A multi-method approach to selecting PRO-CTCAE symptoms for patient-reported outcome in women with endometrial or ovarian cancer undergoing chemotherapy

BackgroundWomen with endometrial or ovarian cancer experience a variety of symptoms during chemotherapy. Patient-Reported outcomes (PROs) can provide insight into the symptoms they experience. A PRO tool tailored to this patient population can help accurately monitor adverse events and manage symptoms. The objective of this study was to identify items in the National Cancer Institute's measurement system Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE & REG;) appropriate for use in a PRO tool for a population of women with endometrial or ovarian cancer undergoing treatment with taxanes (paclitaxel or docetaxel) in combination with carboplatin.MethodsA two-phase, sequential multi-methods approach was applied. In phase one, a comprehensive literature search was done to map the toxicity of the applied chemotherapeutics and phase III clinical studies. Phase two, which comprised selecting the PRO-CTCAE items, included discussions with and feedback from a patient advisory board, an additional literature search, and focus group interviews with senior oncologists and specialized oncology nurses. A national expert panel facilitated both phases in terms of carefully select items from the PRO-CTCAE library.ResultsPhase one identified 18 symptoms and phase two, three additional ones, leading to the inclusion of 21 PRO-CTCAE symptoms in the final PRO tool. Since PRO-CTCAE also contains one to three sub-questions on the frequency, severity, and interference with daily activities of symptoms, there were 44 potential items.ConclusionsThis study describes taking a multi-method approach to selecting items from the PRO-CTCAE library for use in a population of women with endometrial or ovarian cancer undergoing chemotherapy. By systematically combining diverse approaches, we carefully selected 21 clinically relevant symptoms covered by 44 items in the PRO-CTCAE library. Future studies should investigate the psychometric properties of this PRO tool for women with endometrial or ovarian cancer. Plain English SummaryWomen undergoing chemotherapy for endometrial or ovarian cancer experience a variety of symptoms and side effects associated with the disease and its treatment. One way to strengthen patient involvement during the treatment trajectory is to use patient-reported outcomes (PROs). Since PROs represent the patient's response to inquiries about their current level of health, they should be tailored to the specific disease. As a result, we developed a PRO tool that targets women undergoing chemotherapy for endometrial or ovarian cancer. We conducted a comprehensive literature search and used various methods to map symptoms and side effects. Furthermore, discussions with and feedback from a patient advisory board, focus group interviews with oncologists and specialized oncology nurses, and advice from a gynecological national expert panel that we established helped us determine which symptoms a PRO tool for this patient group should include. This led to the inclusion of 21 symptoms in the final PRO tool, which is currently being tested. The selection process we applied may be generalizable for use in selecting PROs for other cancer populations.