Cancer Rehabilitation Publications (2008–2018) With a Focus on Physical Function: A Scoping Review

Abstract

Background

Cancer rehabilitation research has accelerated over the last decade. However, closer examination of the published literature reveals that the majority of this work has focused on psychological interventions and cognitive and behavioral therapies. Recent initiatives have aggregated expert consensus around research priorities, highlighting a dearth in research regarding measurement of and interventions for physical function. Increasingly loud calls for the need to address the myriad of physical functional impairments that develop in people living with and beyond cancer have been published in the literature. A detailed survey of the landscape of published research has not been reported to our knowledge.

Purpose

This scoping review systematically identified literature published between 2008 and 2018 related to the screening, assessment, and interventions associated with physical function in people living with and beyond cancer.

Data Sources

PubMed and CINAHL were searched up to September 2018.

Study Selection

Study selection included articles of all levels of evidence on any disease stage and population. A total of 11,483 articles were screened for eligibility, 2507 full-text articles were reviewed, and 1055 articles were selected for final inclusion and extraction.

Data Extraction

Seven reviewers recorded type of cancer, disease stage, age of participants, phase of treatment, time since diagnosis, application to physical function, study design, impairments related to physical function, and measurement instruments used.

Data Synthesis

Approximately one-third of the articles included patients with various cancer diagnoses (30.3%), whereas the rest focused on a single cancer, most commonly breast (24.8%). Most articles (77%) measured physical function following the completion of active cancer treatment with 64% representing the assessment domain. The most commonly used measures of physical function were the Medical Outcomes Study 36-Item Health Survey Questionnaire (29%) and the European Organization for Research and Treatment of cancer Quality of Life Questionnaire-Cancer 30 (21.5%).

Limitations

Studies not written in English, study protocols, conference abstracts, and unpublished data were excluded.

Conclusions

This review elucidated significant inconsistencies in the literature regarding language used to define physical function, measurement tools used to characterize function, and the use of those tools across the cancer treatment and survivorship trajectory. The findings suggested that physical function in cancer research is predominantly measured using general health-related quality-of-life tools rather than more precise functional assessment tools. Interdisciplinary and clinician-researcher collaborative efforts should be directed toward a unified definition and assessment of physical function.

More than 15.5 million Americans have a history of cancer, and by 2026 the American Cancer Society estimates that this number will increase to 20.3 million.¹ Up to 20% of people who have survived childhood cancer and 53% of people living with and beyond cancer during adulthood have impaired physical function^2–6 that negatively affects their ability to work and participate in life roles^7–11 and increases their risk of mortality.^12–14 Despite the growing population of survivors and their demonstrably high level of functional morbidity, interventions to maintain and improve physical function are essentially absent in oncology care outside of overt disability.^{15  ,  16} Evidence clearly identifies this as a significant gap in cancer care and suggests the need for focused efforts to eliminate this gap.^{15  ,  17–19}

When reviewing the literature on physical function and rehabilitation, it is evident that a clear, consistent, and universal definition is difficult to find. The most common definition the authors found that they believe resonates best with rehabilitation is described by Painter et al.²⁰ Painter et al proposed a definition of physical function that aligns with how most experts characterize rehabilitation: “the ability to perform the basic actions that are essential for maintaining independence and carrying out more complex activities.”²⁰ An individual’s level of physical functioning is an essential building block to performing activities of daily living (ADLs) and instrumental ADLs (IADLs).²⁰ To adequately manage physical function through the cancer continuum, it is requisite to measure function at appropriate times during cancer care using tools that provide insight into meaningful changes related to functional decline. Although a myriad of measurement tools exist, it is unclear how these tools are being leveraged in research and practice beyond just characterizing symptom burden in cancer cohorts. Understanding the current practice of functional measurement in cancer care can provide insight into why such substantial gaps exist in promoting adequate interventions to manage physical function among individuals with cancer.

The purpose of this scoping review was to systematically identify literature published between 2008 and 2018 related to the screening, assessment, and interventions associated with physical function in people living with and beyond cancer.

Methods

This review follows the Transparent Reporting of Systematic Reviews and Meta-Analysis extension for Scoping Reviews checklist and explanation.²¹

Data Sources and Searches

A systematic search was conducted on the basis of the Population/Problem, Intervention, Comparison, Outcome format: patient—any individual (across the life span) with a current or previous oncologic diagnosis; intervention—any study that used patient-reported or clinical measures of physical function to screen, assess, or measure an intervention outcome; comparison—any study that compared interventions designed to improve physical function; and outcomes—any study that reported the use of measurement tools to screen, assess, or measure an intervention outcome.

PubMed and CINAHL Plus were searched with the assistance of a National Institutes of Health biomedical librarian using the time period from January 2008 to September 2018. Title, abstract, keyword, and MeSH terms were searched using the criteria outlined in Appendix 1. Reference lists of all included studies and related systematic reviews were hand-searched for any additional, relevant literature.

