Kyte D, Price G, Valderas JM, Hjollund NH (2019) Maximising the impact of patient reported outcome assessment for patients and society. BMJ 24;364

    Google Scholar 

  • Cella D, Yount S, Rothrock N, Gershon R, Cook K, Reeve B, Ader D, Fries JF, Bruce B, Rose M (2007) The patient-reported outcomes measurement information system (PROMIS): progress of an NIH roadmap cooperative group during its first two years. Med Care 45(5 Suppl 1):S3

    Article  Google Scholar 

  • Cella D, Riley W, Stone A, Rothrock N, Reeve B, Yount S, Amtmann D, Bode R, Buysse D, Choi S, Cook K, Devellis R, DeWalt D, Fries JF, Gershon R, Hahn EA, Lai JS, Pilkonis P, Revicki D, Rose M, Weinfurt K, Hays R (2010) The patient-reported outcomes measurement information system (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008. J Clin Epidemiol 63(11):1179–1194

    Article  Google Scholar 

  • Chan A-W, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, Krleža-Jerić K, Hróbjartsson A, Mann H, Dickersin K, Berlin JA, Doré CJ, Parulekar WR, Summerskill WSM, Groves T, Schulz KF, Sox HC, Rockhold FW, Rennie D, Moher D (2013) SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med 158(3):200–207

    Article  Google Scholar 

  • DeMuro C, Clark M, Doward L, Evans E, Mordin M, Gnanasakthy A (2013) Assessment of PRO label claims granted by the FDA as compared to the EMA (2006–2010). Value Health 16(8):1150–1155

    Article  Google Scholar 

  • Dueck AC, Mendoza TR, Mitchell SA, Reeve BB, Castro KM, Rogak LJ, Atkinson TM, Bennett AV, Denicoff AM, O’Mara AM, Li Y, Clauser SB, Bryant DM, Bearden JD 3rd, Gillis TA, Harness JK, Siegel RD, Paul DB, Cleeland CS, Schrag D, Sloan JA, Abernethy AP, Bruner DW, Minasian LM, Basch E (2015) National Cancer Institute PRO-CTCAE Study Group. Validity and Reliability of the US National Cancer Institute’s Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). JAMA Oncol 1(8):1051–1109. https://doi.org/10.1001/jamaoncol.2015.2639. Erratum in: JAMA Oncol. 2016 Jan;2(1):146. PMID: 26270597; PMCID: PMC4857599

  • Dy SM, Roy J, Ott GE, McHale M, Kennedy C, Kutner JS, Tien A (2011) Tell usâ„¢: a web-based tool for improving communication among patients, families, and providers in hospice and palliative care through systematic data specification, collection, and use. J Pain Symptom Manag 42(4):526–534

    Article  Google Scholar 

  • Dy SM, Walling AM, Mack JW, Malin JL, Pantoja P, Lorenz KA, Tisnado DM (2014) Evaluating the quality of supportive oncology using patient-reported data. J Oncol Pract 10(4):e223–e230

    Article  Google Scholar 

  • European Medicines Agency, C. f. M. P. f. H. U (2005) Reflection paper on the regulatory guidance for the use of health related quality of life (HRQL) measures in the evaluation of medicinal products. Retrieved March 3, 2019, from https://www.ema.europa.eu/en/regulatory-guidance-use-health-related-quality-life-hrql-measures-evaluation-medicinal-products

  • Frank L, Basch E, Selby JV, F. t. P.-C. O. R. Institute (2014) The PCORI perspective on patient-centered outcomes research the PCORI perspective on patient-centered research the PCORI perspective on patient-centered research. JAMA 312(15):1513–1514

    Article  Google Scholar 

  • Ganz PA, Hays RD, Kaplan RM, Litwin MS (2014) Measuring health-related quality of life and other outcomes. In: Kominski GF (ed) Changing the U.S. health care system: key issues in health services policy and management. Wiley, San Francisco, pp 307–341

    Google Scholar 

  • Gnanasakthy A, DeMuro C, Clark M, Haydysch E, Ma E, Bonthapally V (2016) Patient-reported outcomes labeling for products approved by the Office of Hematology and Oncology Products of the US Food and Drug Administration (2010–2014). J Clin Oncol 34(16):1928–1934

    Article  Google Scholar 

  • Gnanasakthy A, Mordin M, Evans E, Doward L, DeMuro C (2017) A review of patient-reported outcome labeling in the United States (2011–2015). Value Health 20(3):420–429

    Article  Google Scholar 

  • HealthMeasures. PROMIS (2019) Explore measurement systems. Retrieved March 20, 2019 from http://www.healthmeasures.net/explore-measurement-systems/promis/intro-to-promis

  • Institute of Medicine (2011) Leading health indicators for healthy people 2020: letter report. National Academies Press, Washington, DC. Retrieved 15 March 2019 from http://books.nap.edu/openbook.php?record_id=13088&page=R1

    Google Scholar 

  • Kluetz PG, Pazdur R (2016) Looking to the future in an unprecedented time for cancer drug development. Semin Oncol 43(1):2–3

    Article  Google Scholar 

  • Kluetz PG, O’Connor DJ, Soltys K (2018) Incorporating the patient experience into regulatory decision making in the USA, Europe, and Canada. The lancet Oncology 19(5):e267–e274

    Google Scholar 

  • Kyte D, Duffy H, Fletcher B, Gheorghe A, Mercieca-Bebber R, King M, Draper H, Ives J, Brundage M, Blazeby J, Calvert M (2014) Systematic evaluation of the patient-reported outcome (PRO) content of clinical trial protocols. PLoS One 9(10):e110229

    Article  Google Scholar 

  • Lipscomb JG, Gotay CC, Snyder C (2005) Outcomes assessment in cancer: measures, methods, and applications. Cambridge University Press, Cambridge

    Google Scholar 

  • Nayfield SG, Ganz PA, Moinpour CM, Cella DF, Hailey BJ (1992) Report from a National Cancer Institute (USA) workshop on quality of life assessment in cancer clinical trials. Qual Life Res 1(3):203–210

    Article  Google Scholar 

  • Piantadosi S (2017) Clinical trials: a methodologic perspective. Wiley, Hoboken

    MATH  Google Scholar 

  • Spilker B (1996) Quality of life and pharmacoeconomics in clinical trials. Lippincott-Raven Publishers, Philadelphia

    Google Scholar 

  • Testa MA, Simonson DC (1996) Assessment of quality-of-life outcomes. N Engl J Med 334(13):835–840

    Article  Google Scholar 

  • US Department of Health and Human Services (USDHHS): Food and Drug Administration. Accessed 1 March 2019; Draft guidance for industry. Patient-reported outcome measures: use in medical product development to support labeling claims. 2006 February.; www.ispor.org/workpaper/FDAPROGuidance2006.pdf

  • US Department of Health and Human Services (USDHHS): Food and Drug Administration. Accessed 1 March 2019; Guidance for industry. Patient-reported outcome measures: use in medical product development to support labeling claims. 2009 December.; www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM193282.pdf

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Correspondence to Patricia A. Ganz .

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Gresham, G., Ganz, P.A. (2021). Patient-Reported Outcomes. In: Piantadosi, S., Meinert, C.L. (eds) Principles and Practice of Clinical Trials. Springer, Cham. https://doi.org/10.1007/978-3-319-52677-5_241-1

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  • DOI: https://doi.org/10.1007/978-3-319-52677-5_241-1

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