Society of Gynecologic Oncology Calls on Clinicians to Measure Patient-Reported Outcomes Routinely

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The field of oncology has long time experience with using patient-reported outcome measures (PROMs) to identify treatment toxicities, improve symptom management and guide end-of-life care. However, the knowledge base about PROMs is derived almost exclusively from clinical trials.

The Society of Gynecologic Oncology (SGO) believes the collection and use of PRO data are essential to patient-centered care. In December 2018, its Policy, Quality and Outcomes Taskforce convened a daylong seminar to make pragmatic, disease-specific recommendations for routine practice. Rachel Sisodia, MD, a gynecologic oncologist in the Division of Gynecologic Oncology at the Massachusetts General Hospital Cancer Center, and colleagues published a two-part report on the seminar in Gynecologic Oncology.

Selecting PROMs

The SGO recommends using the same quality of life instrument for all patients, then supplementing with disease-specific tools.

A simple general quality of life (QOL) instrument is the seven-item Functional Assessment of Cancer Therapy (FACT)-G7, which screens for pain, fatigue, nausea, anxiety, sleep disturbance, functional difficulty and worry about a worsening condition. It can be completed in one minute and is easily scored. The scale can be augmented by adding a single item, "I am bothered by the side effects of treatment."

The SGO suggests administering the FACT-G7 preoperatively, seven days postoperatively, with each cycle of adjuvant chemotherapy (when applicable), after completion of all cancer-directed therapy and at the time of surveillance visits.

The recommended disease-specific PROMs are:

• Ovarian cancer—The FACT-O subscale, the European Organization for Research and Treatment of Cancer (EORTC)-OV-28 subscale, the National Comprehensive Cancer Network/FACT ovarian symptom index or single items from the Patient-Reported Outcomes Measurement Information System (PROMIS) item bank to address concerns such as abdominal pain and bloating
• Uterine cancer—The FACT-EN, the EORTC-EN24, the Functional Assessment of Chronic Illness Therapy (FACIT) item library or the PROMIS item bank
• Cervical cancer—FACT-Cx or EORTC-CX24
• Vulvar and vaginal cancer—The FACT-V is newly validated; the EORTC is in the process of validating its own vulvar subscale

Assessing Sexual Function

18% to 79% of female cancer survivors report distressing sexual, vaginal or menopausal symptoms, but few instruments that address sexual health have been validated in cancer populations. Notable exceptions are the:

• Female Sexual Function Index
• EORTC-QLQ-SHQ22
• PROMIS Sexual Function and Satisfaction version 2.0

Questions should be worded to be inclusive of women who have sex with women, those who are sexually active without a partner and those who are not sexually active.

These questionnaires are rather long, so it is worthwhile to ask patients, "Would you like to discuss your sexual health?" Patients who answer affirmatively will be more likely to spend the time required. Clinicians should take care not to avoid conversations about sexual health because of their own time constraints or discomfort.

An Ongoing Effort

Some of these recommendations are based on nascent data. The SGO plans to conduct patient and clinician focus groups, and seek recommendations from policymakers, then issue final guidelines about collecting and using PROM data. The ultimate goal is to standardize metrics on a large scale so outcomes can be compared across the country.

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