Study Selection

Inclusion and exclusion criteria were informed by the authors’ intent to review literature focused on measurement of physical function. Physical function was defined as the ability to perform the basic actions that are essential for maintaining independence and carrying out more complex activities.²⁰ Studies included were published after 2008 on a cancer population, either current or prior, at any point in the life span and included screening, assessment, and/or intervention related to physical function. All published literature that met these criteria were reviewed regardless of study design. Because this was a scoping review, which is designed to provide an overview of the existing evidence base regardless of quality, a formal assessment regarding levels of evidence was not performed.²² The overarching question the authors considered for inclusion was the following: “Does the article provide insight into measurement tools used for screening, assessment and/or intervention related to physical function in individuals with cancer?” Articles were excluded, if they were not available in English; were published prior to 2008; included pharmaceutical interventions; included populations without cancer; were nonhuman studies; were published protocols of ongoing trials; or did not screen, assess, and/or intervene for physical function. Studies of cognitive function were excluded, as were studies of physiological functions or physical activity that had no clear measures of physical function included in the study. Studies of female sexual function that did not include a physical component such as pelvic floor muscle retraining or movement-based activity were excluded. Finally, articles that used a quality-of-life measurement tool that did not directly assess physical function were excluded. This specifically excluded the Functional Assessment of Cancer Therapy tools because these examine physical well-being and symptoms, not physical function as defined by Painter et al²⁰ and Cella et al.²³

Data Extraction

Seven reviewers extracted data from the included studies using an electronic spreadsheet with predetermined, standardized content fields. Data extracted from each article included the following.

Domains of functional measurement

Screening was defined as the use of a measurement tool to identify a symptom, impairment, or problem.²⁴ Assessment was defined as the use of a measurement tool to provide a more in-depth, multidimensional, and comprehensive way to identify the extent of an impairment or functional problem.²⁴ Intervention was defined as the use of a measurement tool to measure change over time as the outcome of an intervention.

Phase of treatment

The phases of treatment were prehabilitation, active cancer treatment, survivorship after active treatment, and palliative care.

Populations

The populations were pediatric (<18 years old), adult (18–65 years old), and geriatric (>65 years old).

Stage of disease

The stages of disease were 0 to III, all stages, and metastatic.

Time since diagnosis

The times since diagnosis were <1 year, 1 to 5 years, and >5 years.

Type of study

The types of study were case study, editorial or commentary, narrative review, systematic review/meta-analysis, observational trials, and controlled trials.

Interval of measurement

The intervals of measurement were cross-sectional, before test/after test, and repeated intervals.

Measurement tools used

The measurement tools were all of the tools that were used in the study and that were specific to physical function.

If there was a discrepancy in the extracted data, the full-text article was reexamined by 2 independent reviewers to arrive at a consensus. No formal quality assessment of individual manuscripts was undertaken following standard practice for scoping reviews.²⁵

Data Synthesis and Analysis

Descriptive data extracted under the coded categories were analyzed quantitatively through summary counts in Microsoft Excel (Microsoft, Redmond, WA, USA) and Tableau (Tableau Software, Mountain View, CA, USA). Data were aggregated for analysis based on the study’s primary application of physical function measures: screening, assessment, or intervention, and the results are presented by these 3 domains.

Results

The search identified 11,479 articles following the removal of duplicates. After initial screening of titles and abstracts, 2507 references underwent full-text review, and 1055 articles were included (Suppl. Fig., available at https://academic.oup.com/ptj). Approximately one-third of the articles included patients with various cancer diagnoses (30.3%), whereas the rest focused on a single cancer, most commonly breast (24.8%) and hematological (8.6%) (Tab. 1). Of the trials, 86% included participants who received some combination of antineoplastic therapies (surgery, chemotherapy, radiation therapy, and/or hormonal treatments). Of the studies that reported disease stage (n = 650), 11.1% focused on metastatic populations.

Table 1.

Descriptive Data

Characteristic	No. of Articles	% of Articles
Cancer type
Bladder	5	0.5
Breast	262	24.8
Brain	38	3.6
Colon	54	5.1
Gynecological	58	5.5
Head and neck	66	6.3
Hematological	91	8.6
Lung	25	2.4
Sarcoma	29	2.8
Other gastrointestinala	21	2.0
Prostate	64	6.1
Variousb	320	30.3
Melanoma	7	0.7
Testicular	5	0.5
Other cancers	11	1.0
Adult survivors of childhood cancerc	40	3.8
Disease stage
0–III	467	44.3
All stages	109	10.3
Not reported	406	38.5
Metastatic (IV+)	73	6.9
Phase of treatment
Prehabilitation	28	2.7
Active cancer treatment	171	16.2
Survivorship after active cancer treatment	814	77.1
Palliative treatment	4	0.4
Not reported	38	3.6
Population
Adult >18 y old	842	79.8
Pediatric <18 y old	69	6.5
Geriatric >65 y old	97	9.2
Not reported	46	4.4
Domain
Screening	206	19.5
Assessment	648	61.4
Intervention	200	19.0
Study type
Case report	17	1.6
Editorial	32	3.0
Narrative review	103	9.8
Controlled trials	346	32.8
Systematic reviews	85	8.1
Observational studies	472	44.7

^a Other gastrointestinal includes all cancers of the gastrointestinal tract including esophageal, stomach, gall bladder, pancreas, intestinal, excluding sarcomas.

