A Core Outcome Set for Evaluating Prognostication Impact in Advanced Cancer

09 Apr 20264 min read0 viewsJournal Feed

GIST

This study describes the development of a preliminary Core Outcome Set (COS) to evaluate the impact of prognostication in people with advanced cancer. Using Core Outcome Measures in Effectiveness Trials guidance, the authors combined a systematic review of prognostic studies with in-depth interviews of patients, informal caregivers, and clinicians to identify potential outcomes.

A comprehensive list was generated, then refined and prioritized via a two-round Delphi process with an international expert panel, followed by a consensus meeting to finalize the COS. The systematic review identified 70 outcomes, supplemented by 16 from interviews, yielding 67 outcomes for Delphi review.

Forty-nine experts from 14 countries participated in the Delphi rounds, with 31 completing both rounds. After two rounds, 34 outcomes were rated as critically important; the subsequent consensus meeting, attended by 12 participants, agreed on 9 core outcomes across five domains: physiological/clinical outcomes, global quality of life, care delivery, perceived health status, and personal circumstances.

Clinical Editorial

Summary

Framework and objective: Establishing a standardized set of outcomes to evaluate the impact of prognostication in advanced cancer

The authors aim to standardize how outcomes are selected, collected, and reported when assessing prognostic models in clinical practice.
The motivation is that prognostication affects patient and healthcare outcomes, and trials evaluating prognostic impact should use consistent outcomes for comparability.

Study design and methodological approach

Methods followed the Core Outcome Measures in Effectiveness Trials framework.
The process integrated a systematic review of prognostic studies with qualitative input from patients, informal caregivers, and clinicians.
A comprehensive list of potential outcomes was distilled from the review and interviews, then prioritized through a two-round Delphi survey with international experts.
An online consensus meeting finalized the preliminary Core Outcome Set (COS).

Evidence sources and initial outcome pool

Systematic review identified 70 outcomes.
Semi-structured interviews contributed an additional 16 outcomes.
After synthesis, 67 outcomes were prepared for Delphi review.
Delphi participation included 49 experts across 14 countries; 31 completed both rounds (63%).

Delphi process and consensus outcomes

Following two Delphi rounds, 34 outcomes were deemed critically important by participants.
A subsequent consensus meeting with 12 attendees refined these discussions, resulting in agreement on a concise core set.

Core outcomes and domains

The finalized Core Outcome Set comprises 9 core outcomes.
These outcomes span five domains:
Physiological/clinical outcomes
Global quality of life
Care delivery
Perceived health status
Personal circumstances

Interpretation and implications

The preliminary COS provides a structured framework for selecting, collecting, and reporting prognostic impact outcomes in advanced cancer research.
It aims to improve comparability across future prognostic impact studies, with the potential to inform clinical practice and patient care.
The authors position the COS as preliminary, inviting further validation and potential refinement.

Limitations and context notes

The synthesis is limited to the identified literature and stakeholder input up to the consensus process described.
The authors do not report numerical outcomes, effect sizes, or trial-level results beyond the consensus statements.