The Cancer Rehabilitation Medicine Metrics Consortium: A Path to Enhanced, Multi-Site Outcome Assessment to Enhance Care and Demonstrate Value

Abstract

PurposeA primary objective stated at the Cancer Rehabilitation Symposium at the National Institutes of Health was to improve outcome measurement. The purpose of this project was for the Cancer Rehabilitation Medicine Metrics Consortium (CRMMC) to develop an assessment tool to evaluate function in cancer patients via a data-driven and methodologically sound process. There is no agreed-upon measure of physical and cognitive function for cancer patients, making it difficult to demonstrate the value of rehabilitation interventions. Cancer patients are a particularly challenging population, with many tumor- and treatment-related variables impacting function.MethodsInvestigators from nine different cancer rehabilitation programs participated in a modified-Delphi process to delineate necessary aspects of an ideal patient assessment tool, including instrument type, domains evaluated, applicability across a range of patient traits, clinical feasibility, and item response characteristics. This involved numerous meetings, data review, and analysis of items involved in patient assessment.ResultsThe CRMMC developed a 21-item patient-reported outcome measure based on item response theory. The process by which the short form was developed was documented and provides a framework for other clinicians to follow. ConclusionThis document provides a framework for rehabilitation providers to follow when developing an assessment tool. This process is described in a stepwise fashion for reproducibility even in different, non-cancer populations.

The critical need to implement and utilize patient‐reported measures of function in cancer care delivery

“…Smith and colleagues should be commended for performing this psychometric validation of the Cancer Function Brief 3D Profile. After the preliminary development of their measure in previous work, 2,3 the authors undertook the next step of examining the longitudinal construct validity. Such analyses investigate whether a measure actually captures the latent variable for which it has been developed.…”

“…The article titled “Responsiveness and Interpretation of the PROMIS Cancer Function Brief 3D Profile” by Smith et al 1 provides an important psychometric evaluation of a patient‐reported outcome measure (PROM) that specifically assesses patient functioning. The authors, who developed 2 and validated 3 this tool through the Cancer Rehabilitation Medicine Metrics Consortium, provide an exceptional and psychometrically rigorous analysis demonstrating the tool's responsiveness to measuring clinically significant change in function over time for individuals going through active cancer treatment. Valid patient‐reported measures of function are a critical gap in cancer care delivery 4 .…”

Clinical Outcome Assessment in Cancer Rehabilitation and the Central Role of Patient-Reported Outcomes

“…Although the AM-PAC is not cancer-specific, other PROMs have been developed specifically for cancer rehabilitation. An example is the tool by the Cancer Rehabilitation Medicine Metrics Consortium (CRMMC) measuring physical and social function as well as fatigue [ 61 ]. Another instrument focusing specifically on the needs and quality of life of patients with cancer is the Cancer Rehabilitation Evaluation System (CARES), which also exists as a short form (CARES-SF) [ 62 ].…”

Rehabilitation for Symptom Management for Patients with Cancer at the End of Life: Current Evidence and Barriers to Care

“…The Cancer Rehabilitation Medicine Metrics Consortium (CRMMC) is identifying instruments to assess important patient-centered domains in cancer care [73], recently conducting a large-scale study to psychometrically validate the Patient-Reported Outcomes Measurement Information System (PROMIS) Cancer Function Brief 3D Profile [74]. The PROMIS measure changes as a patient's disease advances, allowing for capture of functional decline as part of data collected [74].…”