^b Various are studies for which the population is comprised of more than 1 type of cancer.

^c Adult survivors of childhood cancers were identified as a unique cohort within the adult population.

Phase of Treatment

Most articles (77%) measured physical function following the completion of active cancer treatment. Only 16% featured the active cancer treatment phase, and 0.3% were palliative care. Prehabilitation phase, prior to onset of cancer treatments, was highlighted in 2.6% of the studies, including 7 for lung cancer and 6 for colorectal cancer (Tab. 1). Prehabilitation studies that screened physical function most commonly used broad oncology-based performance status measures such as Karnofsky Performance Scale and the Eastern Cooperative Oncology Group performance measure. Alternatively, a number of prehabilitation studies measured changes in cardiorespiratory fitness and ADL/IADL with more specific measures over the duration of a rehabilitative intervention designed to prepare people for their pending antineoplastic therapies (Suppl. Tab., available at https://academic.oup.com/ptj).

Of 171 studies focused on physical function during active cancer treatments, 13 (7.6%) targeted geriatric populations (most commonly prostate cancer) and 16 (9.4%) were pediatric (typically hematologic cancers) (Tab. 1). A few were undertaken during isolated cancer therapy: 0.2% radiation, 1% chemotherapy, and 0.6% hormonal therapy. In these instances, functional endpoints measured the impact of treatment side effects (eg, neuropathy, fatigue, joint arthralgias) or of an intervention targeting side effects of treatment (eg, exercise for fatigue or loss of lean mass).

Most (64%) of the 814 studies of survivorship after active cancer treatment were in the assessment domain, and 64% of those implemented a cross-sectional design to characterize the functional impact of various cancer treatments and side effects on the individual (Suppl. Table). Studies classified as screening were primarily observational (69%) that used survey data from a larger ongoing study, obtained retrospective data on physical functional measures, or surveyed a population to assess physical function. A total of 128 controlled trials were conducted after active cancer treatment, with 75% of those being intervention trials. Of studies that reported time since diagnosis (n = 610), 45.5% were conducted on populations >5 years after the completion of cancer treatments, 34.5% were within 1 to 5 years of treatment, and 20% were <1 year from diagnosis (Suppl. Table).

Age Group of Interest

The most frequently studied age group (80%) was adults more than 18 years old, whereas 9.1% of studies focused on geriatrics (>65 years old) and 6.5% (n = 69) focused on pediatrics (<18 years old) (Tab. 1). Of the adult studies, 4.8% (n = 40) highlighted people who survived childhood cancer. The geriatric studies were primarily (41%) breast or prostate cancer but 25% included a variety of cancer types. Studies focused on geriatric and pediatric populations routinely utilized age-specific functional measures (eg, Pediatric Quality of Life Inventory and Comprehensive Geriatric Assessment).

Domain of Measurement Application and Functional Measurement Tools

Of the included studies, 61.5% assessed physical function, 19.5% screened for impairment, and 19.0% applied functional tools to measure effectiveness of an intervention. Figures 1 through 3 illustrate the most used tools by type of cancer for each of the 3 application domains. The Medical Outcomes Study 36-Item Health Survey Questionnaire (SF-36) was the most frequently used measure for screening (n = 39), assessment (n = 186), and intervention (n = 57). Across all 3 domains, the most commonly used measures of physical function were the SF-36 (29%), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire–Cancer 30 (EORTC QLQ-30) (21.5%), specific symptom-based modules of the EORTC (10%), the 6-minute walk test (7.4%), and other self-developed tools (13%). The latter term describes tools or surveys developed by authors for their own use.

Figure 1.

Frequency of screening measurement tools by cancer. 1RM = 1-repetition maximum; 6MWT = 6-Minute Walk Test, DASH = Disabilities of Arm, Shoulder, and Hand; EORTC = European Organization for Research and Treatment of Cancer; Performance Status Scale = Performance Status Scale for Head and Neck Cancer, QLQ-C30 = Quality of Life Questionnaire-Cancer; SF-36 = Medical Outcomes Study 36-Item Health Survey Questionnaire; SPADI = Shoulder Pain and Disability Index; TUG = Timed ``Up & Go''; University of California = University of California, San Diego - Shortness of Breath Questionnaire (UCSD-SOBQ) for Chronic Obstructive Pulmonary Disease (COPD); VO2max = maximum oxygen consumption.

Figure 3.

