Patient-Reported Outcomes as Prognostic Indicators for Overall Survival in Cancer
Bibliographic record
Abstract
Importance: Patient-reported outcomes (PROs) are health data that are collected directly from patients to assess symptoms, functional status, and quality of life. While studies have reported associations between PROs and survival, the prognostic significance of specific PRO domains has not been systematically quantified. Objective: To evaluate the association between baseline PROs and overall survival (OS) in patients with cancer and quantify the prognostic significance of various PRO domains through a systematic review and meta-analysis of randomized clinical trials (RCTs). Data Sources: A systematic literature search of PubMed (MEDLINE), Ovid Embase, and the Cochrane Library was conducted to identify eligible studies published between January 1, 2000, and June 1, 2024. The data were analyzed on January 15, 2025. Study Selection: Eligible studies were prospective RCTs that enrolled adult patients with cancer (18 years or older) that included at least 1 baseline PRO measure, reported OS as an outcome, and conducted multivariate analyses that adjusted for clinical and disease-related confounders. Data Extraction and Synthesis: Data from eligible RCTs were extracted independently and in duplicate by 4 reviewers. Studies using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire were meta-analyzed using a random-effects model with an inverse variance-weighted approach. Main Outcome and Measure: The primary outcome was the association between baseline PROs and OS reported using pooled hazard ratios (HRs) and 95% CIs. Results: A total of 69 RCTs comprising 44 030 patients were included in the systematic review, with 31 RCTs (44.9%) meeting criteria for the meta-analysis. Higher global health status scores and quality of life were associated with improved OS (hazard ratio [HR], 0.99; 95% CI, 0.98-0.99). Among functional scales, physical functioning (HR, 0.94; 95% CI, 0.92-0.96) and role functioning (HR, 0.96; 95% CI, 0.94-0.98) were associated with improved OS. Conversely, higher symptom burden, including nausea and vomiting (HR, 1.12; 95% CI, 1.04-1.21), fatigue (HR, 1.05; 95% CI, 1.00-1.10), and pain (HR, 1.07; 95% CI, 1.04-1.11), was associated with worse OS. The overall pooled effect demonstrated that increasing individual symptom severity was associated with higher mortality risk (HR, 1.03; 95% CI, 1.01-1.04). The Egger test showed no evidence of publication bias. Conclusions and Relevance: This systematic review and meta-analysis found that PROs offer independent prognostic information for cancer survival. These findings support the integration of PRO assessments into clinical decision-making and risk stratification in oncology.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.044 | 0.157 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.014 |
| Bibliometrics | 0.006 | 0.009 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".