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titleInformation for Reviewers

Text in black is part of the template used to create this document and is not under review. Please review the blue text; this text represents the changes made to the template that are specific to this QRS instrument.

Please especially note assumptions 7 through 9, which discuss the concept of "conditional branching," and Example 1, which shows an example of data not done due to conditional branching in the electronic version of the PRO-CTCAE. Conditional branching replaces the concept of logically skipped items as it allows for situations (such as in the electronic version of the PRO-CTCAE) where items can be not done due to conditional branching. In this case NIH provides scoring for those items not done due to conditional branching. Because it is known that the items were not done due to the symptom not occurring (e.g., when the frequency item response is "neverNever"), any remaining items for the symptom are provided a standardized score of "None" or "Not at all", with a numeric value of 0.

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Title

Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE®) Library Version 1.0 (PRO-CTCAE V1.0)

CDISC ReferenceQuestionnaireSupplement to the Study Data Tabulation Model Implementation Guide for Human Clinical Trials
QRS Short Name

PRO-CTCAE V1.0

QRS Permission StatusApproved
TeamCDISC Questionnaires, Ratings, and Scales (QRS) Subteam
Supplement Version1.0
StatusDRAFT
Date2022-09-0715
NotesThis supplement is intended to be used with other CDISC user guides for specific therapeutic/disease areas and follows the CDISC Study Data Tabulation Model Implementation Guide for Human Clinical Trials.
Known Issue
  • The concept of “conditional branching” in QRS instruments is when the instrument directs the subject to another item of the instrument based on the result of a response compare for a given condition. This concept was reviewed with the CDISC standards teams and it was agreed to use this term instead of “Logically Skipped Item” “logically skipped item” moving forward for this QRS instrument use case. A new QRS variable named “QSCBRFL” with the description of “Conditional Branched Item Indicator” has been requested to be released for release in the SDTMIG v4.0. This new variable will streamline the data representation of conditional branched items.

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Revision History


DateVersion
2022-09-07151.0 Draft
Info

The CDISC PRO-CTCAE V1.0 supplement version Version 1.0 was developed based on the NCI/NIH PRO-CTCAE® website. The website’s PRO-CTCAE Version 1.0 Release Notes release notes indicate the revisions made by NCI/NIH on the PRO-CTCAE 1.0 measurement system. The measurement system version is 1.0 based on the website's release notes (specific correction of typographical errors in the different CRF translations). NCI/NIH will notify CDISC of any major changes in the future that would require a change control to the CDISC PRO-CTCAE V1.0 supplement version.

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The PRO-CTCAE® Measurement System is owned exclusively by National Cancer Institute (NCI). Use of the PRO-CTCAE V1.0 is subject to NCI terms of use policy listed on the website. Based on these terms of use, CDISC considers this instrument exempt from copyright restrictions. CDISC has included this supplement in the CDISC inventory of QRS data standards supplements. Hence, CDISC developed QSTESTCD and QSTEST for each item based on the actual text on the measurement system

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CDISC acknowledges Sandra Mitchell, PhD, CRNP, Research Scientist and Program Director Scientific Lead, Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) Outcomes Research Branch; , Healthcare Delivery Research Program Division Program, Division of Cancer Control and Population Sciences, National Cancer Institute, for the approval to include the PRO-CTCAE V1.0 in the CDISC data standards.

Reference References for the PRO-CTCAE V1.0:

  • These materials discuss and/or include the Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events ( PRO-CTCAE® ) Item Library Version 1.0 (PRO-CTCAE V1.0).   The PRO-CTCAE® Measurement System is owned exclusively by the National Cancer Institute.    No part of the PRO-CTCAE® Measurement System may be adapted, altered, amended, abridged, modified, condensed, made into derivative works, or translated without prior written permission from the US National Cancer Institute.   PRO-CTCAE is a registered trademark of the US Department of Health & Human Services. All rights reserved. For additional terms of use and to access PRO-CTCAE® Measurement System content, please visit: visit https://healthcaredelivery.cancer.gov/pro-ctcae/. PRO-CTCAE is a registered trademark of the U.S. Department of Health & Human Services. All rights reserved.
  • Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) Item Library Version 1.0 (PRO-CTCAE V1.0) (The PRO-CTCAE trademark items and information herein were developed by the Division of Cancer Control and Population Sciences in the National Cancer Institute at the National Institutes of Health, in Bethesda, Maryland, U.S.AUSA. Use of the PRO-CTCAE is subject to NCI’s " Terms of Use". PRO-CTCAE Measurement System content should be downloaded using the "Instrument Instruments & Form Builder ". link (https://healthcaredelivery.cancer.gov/pro-ctcae/).
  • Basch E, Reeve BB, Mitchell SA, Clauser SB, Minasian LM, Dueck AC, Mendoza TR, Hay J, Atkinson TM, Abernethy AP, Bruner DW, Cleeland CS, Sloan JA, Chilukuri R, Baumgartner P, Denicoff A, St Germain D, O'Mara AM, Chen A, Kelaghan J, Bennett AV, Sit L, Rogak L, Barz A, Paul DB, Schrag D. Development of the National Cancer Institute's patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE).J Natl Cancer Inst 2014 Sep 29;106(9)).
  • National Institutes of Health – National Cancer Institute, Division of Cancer Control & Population Sciences. (2017, July 2) https://healthcaredelivery.cancer.gov/pro-ctcae/overview.html