Frequency of intervention measurement tools by cancer. CTCAE = Common Terminology Criteria for Adverse Events; ECOG = Eastern Cooperative Oncology Group; EORTC = European Organization for Research and Treatment of Cancer, QLQ-C30 = Quality of Life Questionnaire-Cancer; SF-12 = Medical Outcomes Study 12-Item Health Survey Questionnaire; SF-36 = Medical Outcomes Study 36-Item Health Survey Questionnaire; TUG = Timed ``Up & Go''; UW-QOL = University of Washington Quality of Life Questionnaire; VAS = visual analog scale; UCLA-PCI = UCLA Prostate Cancer Index.

Figure 2.

Frequency of assessment measurement tools by cancer. 1-RM = 1-repetition maximum; 6MWT = 6-Minute Walk Test; 12MWT = 12-Minute Walk Test; 400m walk = 400-Meter Walk Test; BMI = body mass index; DASH = Disabilities of Arm, Shoulder, and Hand; EORTC = European Organization for Research and Treatment of Cancer; EQ-5D-5L = 5-level version of the EuroQol; KPS = Karnofsky Performance Scale; PedsQL = Pediatric Quality of Life Inventory, Performance Status Scale = Performance Status Scale for Head and Neck Cancer, PROMIS = Patient-Reported Outcomes Measurement Information System, QuickDASH = Quick Disabilities of Arm QLQ-C30 = QLQ-C30 = Quality of Life Questionnaire-Cancer, SF-12 = Medical Outcomes Study 12-Item Health Survey Questionnaire; SF-36 = Medical Outcomes Study 36-Item Health Survey Questionnaire; TUG = Timed ``Up & Go''; VAS = visual analog scale.

Impairment Findings

Impairment data were extracted from controlled trials, observational studies, and narrative and systematic reviews. Up to 5 impairments (if applicable) and all measurement tools were extracted for each article. However, because of the magnitude of data extracted in this scoping review, we elected to report only on primary and secondary impairments identified and the first 3 measurement tools reported in each study (Appendixes 2–  7). (The reader can review online supplementary tables [available at https://academic.oup.com/ptj] for the full data set.) The most frequently measured physical impairments were health-related quality of life (HRQOL), ADLs/IADLs/extended IADLs, swallowing and speech, incontinence, cardiorespiratory fitness, weakness, sexual function, and cancer treatment–related symptoms (pain, fatigue, lymphedema, and neuropathy).

Appendixes 2 through 7 provide a detailed breakdown of the top 3 measurement tools identified in studies based on type of cancer and the primary and secondary impairments. Although reviewers extracted up to 5 impairments from each study and characterized all of the measurement tools used within a study, only the primary and secondary impairments and the top 3 measurement tools are presented in this article; the remainder of the information is available in online supplementary material (available at https://academic.oup.com/ptj).

Appendixes 2 through 7 show the combination of measures by impairments and reveal that specific impairment-based measurement tools (measures of balance, swallowing, and incontinence) were frequently combined with more generic tools, such as the SF-36 or the EORTC, likely to characterize a specific impairment in greater detail than these general tools allow. The Supplemental Table characterizes the number of different tools used for impairment measurement.

Discussion

To our knowledge, this is the first scoping review on measurement of physical function in individuals who have or have had cancer. Results suggest that in cancer research, physical function is predominantly measured using general HRQOL tools rather than more precise functional assessment tools. Further, results point to inconsistencies in language used to describe physical function, measurement tools used to characterize function, and application of those tools across the cancer treatment and survivorship trajectory. No universally accepted operational definition of physical function was identified. Each gap revealed by this scoping review is also a research and practice opportunity with potential to improve the measurement and management of physical function in interprofessional cancer care (Tab. 2).

Table 2.

Knowledge Gaps Present in Cancer Rehabilitation Research and Clinical Practice Opportunities^a

Knowledge Gap	Cancer Rehabilitation Research Opportunity	Knowledge Translation/Clinical Practice Implementation Opportunity
Universal physical function definition	Identify gold standard tools/battery for cancer settings; validate reliable core measures with minimal floor and ceiling, responsive to a range of cancer treatments and across life-span	Achieve interprofessional collaboration toward a unified definition of physical function, responsive to cancer journey and able to transcend discipline-specific needs
Baseline cross-sectional physical function assessment	Expand evidence base for predictive and prognostic value of baseline physical function for outcomes, including treatment tolerance and overall survival	Inform surgical, medical, and radiation oncology for physical function consideration during prescription of cancer treatment (modality and/or dose)
Prospective physical function assessment, started before cancer treatment	Establish value and effectiveness of cancer rehabilitation prospective surveillance models; quantify natural history of physical function by cancer site and treatment	Provide preemptive education for early detection of new deficits over course of cancer treatment; assist radiation and medical oncologists in titrating treatment dose on basis of patient response
Prospective assessment focused on impact of a single agent or specific multimodal regimen	Identify mechanisms behind functional decline	Assist medical and radiation oncology colleagues in titrating dose for individual patient response
Prehabilitation	Expand evidence base for prehabilitation approaches improving treatment outcomes and survival, with prehabilitation models targeting cancer site- and treatment-specific factors and designed to inform specifics of a prescription	Implement existing evidence for prehabilitation by promoting these models as standard of care
PROMIS physical function scales for cancer	Establish expanded psychometric properties for use in screening, assessment, and capturing change with intervention in cancer rehabilitation	Initiate/expand use of CAT-based measures to quantify severity of deficits and capture changes to justify care
Performance-based assessment	Enrich study assessments by complementing patient-reported outcomes with actual measures of performance, known to capture complementary but distinct aspects of the domain	Supplement patient-reported outcomes with tests less prone to intentional censorship of deficits (eg, for fear of treatment discontinuation)
Outcomes to capture physical function changes in response to cancer rehabilitation interventions	Validate best outcomes to capture changes in physical function and use in studies of interventions to rehabilitate and prehabilitate physical function	Measure and report individual physical function–focused outcomes of cancer rehabilitation in provision of value-based care

