Patients, caregivers, and clinicians differ in performance status ratings: Implications for pediatric cancer clinical
Scott H Maurer1, Pamela S Hinds2, Bryce B Reeve3
1UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Insights
Caregiver ratings of child performance on the Lansky Play-Performance Scale (LPPS) were consistently lower than clinician ratings. These differences, along with associations with child-reported outcomes, suggest clinician LPPS scores alone are insufficient for clinical trial eligibility.
Area of Science:
- Pediatric Oncology
- Clinical Trial Eligibility
- Patient-Reported Outcomes
Background:
- The Lansky Play-Performance Scale (LPPS) is crucial for pediatric cancer clinical trial eligibility.
- Discrepancies between clinician and caregiver LPPS ratings are not well understood.
- The association of these ratings with child-reported functioning needs evaluation.
Purpose of the Study:
- To evaluate differences between clinician and caregiver LPPS ratings in children with cancer.
- To assess the association of these ratings with child-reported functioning and symptoms.
Main Methods:
- Recruited 482 children (7-18 years) undergoing cancer treatment and their caregivers.
- Collected LPPS scores from clinicians and caregivers, and PROMIS pediatric measures from children at two time points.
- Utilized t tests, mixed-linear models, and polyserial correlations for data analysis.
Main Results:
- Caregivers consistently reported lower LPPS scores than clinicians (P < .01 at both time points).
- Differences were not linked to child's age, diagnosis, sex, or time point.
- Small to moderate correlations were found between LPPS ratings and child-reported mobility, fatigue, and pain interference.
Conclusions:
- Significant differences between clinician and caregiver LPPS ratings persist over time.
- Clinician LPPS ratings alone are insufficient for determining clinical trial eligibility.
- Supplementing clinician ratings with child and caregiver perspectives is recommended for accurate functional status assessment.
Background:
The Lansky Play-Performance Scale (LPPS) is often used to determine a child's performance status for cancer clinical trial eligibility. Differences between clinician and caregiver LPPS ratings and their associations with child-reported functioning have not been evaluated.
Methods:
Children aged 7 to 18 years who were receiving cancer treatment and their caregivers were recruited from 9 pediatric cancer centers. Caregivers and clinicians reported LPPS scores, and children completed Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric functioning and symptom measures before treatment (time 1 [T1]) and after treatment (time 2 [T2]). t tests and mixed-linear models were used to assess differences in caregiver and clinician LPPS scores; polyserial correlations quantified associations between PROMIS and LPPS scores.
Results:
Of 482 children, 281 had matched caregiver- and clinician-reported LPPS T1/T2 scores. Caregivers rated children significantly worse on the LPPS than clinicians at both T1 (mean, 73.3 vs 87.4; P < .01) and T2 (mean, 67.9 vs 83.1; P < .01). These differences were not related to a child's age (P = .89), diagnosis (P = .17), or sex (P = .64) or to the time point (P = .45). Small to moderate associations existed between caregiver- and clinician-reported LPPS ratings and child-reported PROMIS scores for mobility (caregiver T1/T2 r = 0.51/0.45; P < .01; clinician T1/T2 r = 0.40/0.35; P < .01), fatigue (caregiver T1/T2 r = -0.46/-0.37; P < .01; clinician T1/T2 r = -0.26/-0.27; P < .01), and pain interference (caregiver T1/T2 r = -0.32/-0.30; P < .01; clinician T1/T2 r = -0.17/-0.31; P < .01). Caregivers and clinicians assigned significantly lower LPPS scores at T2 (caregiver Δ = -5.37; P < .01; clinician Δ = -4.20; P < .01), whereas child-reported PROMIS scores were clinically stable.
Conclusions:
Significant differences between clinician and caregiver LPPS ratings of child performance were sustained over time; their associations with child reports were predominantly small to moderate. These data suggest that clinician-reported LPPS ratings by themselves are inadequate for determining clinical trial eligibility and should be supplemented by appropriate measures of a child's functional status reflecting the child and caregiver perspectives.
Related Concept Videos
01:20Comparing the Survival Analysis of Two or More Groups
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
01:21Cancer Survival Analysis
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
01:16Clinical Trials
There are four phases in a clinical trial. A phase one...