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The PRO-CTCAE measurement system is a patient-reported outcome (PRO) developed to capture symptomatic adverse events of patients in cancer clinical trials. The PRO-CTCAE V1.0 was designed to be used in conjunction with the Common Terminology Criteria for Adverse Events (CTCAE). It consists of an item library rather than a static/fixed item type of instrument. This item library concept is different than other CDISC public domain and copyrighted specific QRS instruments. Users are directed to use the form builder as described on the PRO-CTCAE website to build CRFs with instructions provided by NCI to select the items to implement it in a clinical study. The PRO-CTCAE V1.0 includes multiple-choice questions on the frequency, severity, interference, presence/absence, and /or amount of specific adverse events.

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  1. As a CDISC QRS standard, the supplement name is PRO-CTCAE V1.0, as provided in this document. As an item library, sponsors may select items from the overall library as a subset of items with the same CDISC Controlled Terminology as appropriate for the condition being studied. It is the user's responsibility to identify the subset of items used from the overall PRO-CTCAE V1.0 Item Library (Version 1.0). The subsetted PRO-CTCAE V1.0 user's measurement system should be titled "PRO-CTCAE sponsor-specified symptoms..." based on the sponsor's discretion when they identify the specific items being used. This will distinctly describe the subsetted measurement system from the overall PRO-CTCAE V1.0.
  2. For the PRO-CTCAE V1.0, QSORRES is represented with the text description; the numeric rating is represented in the standardized character and numeric result variables QSSTRESC and QSSTRESN. Please see the PRO-CTCAE website FAQs for more details on the numeric responsesThe responses for the PRO-CTCAE V1.0 are as follows:

    1. Depending on the symptomatic adverse event (AE) being measured, items assessing symptom presence/absence are rated as follows:
      1. Items rated on a binary response scale and rated from 1-0 (e.g., 1 = “Yes” and 0 = “No”);
      2. Items rated on a multiple (more than 2) response scale and rated from 1-0 (e.g., 1 = “Yes” and , 0 = “No”, and “Not applicable”);
    2. Items assessing symptom frequency are rated on a 5-point scale and are rated from 0-4 (e.g., 0 = “Never”, 1 = “Rarely”, 2 = “Occasionally”, 3 = “Frequently”, and 4 = “Almost constantly”).
    3. Items assessing symptom severity are rated on a 5-point scale rated from 0-4 (e.g., 0 = “None”, 1 = “Mild”, 2 = “Moderate”, 3 = “Severe”, and 4 = “Very severe”).
      1. QSTESTCD=PT01036A assessing symptom severity is rated on a 5-point scale rated from 0-4 (e.g., 0 = “None”, 1 = “Mild”, 2 = “Moderate”, 3 = “Severe”, and 4 = “Very severe”, and "Not applicable")
    4. Items assessing symptom interference are rated on a 5-point scale and are rated from 0-4 (e.g., 0 = “Not at all”, 1 = “A little bit”, 2 = “Somewhat”, 3 = “Quite a bit”, and 4 = “Very much”).
    5. Items assessing symptom amount are rated on a 5-point scale and rated from 0-4 (e.g., 0 = “Not at all”, 1 = “A little bit”, 2 = “Somewhat”, 3 = “Quite a bit”, and 4 = “Very much”).
    6. QSTESTCD = "PT01066A " to "PT01071A" sexual symptoms have specific responses .
      1. QSTESTCD=PT01069A and QSTESTCD=PT01070A assessing sexual symptom presence/absence are rated on multiple (more than two2) response scale and rated from 1-0 (e.g., 1 = “Yes” and 0 = “No”, “Not sexually active”, and “Prefer not to answer”).
      2. QSTESTCD=PT01066A, PT01068A, and PT01071A assessing sexual symptom severity are rated on a 5-point scale rated from 0-4 (e.g., 0 = “None”, 1 = “Mild”, 2 = “Moderate”, 3 = “Severe”, and 4 = “Very severe”, "Not sexually active", and “Prefer not to answer”).