^a CAT = computer-adapted technology; PROMIS = Patient-Reported Outcomes Measurement Information System.

Opportunity: Assess Function Prospectively From a Pretreatment Baseline

In the articles reviewed, physical function assessment was overwhelmingly cross-sectional and occurred well into the posttreatment survivorship phase with >45% of studies taking place >5 years after treatment completion. Posttreatment functional status is important but difficult to interpret without a pretreatment baseline or a matched cancer- or treatment-free comparison group. This highlights one of the most significant gaps in current evidence and practice: prospective assessment of functional changes from a pretreatment baseline.

Cancer treatment–related functional problems are underidentified and undertreated.²⁶ Less than 2% of individuals who present with clinically identifiable functional limitations are referred for rehabilitation services to manage these limitations.^{16  ,  27} In the absence of rehabilitation, conditions like cancer-related fatigue, lymphedema, and chemotherapy-induced peripheral neuropathy may lead to life-long disability.^{28  ,  29} Many treatment-induced impairments that contribute to functional decline during cancer treatment are amenable to rehabilitation. When intervention is implemented early in the oncology care plan, physical impairments can be effectively managed to prevent or mitigate functional decline.^{27  ,  30} Theoretical models that promote proactive functional assessment and interventions to maximize function, leveraging rehabilitation professionals, were common among narrative reviews and commentary articles in our results.^{27  ,  31  ,  32} However, controlled trials testing such models were rare.

Cancer rehabilitation prospective surveillance models were first published nearly a decade ago, yet they are not the clinical standard of care, even for cancers (breast, head and neck) with well-documented and predictable neuromusculoskeletal impairments.^33–36 The clinical goals of prospective models are to repeatedly screen and educate at routine intervals during cancer treatment to facilitate early identification and intervention to mitigate or even prevent functional decline.^{32  ,  36} Early identification and management of symptoms does more than support survivors; recent findings suggest that life span is extended when supportive care begins at the time of an advanced cancer diagnosis.^{37  ,  38}

Baseline functional assessment can also assist medical, surgical, and radiation oncology teams as they prescribe life-extending cancer therapies. Often, patients are refused optimal cancer therapeutics based on a provider’s subjective appraisal of their physical performance. Using specific patient-reported tools and clinical performance tests may support more accurate classification of physical function, enabling greater precision in oncologic treatment planning.^{39  ,  40} The model for baseline functional assessment also enables prehabilitation interventions for those individuals who fall in “borderline” categories for physical tolerance to cancer therapies and may enable them to jump to the “fit for treatment” category.

As a research opportunity, prospective assessment would provide historical comparison data for the natural history of functional change during cancer treatment, the absence of which confounds discussions of how to achieve optimal long-term survivorship.⁴¹ Data on proactive functional changes through cancer treatment can support delivery of exercise and rehabilitative interventions of the most appropriate intensity in the least restrictive environment to promote function. Evidence is rapidly growing to support the predictive and prognostic value of baseline physical function for cancer outcomes, ranging from reduced surgical complications to overall survival.^{42  ,  43} Experts have identified physical function as an emerging prognostic biomarker in cancer.⁴⁴ Ample opportunity exists to further explore physical function as a prognostic biomarker, because there is no single gold standard physical function metric.

Opportunity: Identify Predictive and Informative Transdisciplinary Tools

Although patient-reported and performance measures were both identified, our scoping review results are clear: physical function was more commonly assessed through patient report than by actual measurement of physical performance, and the resulting characterization of function was largely based on subscales of larger HRQOL measures. An optimal tool predicts meaningful outcomes, informs the specific nature of a survivor’s functional decline, and detects meaningful changes that necessitate triage for intervention. This review identified a preponderance of nonspecific tools applied for both screening and assessment of physical function; we suspect this is a key factor leading to the relative underreporting and undertreatment of cancer-related functional problems.

