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Supportive Care in Cancer

, Volume 27, Issue 2, pp 521–530 | Cite as

Development and prospective evaluation of CAPLET, a cancer ambulatory patient physical function longitudinal evaluation tool for routine clinical practice

  • Elizabeth Hall
  • Emily Tam
  • Mindy Liang
  • Quihuang Zhang
  • Lin Liu
  • Lauren Wong
  • Samantha Sarabia
  • Sabrina Yeung
  • Gursharan Gill
  • Lawson Eng
  • Andrea Perez-Cosio
  • M. Catherine Brown
  • Wei Xu
  • Madeline Li
  • Nicole Mittmann
  • Jennifer Jones
  • Doris HowellEmail author
  • Geoffrey LiuEmail author
Original Article
  • 120 Downloads

Abstract

Purpose

A patient’s physical function is a critical outcome variable for measuring and improving chronic care management. However, patient-reported outcome measures of physical function are not routinely assessed in cancer outpatients, in part due to limitations of tools available. This study presents the development and evaluation of the Cancer Ambulatory Patient Physical Function Longitudinal Evaluation Tool (CAPLET) as an adaptive response tool for routinely screening for physical dysfunction in oncology clinical practice.

Methods

In phase 1, 407 adult outpatients at Princess Margaret Cancer Centre completed the World Health Organization Disability Assessment Schedule (WHODAS) 2.0, Health Assessment Questionnaire Disability Index (HAQ-DI), EuroQuol-5D-3L ( EQ-5D-3L), and patient-reported outcome (PRO)-Eastern Cooperative Oncology Group (ECOG). CAPLET was developed based on a branching logic algorithm navigating patients to appropriate domains of HAQ-DI/WHOAS using their responses to the PRO-ECOG/EQ-5D-3L as screeners. Sensitivity/specificity of CAPLET screeners for HAQ-DI/WHODAS items were reported. In phase 2, CAPLET vs the WHODAS/HAQ-DI were alternatively administrated to 318 adult outpatients in a two-arm trial comparing time to completion and acceptability between the tools.

Results

Using a patient’s ECOG status and the sum of the mobility, self-care, and usual activity dimensions of the EQ-5D-3L to dichotomize patients as with or without difficulty, CAPLET achieved a sensitivity > 90% against recommended WHODAS and HAQ-DI cutoffs for significant dysfunction. Sensitivity of screeners for capturing dysfunction in individual WHODAS/HAQ-DI items ranged from 85 to 100%. Compared to the HAQ-DI/WHODAS, CAPLET was associated with a 50% reduction in administration times and improved patient acceptability, while reducing question burden by 84% for half the sample population.

Conclusions

CAPLET improves the feasibility of capturing detailed assessments of patient-reported physical function in cancer outpatients.

Keywords

Physical function Patient reported outcome Cancer Computer logic Sensitivity Specificity 

Notes

Funding information

This project was completed with support from Cancer Care Ontario, the Ontario Patient-Reported Outcomes for Symptoms and Toxicity Applied Clinical Research Unit (CCO ON-PROST ACRU), Lucy Wong Fund, Posluns Family Fund, and Alan B. Brown Chair in Molecular Genomics.

Compliance with ethical standards

All study protocols were approved by the research ethics board of the University Health Network in Toronto, Ontario, Canada.

Disclosures

A portion of the data included in this manuscript has been presented (1) at the American Society of Clinical Oncology Survivorship Symposium, January 29, 2017 and (2) at the American Society of Clinical Oncology Quality Care Symposium.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

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Supplementary Figure 1 (JPG 156 kb)
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Supplementary Table 1 (DOCX 18 kb)
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Supplementary Table 2 (DOCX 16 kb)
520_2018_4333_MOESM4_ESM.docx (14 kb)
Supplementary Table 3 (DOCX 14 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Elizabeth Hall
    • 1
  • Emily Tam
    • 1
  • Mindy Liang
    • 1
  • Quihuang Zhang
    • 2
  • Lin Liu
    • 2
  • Lauren Wong
    • 1
  • Samantha Sarabia
    • 1
  • Sabrina Yeung
    • 1
  • Gursharan Gill
    • 1
  • Lawson Eng
    • 1
  • Andrea Perez-Cosio
    • 1
  • M. Catherine Brown
    • 1
  • Wei Xu
    • 2
  • Madeline Li
    • 3
  • Nicole Mittmann
    • 4
  • Jennifer Jones
    • 5
  • Doris Howell
    • 3
    • 6
    Email author
  • Geoffrey Liu
    • 1
    • 7
    Email author
  1. 1.Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre and Departments of Medicine and Epidemiology, Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  2. 2.Department of Biostatistics, Princess Margaret Cancer Centre, Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  3. 3.Psychosocial OncologyPrincess Margaret Cancer CentreTorontoCanada
  4. 4.Sunnybrook Health Sciences CentreTorontoCanada
  5. 5.Survivorship ProgramPrincess Margaret Cancer CentreTorontoCanada
  6. 6.Lawrence Bloomberg School of NursingUniversity of TorontoTorontoCanada
  7. 7.Department of Epidemiology, Dalla Lana School of Public Health, Departments of Medicine and BiophysicsUniversity of TorontoTorontoCanada

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