CORR Insights®: The Pediatric Toronto Extremity Salvage Score (pTESS): Validation of a Self-reported Functional Outcomes Tool for Children with Extremity Tumors.

Abstract

Outcomes following treatment can be determined with the use of disease-specific outcomes tools like theWOMAC for hip and knee osteoarthritis or, if one seeks a moreholistic view of the patient’s overall well-being, then the use of broader functional outcomes and/or healthrelated quality of life measures may be more appropriate. While subspecialists may tend to focus ondisease or even jointspecific scales, the understanding of a patient’s overall outcome is likely to be incomplete if function and health-related quality of life are not measured [1]. Most oncology studies now include function and health-related quality of life measures, and perhaps because of this, some have delivered important findings [3, 5, 7]. For example, one study found that anxiety and depression was the domain with the greatest change between the time of diagnosis of adult soft-tissue sarcoma and 1-year following completion of treatment [3]. Another study found that body image issues and mobility concerns are common among survivors of sarcoma and these individuals may be reluctant to share these concerns with their providers [7]. Finally, a study on Ewing’s sarcoma survivors reported mild-to-moderate disability and impairments in 32% of patients, with older patients, females, and those with a pelvic site of disease to be at greatest risk of long-term issues [5]. These studies exemplify the importance of a more comprehensive outcome measurement compared to disease-specific or functional outcomes alone. Standardization of health-related quality of life tools and interpretation among children, adolescents, and young adult populations has been recommended on the basis of results from a systematic review [6], in order to improve the information provided by these measures. Before including either functional or health-related quality of life outcome measures in a study, the measurement tool must be validated in the specific population in which it is intended to be used. Absent this information, it is not possible to know whether the outcome tool measures what it intends to measure or does so accurately or in a valid way. In the current study, Piscione and colleagues [4] accomplished this critical task for the pediatric population with benign and malignant bone tumors. By developing and subsequently validating a measure of physical function specific to this patient population, they have contributed a means by which to determine patient reported physical function amongst children and adolescents.