Patient-reported measures

The most frequently used scale to measure physical function was the nonspecific SF-36, followed by the cancer-specific EORTC and its site- and symptom-specific derivations. These measures primarily capture HRQOL, but the physical function scales offer a limited assessment of the broad range of extended ADLs. Furthermore, these tools may not be responsive to measuring functional change over time.⁴⁵

Likely because it is newer, the Patient-Reported Outcomes Measurement Information System (PROMIS) measures were rarely identified among the articles reviewed. PROMIS uses a computer-adapted technology format with follow-up questions offered or withheld based on the answer to a “stem” and accommodates individual patient responses. PROMIS offers greater responsiveness with less burden.⁴⁶ A set of PROMIS tools are specifically designed and validated for cancer populations.⁴⁷ Another computer-adapted technology functional assessment tool, the Activity Measure Post Acute Care, is being tested in prospective surveillance trials.^{48  ,  49} These individualized tools may provide greater specificity in functional assessment in the future.

Performance measures

Performance measures commonly used in oncology care, such as the Eastern Cooperative Oncology Group performance measure or the Karnofsky Performance Scale, are based on provider observation and lack specificity in functional assessment. Although these scales provide a quantitative score, they are not informed by objective or quantifiable measures of performance. Recent reviews in geriatric oncology identify shortcomings in the ability of these tools to accurately identify important and emerging functional changes, challenging their specificity compared with a more comprehensive battery of tests.^{50  ,  51}

Clinical performance measures reported in this review ranged from the Timed “Up & Go” (TUG) Test and the 6-minute walk test to more comprehensive assessments like the Short Physical Performance Battery. Questions exist regarding the responsiveness of some tools like the TUG Test and the Activity Measure Post Acute Care, which were validated in disabled populations outside of oncology. Their use in oncologic populations, specifically the potential for ceiling effects when applied to higher functioning cohorts, is concerning considering the wide variability in impairment severity that an individual can experience through cancer care.^{52  ,  53} Many individuals express self-reported concerns about physical function below their personal baseline, or “normal,” even when their clinical measures improve.⁵³ Reconciling discordant patient-reported measures and clinical performance measures is a documented challenge.⁵²

Identifying an optimal interdisciplinary tool valid across diverse cancer populations will prove challenging, especially one that can meet a range of needs across the life span. Increasingly, validated scales that serve multiple needs in similar populations are often batteries of tests.⁵⁴ The geriatric assessment for people living with and beyond cancer is now a well-validated battery of tests and includes a physical performance test (TUG test) to supplement patient report, but, as intended, its validation has been limited to older adults.^{55  ,  56} Moreover, ADLs and IADLs are increasingly supported in the literature as predictors of meaningful cancer outcomes specifically in breast and prostate cancers.^57–59 Performance assessment batteries⁶⁰ fit well within the expertise of rehabilitation providers, yet our scoping review suggests that IADLs are currently captured primarily by patient report, perhaps for feasibility.

Interestingly, recent evidence suggests that gait speed, as a single performance-based measure of function mobility, is almost as useful as larger batteries, such as the Comprehensive Geriatric Assessment, yet is less burdensome and more clinically feasible.⁶¹ As a single performance measure valid for both risk stratification and outcomes assessment, gait speed is one of the physical function tools validated in oncologic populations^{53  ,  62} and correlates well with other performance measures (6-minute walk test and TUG test).⁶³

Identifying a single tool capable of capturing all domains of physical function across the cancer experience (premorbid status, cancer site, cancer stage, and the highly individualized response to treatments), and applicable to all disciplines within cancer rehabilitation, will be no small task. Emphasis should initially be placed on studying the construct of repeated measures and the responsiveness of these tools to functional change. Future research endeavors can then explore effective combinations of measures based on an individual presentation. This patient-specific approach is being championed by policy makers in oncology care delivery.⁶⁴

Opportunity: Selective Assessment of Single Antineoplastic Modalities or Regimens

In more than 80% of articles reviewed, patients had received multiple cancer treatment modalities (eg, surgery, radiation, and chemotherapy). This is likely due to the propensity of cross-sectional assessments conducted long after treatment ended. Although these studies provide insight into the incidence of late effects, they fail to characterize mechanisms for functional decline based on single treatment modalities. More selective prospective observation, with pretreatment baseline, would inform the critical knowledge gap of mechanisms behind physical function declines by specific cancer population and treatment regimen. For example, chemotherapy-induced peripheral neuropathy is known to negatively affect ADLs and functional mobility because of sensory, proprioceptive, and motor deficits. Functional measures taken before and during the delivery of neurotoxic chemotherapy agents may facilitate triage for rehabilitative interventions that can mitigate functional decline.⁶⁵ Some specificity of functional measures to guide intervention was identified around the perioperative time period, primarily in breast cancer and targeting restoration of upper extremity mobility. The premise that surgery incites functional deficits that require rehabilitative interventions is well regarded.^66–68 There is merit to carrying this rationale over to chemotherapy, radiotherapy, and hormonal therapy because the morbidity burden is equally, if not more, important in context to the treatment rendered.

Opportunity: Align Semantics for Concise and Precise Functional Assessment

Inconsistencies in language and terminology are notable across the studies in this review. Perhaps this relates to the lack of a universally accepted definition of physical function. The semantic variations present a conflict when attempting to look across studies and draw conclusions on optimal approaches to measure and manage physical function.

