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Establishing the Ecological Validity of Cognitive Patient Reported Outcome Measures in Breast Cancer Survivors: A
Ashley M Henneghan1,2, Oscar Y Franco-Rocha1,3, Kathleen M Van Dyk4,5,6
1School of Nursing, University of Texas at Austin, Austin, Texas, USA.
Objective:
The aim of this study was to determine which cognitive patient reported outcome measure (PROM) best represents self-reported cognitive functioning in real-world environments among breast cancer survivors (BCS) as measured by ecological momentary assessments (EMA), and to compare their ability to predict future everyday functioning.
Methods:
One-hundred twenty-four BCS (ages 24-88) completed self-report measures of cognitive functioning (FACT-Cog PCI, PROMIS Cog, CFQ, EORTC-CF) and everyday functioning (SDI, FACT-G Functional Well-being subscale) at baseline (Time 1) and at 9 weeks follow up (Time 2). Between assessments, EMA protocols (including one item to assess cancer-related cognitive symptoms) were administered every other day for 8 weeks. Person-specific means and standard deviations were calculated for EMA data. Hierarchical linear regression models were used to model cognitive PROM predictors of person-specific averages and variability in EMAs, SDI, and FACT-G functional well-being, and model parameters (R2, AIC, BIC, semi-partial R) were compared.
Results:
Follow-up FACT-Cog PCI most accurately predicted both the average (ΔR2 = 0.213, p < 0.001) and variability (ΔR2 = 0.071, p < 0.001) in EMA CRCI symptoms. For future functional outcomes, the PROMIS Cog and FACT-Cog PCI at baseline demonstrated similar predictive power for Time 2 Functional Well-being (ΔR2 = 0.210, p < 0.001). Additionally, baseline FACT-Cog PCI was the strongest predictor of social dysfunction (SDI; ΔR2 = 0.205, p < 0.001).
Conclusions:
These findings support the ecological validity of cognitive PROMs in BCS and indicate that both FACT-Cog PCI and PROMIS Cog effectively capture real-world cognitive symptoms and predict future everyday functioning, including social function and well-being.
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