      3. QSTESTCD = "PT01067A" assessing sexual symptom frequency is rated on a 5-point scale rated from 0-4 (e.g., 0 = “Never”, 1 = “Rarely”, 2 = “Occasionally”, 3 = “Frequently”, 4 = “Almost constantly”, "Not sexually active", and “Prefer not to answer”).
  3. The CRF represents up to 5 "other symptoms" to be recorded. In discussions with NIH, it was agreed to provide up to 10 "other symptoms" to be recorded if they existed. QSTESTCDs (QSTESTCDs "PT01082A" through "PT01091A") and severity of the symptom at its worst (QSTESTCDs "PT01082B" through "PT01091B").
  4. PRO-CTCAE V1.0 total scoring instructions have not yet been developed. Item-level scores are not combined (i.e., No no total score nor symptom-specific scores are calculated.).
  5. The time period of evaluation for the PRO-CTCAE V1.0 is populated in the QSEVLINT field in ISO 8601 format when the evaluation interval can be precisely described as duration. The evaluation interval for the PRO-CTCAE V1.0 is the past 7 days (QSEVLINT = "-P7D". Please see the PRO-CTCAE website for more details on the evaluation interval.
  6. Items are divided into 15 subcategories represented in the QSSCAT variable. These categorizations represent how the symptom terms are categorized in the PRO-CTCAE V1.0 Item Library (Version 1.0). See Section 4, SDTM Mapping Strategy, for a list of these subcategory values. 
    1. The symptomatic AE being measured by a given item (e.g., the Symptom Term represented on the CRF corresponding to a given item) is stored in the SUPPQS dataset with the QNAM = "QSSYMPTM". This matches the symptom term identified in the PRO-CTCAE V1.0 Item Library (Version 1.0). The exception to this is the solicited verbatim symptom terms QSTESTCD = "PT01081 to PT01091B"with QNAM = "OTHER SYMPTOMS".
  7. Conditional branching is recommended by NCI/NIH in the conduct of the electronic version of the PRO-CTCAE V1.0 for symptom terms that have 2 or more items. The logic branches from frequency, then to severity, then to interference. For example, if frequency is > (greater than) never, next pose the severity question, and if severity > none, pose the interference question. Please see the PRO-CTCAE website for more details on the electronic conditional branching approach.

    1. When a paper version is administered, conditional branching does not apply.
  8. Some items on the PRO-CTCAE may be not done due to conditional branching per the electronic instrument instructions as described in assumption 7. A derived record is created with the assigned responses based on the PRO-CTCAE V1.0 website FAQ and a QS supplemental qualifier variable is used to indicate an item was conditionally branched. Per NIH, these items are assigned values as follows: severity items are assigned responses of "None" and 0; interference items are assigned "Not at all" and 0. When an item is not done due to conditional branching, it is represented as follows:

    1. QSDRVFL = "Y"

    2. QNAM = “QSCBRFL”, QLABEL = “Conditional Branched Item Indicator “, QVAL = “Y” (This this is a QS supplemental qualifier variable.    

    3. QSORRES

      1. For severity items, QSORRES = "None"

      2. For interference items, QSORRES = "Not at all"
    4. QSSTRESC = 0 and QSSTRESN = 0
  9. Records are created in qs.xpt for every item on the sponsor's version of the instrument. In the conduct of the PRO-CTCAE V1.0 NIH expects responses for each item and there should be no missing responses. 
    1. For items not done due to conditional branching, refer to assumption 8.
    2. In the unexpected situation where the reason is unknown, then QSORRES, QSSTRESC, and QSSTRESN are all missing, ; QSSTAT = "NOT DONE", ; and QSREASND is missing.
  10. The language in which the PRO-CTCAE V1.0 was administered (e.g., English, Spanish, Japanese) is collected with the Form Builder application and may be represented as a supplemental qualifier with QNAM = "QSLANGDC". See the PRO-CTCAE V1.0 website for a list of available language translations.
  11. Terminology
    1. QSCAT, QSTESTCD, and QSTEST values are included in CDISC Controlled Terminology.

    2. A full list of value sets for the qualifier, and result fields is provided in Section 4, SDTM Mapping Strategy.

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