Physiological function versus body structure and function

We identified significant variance in the clinical measures used and their extrapolations as a reflection of functional status. One prominent conflict was physiological functions (eg, cardiac ejection fraction, maximum oxygen consumption, pulmonary expiratory volume) and measures of body structures and functions (eg, joint range of motion, muscle power, muscle strength) assessed as proxies for overall physical functioning. Although measures of physiological function, or of body structures and functions, provide insight on the components of body systems, they fail to assess how the individual performs activities and participates in daily life.

Physical activity versus physical function

Some articles purporting to measure physical function actually assessed levels of physical activity. To some extent, whether an individual chooses to be active and participate may speak to their ability to be active and participate. Although physical activity prominently features in observational studies^{12  ,  69} and changes in physical activity levels correlate to cancer disease endpoints, more detailed assessment of how physical function affects physical activity levels should be explored because these are 2 different constructs. Promoting physical activity is a mainstay of cancer control science; however, without perspective on the physical function of people living with and beyond cancer, there may be a critical piece missing in the rationale for population approaches to encouraging physical activity. Physical impairment introduces barriers to achieving optimal levels of physical activity. Clearly delineating between these constructs yet elucidating on their dependent relationship is a need.

Body structure and function versus activities and participation

Although there is an intimate relationship between body structures and functions, and activities and participation, the measure of function in life roles is the most relevant measure of ability or disability. Individuals may be severely incapacitated in body structure and functions (eg, an individual with multiple limb loss) but still able to function in life roles at a high level with supportive services and devices. Therefore, gross measures of impairment, such as joint range of motion, oxygen consumption, and limb volume, may minimally reflect an individual’s ability to participate in life roles. For example, an individual with severe lymphedema may still carry out self-care strategies independently with modifications. Although impairment severity is highly relevant to a plan of care that improves activities and participation, solely assessing the severity of 1 or more impairments is an inadequate measure of function.

Future Recommendations

Achieving an interval prospective surveillance approach that seeks to optimize physical function in oncology will require reliable, predictive, and responsive measures of physical function; a framework for proactive, repeated functional measurement; and clinical pathways to facilitate triage into rehabilitation systems.

With regard to reliable, predictive, and responsive measures of physical function, a variety of patient-reported and clinical measures that examine function have been reported in the literature; however, many of these lack reported psychometric properties specific to the cancer population.^70–72 Additionally, little is known regarding what objective measures of function may predict changes in specific symptoms related to cancer. Future studies should incorporate both patient-reported outcomes as well as objective measures that have sound psychometrics in the cancer population in order to identify functional deficits that are of primary concern to individuals with cancer and may result in symptom interference with functional activities.

A framework for proactive, repeated functional measurement through the duration of cancer treatments should be used to periodically reassess the risk for or the presence of clinically meaningful changes in function. Achieving this aim will require a clear definition of physical function, a rigorous and reproducible assessment protocol, and a pathway to clinical implementation that allows for flexibility in the framework based on the individual, their cancer type, and anticipated treatments.

Clinical pathways to facilitate triage into rehabilitation systems should be used to promote proactive interventions to optimize function throughout the cancer trajectory. This approach not only positively affects an individual’s function during cancer treatment but also promotes optimal long-term function in this population.⁴¹

Limitations of This Scoping Review

We recognize many limitations inherent to this scoping review. Most importantly, we urge readers to interpret the findings with attention to the methods used in this literature search and data extraction. After careful discussion, the extraction team applied the definition of physical function published by Painter et al,²⁰ but individual interpretation occurs even within a seemingly clear definition. Article selection, initially by review of abstracts and then full text, required concordance from 2 reviewers, but there was some opportunity for interrater deviation on key variables during the extraction process.

The operational definitions used in this scoping review are more specific to physical function than prevailing practice in oncology. Although this was intentional to elucidate the gaps in physical function measures, common practice in clinical trials actually supports the use of nonspecific HRQOL tools in clinical trials.

The sheer volume of articles included in this scoping review presented another limitation. Processing >7000 initial hits required significant time from the authorship team, making it impossible to include newly released articles, yet we recognize that publications on this topic are growing exponentially. New publications may counter some of our conclusions by the time of publication. Additionally, although the results are intended for application to the diverse disciplines of cancer rehabilitation, all authors are physical therapists.

Lastly, we did not assess the feasibility of functional measurement nor reports of the rates of complete or missing functional data in trials. Time burden is a recognized issue for patients being asked to complete these tests and assessments. As well, providers experience a time burden in administering, interpreting, and determining a plan of care based on these tests. Closer examination of feasibility and models for implementation of a functional framework are needed.

