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. 2022 Jan;63(1):42-51.
doi: 10.1016/j.jpainsymman.2021.07.018. Epub 2021 Jul 29.

Determination of Cutpoints for Symptom Burden in Oncology Patients Receiving Chemotherapy

Christine Miaskowski  1 , Steven M Paul  2 , Carolyn S Harris  2 , Joosun Shin  2 , Kate Oppegaard  2 , Yvette P Conley  3 , Marilyn Hammer  4 , Kord M Kober  2 , Jon D Levine  5
Affiliations

Determination of Cutpoints for Symptom Burden in Oncology Patients Receiving Chemotherapy

Christine Miaskowski et al. J Pain Symptom Manage. 2022 Jan.

Abstract

Context: Cutpoints can be used as a threshold for screening symptom(s) that warrant intervention(s) and for monitoring patients' responses to these interventions.

Objectives: In a sample of oncology patients undergoing chemotherapy, study purposes were to determine the optimal cutpoints for low, moderate, and high symptom burden and determine if these cutpoints distinguished among the symptom groups in any demographic, clinical, and stress characteristics, as well as QOL outcomes.

Methods: Total of 1329 patients completed a modified version of the Memorial Symptom Assessment Scale (38 symptoms). Using the methodology of Serlin and colleagues, cutpoints were created using symptom occurrence rates and cancer-specific quality of life (QOL) scores. Cutpoints were validated using measures of stress and resilience and a generic measure of QOL (i.e., Medical Outcomes Study Short Form 12 (SF-12)).

Results: Of the 25 possible cutpoints evaluated, the optimal cutpoint, with the largest between category F statistic, was CP8,15 (Low = 0-8, Moderate = 9-15, High = 16-38 symptoms). Percentage of patients in the Low, Moderate, and High cutpoint groups were 25.3%, 36.3%, and 38.4%, respectively. Significant differences were found among the symptom burden groups in global, cancer-specific, and cumulative life stress (i.e., Low < Moderate < High) and resilience and SF-12 (i.e., Low > Moderate > High) scores.

Conclusion: Our findings provide evidence for clinically meaningful cutpoints that can be used to guide symptom assessment and management. These cutpoints may be used to establish alert thresholds for electronic monitoring of symptoms in oncology patients.

Keywords: Symptom burden; cancer; chemotherapy; cutpoints; severity; symptoms.

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Conflict of interest statement

Conflicts of interest: The authors have no conflicts of interest to declare.

Figures

Figure 1 –
Figure 1 –
Differences among the three cutpoint groups in subscale and total scores on the Quality of Life-Patient Version (QOL-PV). All values are plotted as means and standard deviations. Except for spiritual well-being (p=.322), significant differences were found among the three cutpoint groups for the other three subscales and total QOL scores (all p<.001 low> Moderate > High).
Figure 2 -
Figure 2 -
Differences among the three cutpoint groups in Physical Component Summary (PCS) and Mental Component Summary (MCS) scores from Medical Outcomes Study-Short Form-12 (SF-12). All values are plotted as means and standard deviations. Significant differences were found among the three cutpoint groups for both scores (p <.001 low> Moderate > High).
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