Age-normed patient-reported outcome measures among cancer survivors.
Authors: Tam Samantha , Adjei Boakye Eric , Springer Kylie , Poisson Laila , Al-Antary Nada , Elsiss Farah , Nair Mrudula , Zatirka Theresa , Ryan Michael , Chang Steven S. , Movsas Benjamin 
Published: June 2024

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Background: Patient-reported outcome measures (PROMs) are instruments used to collect health-related outcomes that are derived completely from the patient without interpretation from healthcare providers. Monitoring and subsequent intervention based on PROMs collection has demonstrated efficacy in clinical trial settings. This has resulted in implementation of PROMs in routine clinical cancer practices throughout the nation. PROMs have been normed to the general population, but establishing the norms among cancer patients is essential to understanding how PROMs can be evaluated on an individual basis in routine clinical cancer care. This study aims to characterize age-normed PROMs scores among survivors of cancer using the National Institute of Health’s Patient-Reported Outcome Measures Information System (PROMIS) depression, fatigue, pain interference, and physical function domains. Methods: Routine collection of PROMs using 4 domains (depression, fatigue, pain interference, and physical function) of PROMIS were offered to all patients with a diagnosis of cancer of any disease site at visits with an oncologic provider using computer adaptive testing. All patients ≥18 years old with a completed PROM at least 2 years since their diagnosis of cancer were eligible for inclusion in the analysis. Only completed PROMs were included in the final analysis. Generalized estimating equation models were used to assess the relationship between age and the estimated mean T-score for each PROMs domain, considering repeat measures within a single patient. Results: A total of 3,636 patients were included in this retrospective cohort study with a total of 26,173 completed PROMs among all 4 domains. Mean age at diagnosis was 61.2 years (SD=12.44), 64% (n=2324) were female, 68% (n=2,461) identified as White, and 25% (n=893) identified as Black. For fatigue, mean T-score ranged from 48.4 points (SD=9.6) among 18-29 years olds to 56.5 points (SD=10.1) among 90-99 years olds, with no significant change with age (p=0.27). For depression, mean T-score ranged from 48.9 points (SD=9.0) among 60-69 year olds to 51.1 points (SD=8.8) among 80-89 year olds with a 0.3 point/decade decrease in T-score (p=0.01). Pain interference T-scores ranged from 48.6 points (SD=10.5) among 18-29 year olds to 55.0 points (SD=9.4) among 80-89 year olds with a 0.4 point/decade average increase (p<0.001). The largest differences were observed in physical function, where scores ranged from 53.5 points (SD=11.0) among 18-29 year olds to 34.3 points (SD=9.2) among 90-99 year olds. There was a 2.1 point/decade decrease in T-score (p<0.001). Conclusions: Among survivors of cancer, mean PROMIS scores differed by age in the depression, pain interference, and physical function domains but not fatigue. These age-normed PROMIS T-scores, which are required to understand individualized assessments of PROMs, are essential as PROMs are integrated into routine cancer care.