{"doi":"10.1002/cncr.33740","title":"Patients, caregivers, and clinicians differ in performance status ratings: Implications for pediatric cancer clinical trials","abstract":"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.","journal":"Cancer","year":2021,"id":174513,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":23,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8956,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":282788,"name":"Pamela S. Hinds","orcid":"0000-0001-6491-6649","position":1,"is_corresponding":false},{"id":282778,"name":"Bryce B. Reeve","orcid":"0000-0002-6709-8714","position":2,"is_corresponding":false},{"id":282780,"name":"Jennifer W. Mack","orcid":"0000-0001-5791-4178","position":3,"is_corresponding":false},{"id":282779,"name":"Molly McFatrich","orcid":"0000-0001-5202-0335","position":4,"is_corresponding":false},{"id":282786,"name":"Li Lin","orcid":"0000-0003-0530-185X","position":5,"is_corresponding":false},{"id":282783,"name":"Janice S. Withycombe","orcid":"0000-0002-3042-9049","position":6,"is_corresponding":false},{"id":282782,"name":"Shana Jacobs","orcid":"0000-0002-0678-0621","position":7,"is_corresponding":false},{"id":282784,"name":"Justin N. Baker","orcid":"0000-0002-6584-6483","position":8,"is_corresponding":false},{"id":282785,"name":"Sharon M. Castellino","orcid":"0000-0001-8367-2002","position":9,"is_corresponding":false},{"id":230928,"name":"David R. Freyer","orcid":"0000-0001-5280-990X","position":10,"is_corresponding":false},{"id":282781,"name":"Scott H. Maurer","orcid":"0000-0001-5074-1219","position":0,"is_corresponding":true}],"reference_count":28,"raw_metadata":null,"created_at":"2026-07-18T23:47:06.584146Z","pmid":"34196962","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}