Outcome Measures in Cancer Rehabilitation: Pain, Function, and Symptom Assessment

Pain Outcome Measures

The frequency, severity, and impact which pain has on the quality of life of patients living with cancer are important factors to be considered by the clinician. Formal instruments have been developed to help describe and measure pain, thereby helping clinicians and patients track the progression of pain or response to treatment. five commonly used outcome measures

• Brief Pain Inventory (BPI)

• the Shoulder Pain and Disability Index (SPADI)

• Quick-Disability of the Arm, Shoulder, and Hand (Quick-DASH)

• the Pain Disability Index (PDI),

• the McGill Pain Questionnaire (MPQ).

General Functional Outcome Measures

Monitoring patient function prior to, during, and after cancer treatment is an essential function of cancer rehabilitation. Tracking function over time is an important way to assess how patients are progressing with rehabilitation.

• Functional Assessment of Cancer Therapy-General (FACT-G)

• Eastern Cooperative Oncology Group (ECOG)

• Karnofsky Performance Scale (KPS)

• Common Terminology Criteria for Adverse Events (CTCAE)

These are the several widely utilized outcome measures of general function that provide objective data that clinicians utilize before making treatment decisions and assessing the response to cancer and rehabilitation treatments.

General Quality of Life Measures

The assessment of the quality of life (QOL) has become one of the most critical parts of oncologic care. It is common that decisions to initiate, avoid, and cease treatment may be based on a discussion regarding QOL of the patient. In addition, QOL has become an important measure of the success (and failure) of the aspects of oncologic treatment. Therefore, familiarity with various QOL measurement tools is essential in oncology care. 

Fatigue Outcome Measures

Cancer-related fatigue is a common experience among cancer survivors. It is estimated that the predominance of this symptom is close to 48% and may increase with disease burdens, such as metastasis, or treatment, such as chemotherapy. A significant variable driving the assessment and treatment of cancer-related fatigue has been the recognition of its negative effect on the quality of life. Various scales have been used to objectively measure fatigue in both the research and clinical settings.

• Patient-Reported Outcomes Measurement Information System (PROMIS) Fatigue Short Form

• Modified Brief Fatigue Inventory (MBFI)

• Visual Analog Scale to Evaluate Fatigue Severity (VAS-F).

Cognitive Outcome Measures

Impaired cognition is a common issue reported in patients undergoing cancer treatment as well as beyond treatment. Many factors have been proposed to impact cognition in cancer, including various cancer treatments, mood disorders, fatigue, and poor sleep. Given how pervasive these symptoms can be, it is important to assess and monitor cognitive function during and after cancer treatment. we review the Montreal cognitive assessment (MoCA) and the FACT-cognitive function (FACT-COG). While FACT-COG is designed specifically for cancer survivors, it should be noted that there is no gold standard cognitive assessment for the cancer population. Overall, it is important to consider that all cognitive screening measures carry a risk of false-positive errors, particularly when used with individuals whose education level and/or cultural and linguistic backgrounds differ from that of the normative sample. In addition, they may also fail to detect more subtle cognitive deficits that can cause distress in many patients.

Objective Measures

Strength, balance, mobility, and endurance are some of the important measures that rehabilitation providers look to assess carefully in their respective patient populations. Cancer rehabilitation specialists commonly need close assessments of these data points to better characterize functional capabilities, risk stratification, mortality prognostication, and QOL. Documentation of these data can vary greatly if done so on a subjective basis. However, special tests and instruments are described in Table 6, such as timed up and go (TUG) test, 5 times sit-to-stand (5XSST), and single-leg stance time (SLS) to create objective data points for providers to quantify and compare this data. 

Conclusion

Outcome measures are a critical tool in assessing cancer patients before, during, and after cancer treatments. These assessments can include general function, QOL, pain, cognition, fatigue, and objective measures. These assessments not only monitor research outcomes but also assess a patient's positive and negative responses to interventions and safety to continue with cancer treatment. The outcome measures presented in this review are a small sampling of the available measures in the cancer rehabilitation setting. The author is optimistic that this review will provide the reader with a starting point in considering the useful outcome measures when starting a research project or focused patient assessment.