Patients, caregivers, and clinicians differ in performance status ratings: Implications for pediatric cancer clinical trials

Background The Lansky Play‐Performance Scale (LPPS) is often used to determine a child's performance status for cancer clinical trial eligibility. Differences between clinician and caregiver LPPS ratings and their associations with child‐reported functioning have not been evaluated. Methods Children aged 7 to 18 years who were receiving cancer treatment and their caregivers were recruited from 9 pediatric cancer centers. Caregivers and clinicians reported LPPS scores, and children completed Patient‐Reported Outcomes Measurement Information System (PROMIS) pediatric functioning and symptom measures before treatment (time 1 [T1]) and after treatment (time 2 [T2]). t tests and mixed‐linear models were used to assess differences in caregiver and clinician LPPS scores; polyserial correlations quantified associations between PROMIS and LPPS scores. Results Of 482 children, 281 had matched caregiver‐ and clinician‐reported LPPS T1/T2 scores. Caregivers rated children significantly worse on the LPPS than clinicians at both T1 (mean, 73.3 vs 87.4; P < .01) and T2 (mean, 67.9 vs 83.1; P < .01). These differences were not related to a child's age (P = .89), diagnosis (P = .17), or sex (P = .64) or to the time point (P = .45). Small to moderate associations existed between caregiver‐ and clinician‐reported LPPS ratings and child‐reported PROMIS scores for mobility (caregiver T1/T2 r = 0.51/0.45; P < .01; clinician T1/T2 r = 0.40/0.35; P < .01), fatigue (caregiver T1/T2 r = –0.46/–0.37; P < .01; clinician T1/T2 r = –0.26/–0.27; P < .01), and pain interference (caregiver T1/T2 r = –0.32/–0.30; P < .01; clinician T1/T2 r = –0.17/–0.31; P < .01). Caregivers and clinicians assigned significantly lower LPPS scores at T2 (caregiver Δ = –5.37; P < .01; clinician Δ = –4.20; P < .01), whereas child‐reported PROMIS scores were clinically stable. Conclusions Significant differences between clinician and caregiver LPPS ratings of child performance were sustained over time; their associations with child reports were predominantly small to moderate. These data suggest that clinician‐reported LPPS ratings by themselves are inadequate for determining clinical trial eligibility and should be supplemented by appropriate measures of a child's functional status reflecting the child and caregiver perspectives. The Lansky Play‐Performance Scale (LPPS) is commonly used by clinicians for determining eligibility for pediatric cancer clinical trials. In this prospective cohort study of children