Quality of Life Research

, Volume 27, Issue 4, pp 979–985 | Cite as

Utility of a patient-reported outcome in measuring functional impairment during autologous stem cell transplant in patients with multiple myeloma

  • Nina Shah
  • Qiuling Shi
  • Sergio Giralt
  • Loretta Williams
  • Qaiser Bashir
  • Muzaffar Qazilbash
  • Richard E. Champlin
  • Charles S. Cleeland
  • Xin Shelley Wang
Article

Abstract

Background

We aimed to determine the utility of a patient-reported outcome (PRO) as it relates to patient performed testing (PPT) for measuring functional status in multiple myeloma patients after autologous hematopoietic stem cell transplantation (auto-HCT).

Methods

Symptom interference on walking (a PRO) was measured by the MD Anderson Symptom Inventory (MDASI). PPT was assessed via 6-min walk test (6MWT). Mixed effects modeling was used to examine (1) the longitudinal relationship between the MDASI score and 6MWT distance and (2) the MDASI scores between patients who did or did not complete the 6WMT. Receiver operating characteristic (ROC) curve analysis was performed to quantify the construct validity of the PRO by differentiating performance status.

Results

Seventy-nine patients were included. Mean 6MWT distance significantly correlated with MDASI-walking interference score (PRO) over the first month of auto-HCT (est = 6.09, p = 0.006). There was a significantly higher completion rate for MDASI versus 6MWT at each time point (p < 0.01). Patients who completed the 6MWT reported less interference on walking during the study period (est = 1.61, p < 0.0001). Finally, the PRO demonstrated significant construct validity for measuring functioning status with MDASI-walking against ECOG-PS as the anchor (AUC = 0.77, 95% CI 0.60–0.94, p = 0.003).

Conclusion

The PRO of MDASI-walking interference is a valid physical functioning measure, correlating with an objective functional measure (6MWT) in MM patients undergoing auto-HCT. As patients with poorer functional status during therapy are less likely to complete PPT, this PRO may offer a more practical quantitative measure of functioning in patients.

Keywords

Patient-reported outcomes (PRO) Patient performed testing (PPT) MD Anderson Symptom Inventory (MDASI) Functional status Auto-HCT 

Notes

Acknowledgements

This work was supported in part by the National Cancer Institute of the National Institutes of Health through The University of Texas MD Anderson Cancer Center’s Cancer Center Support Grant, P30 CA016672 (PI: RA DePinho) and program project P01 CA124787 (PI: Charles S. Cleeland).

Compliance with ethical standards

Conflict of interest

The MD Anderson Symptom Inventory (MDASI) is copyrighted and licensed by The University of Texas MD Anderson Cancer Center and by Charles S. Cleeland. The authors declare no other conflicts of interest in this work.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the M.D. Anderson Institutional Review Board.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

11136_2017_1759_MOESM1_ESM.pdf (16 kb)
Supplementary Figure 1. Example of MDASI daily symptom interference on module. Question 25 (red arrow) asked patients to rate interference with “walking” on a 0-10 scale (PDF 15 KB)
11136_2017_1759_MOESM2_ESM.tif (24.3 mb)
Supplementary Figure 2. Kaplan-Meier analysis of overall survival, comparing patients who were able to perform the 6MWT versus those who were not at 5 days after auto-HCT. There was no significant difference in median overall survival between these groups (TIF 24917 KB)

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2017

Authors and Affiliations

  • Nina Shah
    • 1
  • Qiuling Shi
    • 2
  • Sergio Giralt
    • 3
  • Loretta Williams
    • 2
  • Qaiser Bashir
    • 4
  • Muzaffar Qazilbash
    • 4
  • Richard E. Champlin
    • 4
  • Charles S. Cleeland
    • 2
  • Xin Shelley Wang
    • 2
  1. 1.Department of MedicineUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Department of Symptom ResearchThe University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Department of MedicineMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  4. 4.Department of Stem Cell TransplantationThe University of Texas MD Anderson Cancer CenterHoustonUSA

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