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Improving patient assessment in Neuro-oncology: Cut-offs for patient and clinician reported outcomes indicating need for support or increased distress - results of multicenter observational studies
EANS Academy. Hickmann A. Sep 26, 2019; 276101; EP03065
Abstract
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Objective: Psycho-social burden needs to be assessed adequately in neuro-oncological patients. We determined optimal cut-off values or re-evaluated existing cut-offs for this patient population.
Methods: Patients with intracranial tumors were assessed applying the following instruments: Patient Health Questionnaire (PHQ-4, cut-off ≥6), NCCN Distress Thermometer (DT, cut-off ≥6), Hornheide Screening Instrument (HSI), Supportive Care Needs Survey (SCNS SF-34, cut-off ≥3) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire & brain cancer module (EORTC QLQ-C30+BN20). Clinicians completed the Basic Documentation for Psycho-Oncology Short Form (PO-Bado). Optimal cut-off values for PHQ-4, PO-Bado and EORTC functioning indicating need for support (reference: SCNS-SF34 ≥3, HSI, patient wish; as available) or increased distress (reference: DT ≥6) were determined applying ROC analyses.
Results: We evaluated 315 patients (male: n = 156, 50%; glioma: n = 193, 61%; KPS ≥70: n = 280, 89%).
A cut-off of 2.5 for the PHQ-4 moderately discriminated between patients in or not in distress (AUC 0.77; sensitivity 76.8%, specificity 64.6%) and between patients wishing or not wishing support (AUC 0.77; sensitivity 82.5%, specificity 59%). Cut-offs for the EORTC functioning scales moderately indicated increased distress (AUC 0.74-0.85, sensitivity 59.6-86.0%, specificity 59.3-80.5%) and need for support (AUC 0.69-0.78, sensitivity 55.2-76.7%, specificity 34.4-84.6%). Thereby emotional functioning had the best discriminatory properties.
A PO-Bado total score cut-off of 8.5 (AUC 0.77, sensitivity 71.3%, specificity 67.6%) discriminated moderately between patients in and those not in distress. To distinguish between patients in need of support and those without such a need a PO-Bado total score cut-off of 9.5 (AUC 0.78, sensitivity 65.1%, specificity 77.7%) was determined.
Conclusion: Cut-off values of existing instruments should be adapted for neuro-oncological patients. We observed that cut-offs, as recommended in the literature, may be too high in order to detect affected patients with intracranial tumors adequately.
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