Journal of Clinical Oncology, Vol 10, 923-928, Copyright © 1992 by American Society of Clinical Oncology
A comprehensive multiattribute system for classifying the health status of survivors of childhood cancer
D Feeny, W Furlong, RD Barr, GW Torrance, P Rosenbaum and S Weitzman
Department of Economics, McMaster University, Hamilton, Ontario, Canada.
PURPOSE: A multiattribute health status classification system was devised
to describe comprehensively the health status of survivors of childhood
cancer. METHODS: The system consists of seven attributes: sensation,
mobility, emotion, cognition, self-care, pain, and fertility. Three to five
levels of functioning are defined for each attribute. Any specific
combination of seven attribute levels constitutes a health state. In the
first survey, the system was used to classify the health status of 20
children currently undergoing therapy for high-risk acute lymphoblastic
leukemia (ALL), Wilms' tumor, or neuroblastoma, and eight who had completed
treatment. A second survey consisted of 13 children with brain tumors on
active treatment. RESULTS: In general, independent ratings by clinicians
were in agreement, and consensus was readily achieved in 1 to 2 minutes per
patient. Children on therapy experienced a higher burden of morbidity than
those off treatment. Brain tumor patients experienced more morbidity than
patients in the first survey. CONCLUSION: The multiattribute system
provides a compact but comprehensive tool for long-term follow-up of
survivors of childhood cancer. It captures both multiple sequelae and
varying levels of severity. By using a mathematical utility function, a
single summary score of health-related quality of life may be assigned to
each health state. Additional studies to establish reproducibility,
validity, responsiveness, and generalizability are indicated.
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