A new systematic review and meta-analysis published in JAMA Oncology suggests that patient-reported outcomes (PROs) can serve as independent predictors of overall survival (OS) in patients with cancer. The study, led by Ryan S. Huang and colleagues, analysed data from 69 randomised clinical trials (RCTs) encompassing 44,030 patients, making it the largest meta-analysis to date to quantify the prognostic value of PROs.
Key Findings
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Higher baseline global health status (GHQ), physical functioning, and role functioning were associated with improved OS.
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GHQ: HR 0.99 (95% CI, 0.98–0.99)
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Physical functioning: HR 0.94 (95% CI, 0.92–0.96)
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Role functioning: HR 0.96 (95% CI, 0.94–0.98)
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Increased symptom burden predicted poorer survival, including:
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Nausea and vomiting: HR 1.12 (95% CI, 1.04–1.21)
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Fatigue: HR 1.05 (95% CI, 1.00–1.10)
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Pain: HR 1.07 (95% CI, 1.05–1.10)
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Appetite loss: HR 1.04 (95% CI, 1.01–1.07)
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Dyspnea: HR 1.03 (95% CI, 1.00–1.05)
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No significant association was found for cognitive, social, or emotional functioning, or for constipation, insomnia, and diarrhoea.
Methodology
The review included RCTs published from 2000 to 2024 that reported baseline PROs and OS, and adjusted for clinical and disease-related confounders. PROs were assessed using a range of validated instruments, most commonly the EORTC QLQ-C30 (57% of studies) and FACT scales (20%). Among the included trials, 94% reported at least one PRO significantly associated with OS. Meta-analysis was restricted to 31 studies that reported multivariate hazard ratios using the EORTC QLQ-C30.
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Clinical Implications
The study highlights that PROs capture dimensions of patient health not fully reflected by traditional clinical markers such as disease stage or performance status. GHQ and functional scales may reflect underlying physiological resilience, subtle disease progression, or treatment tolerance. Similarly, symptom burden may indicate both the impact of disease and potential interruptions in therapy that compromise survival.
These findings support integrating PRO assessments into clinical decision-making and risk stratification, potentially informing treatment planning, predicting patient outcomes, and guiding supportive care interventions.
Limitations
The authors note variability across trials, potential residual confounding, and the focus on the EORTC QLQ-C30, which may limit generalisability to other PRO instruments. The selective nature of RCT populations may also mean findings differ in routine clinical practice.
Conclusion
Patient-reported outcomes are not just measures of quality of life—they also provide independent prognostic information for survival across diverse cancers. Incorporating PROs into oncology care could enhance personalised treatment planning and improve risk stratification for patients.
Paper: Huang RSChen DBenour A, et al. Patient-Reported Outcomes as Prognostic Indicators for Overall Survival in Cancer: A Systematic Review and Meta-Analysis. JAMA Oncol. Published online September 11, 2025. doi:10.1001/jamaoncol.2025.3153 Access online here.