Conclusion

In summary, this scoping review, the first of its nature, adds to the literature on physical function over the cancer trajectory and across the life span. Functional decline is prevalent in individuals diagnosed with cancer both during and after cancer treatments. Functional morbidity may drive the psychological and emotional issues faced by persons with cancer. Functional loss too often goes undetected until severe. Results of this scoping review suggest that 1 contributor is a lack of consensus about a single physical function definition and best measures of physical function. Although it is clear that both the Eastern Cooperative Oncology Group performance measure and the Karnofsky Performance Scale lack the specificity to measure discrete limitations in physical function and fall short of prompting triggers for triage to rehabilitation, we are unable to promote a single tool or assessment battery as a physical function gold standard based on results of this review. Research opportunities are vast.

The authorship team encourages interdisciplinary and clinician-researcher collaborative efforts toward a unified definition and assessment of physical function, one appropriate for both cancer rehabilitation research and practice. Such efforts should consider current needs for evidence behind (1) baseline assessment for optimal risk-stratification to inform triage for prehabilitation but also immediate cancer treatment prescription, (2) prospective surveillance to capture earliest decline, and (3) outcomes to measure effectiveness of cancer rehabilitation interventions and preventions. We encourage the use of measurement tools specific to activity and participation and the broad assessment of physical function beyond physiological tests and measures that may or may not correlate with overall function. It is likely that no single, static battery will meet all screening, assessment, and intervention needs in the diverse field of cancer rehabilitation, across the life span, and along the cancer trajectory from diagnosis to late survivorship. Even so, settling on a universal definition of physical function is a critical first step.

Author Contributions and Acknowledgments

Concept/idea/research design: S.E. Harrington, N.L. Stout, E. Hile, M.I. Fisher, M. Eden, V. Marchese, L.A. Pfalzer

Writing: S.E. Harrington, N.L. Stout, E. Hile, M.I. Fisher, M. Eden, V. Marchese, L.A. Pfalzer

Data collection: S.E. Harrington, N.L. Stout, E. Hile, M.I. Fisher, M. Eden, V. Marchese, L.A. Pfalzer

Data analysis: S.E. Harrington, N.L. Stout, E. Hile, M.I. Fisher, V. Marchese, L.A. Pfalzer

Project management: S.E. Harrington, N.L. Stout

Providing facilities/equipment: M.I. Fisher

Clerical/secretarial support: N.L. Stout

Consultation (including review of manuscript before submitting): N.L. Stout, M. Eden, L.A. Pfalzer

The authors thank Judith Welsh, (now retired) biomedical librarian from the National Institutes of Health, Clinical Center Library for her guidance on the search strategy and methods for this review. We would also like to thank the American Physical Therapy Association for providing Covidence access to support this review.

Funding

There are no funders to report.

Systematic Review Registration

This scoping review was not registered in PROSPERO.

Disclosures

The authors completed the ICMJE Form for Disclosure of Potential Conflicts of Interest and reported no conflicts of interest. The views expressed do not reflect the official positions or policies of the National Institutes of Health, the Department of Health and Human Services, or the US Government.

Appendix 1

Search Criteria

PubMed 9369 CINAHL 4437 (after filters Human, English, Last 10 years).

(Cancer and Survivor or survivorship) AND (Function or functional or clinical and assessment or screening or measurement OR outcomes) AND (activities of daily living OR ambulation OR amputation OR anemia OR anorexia OR arthralgia OR arthralgias OR balance OR bone density OR cardiopulmonary fitness OR cardiotoxicity OR clinical OR distress OR dyspnea OR edema OR edema OR endurance OR exercise capacity OR fall OR falls OR fatigue OR fatigued OR fibrosis OR fitness OR flexibility OR frail OR frailty OR function OR functioning OR functional OR heart failure OR independent activities of daily living OR insomnia OR immobility OR immune suppression OR impairment OR impairments OR limb salvage OR lymphedema OR lymphoedema OR mobility OR morbidity OR muscle strength OR neutropenia OR neuropathy OR neurotoxicity OR ototoxicity OR paresthesia OR performance status OR quality of life OR pain OR paralysis OR physical performance OR physical strength OR radiculopathy OR range of motion OR respiratory function OR return to work OR risk reduction OR scar OR seizures OR self-care OR sensation OR sensory OR shortness of breath OR skin OR sleep OR strength OR survival OR swelling OR symptom OR symptoms OR thrombocytopenia OR tissue contracture OR walk OR weakness OR weight OR work OR wounds).

 

Appendix 2.

Screening for Physical Education

Most Frequently Reported Tools (>5 Studies)  a	No. of Studies
SF-36	59
EORTC–Cancer 30	48
EORTC modules	30
Other self-developed tools	43
Common terminology criteria for adverse events	23
Eastern Cooperative Oncology Group	17
Pain VAS	17
Comprehensive geriatric assessment	15
Fatigue VAS	15
Timed Up & Go Test	13
MD Anderson Dysphagia Inventory	10
Karnofsky Performance Scale	9
Distress thermometer	9
European Quality of Life–5 Dimensions instrument	8
University of Washington Quality of Life Questionnaire	8
Expanded Prostate Cancer Index Composite	7
Pediatric Quality of Life Inventory	7
Short Form-12 Medical Outcomes Study 12-Item Health Survey Questionnaire	7
6-Min walk test	6

^a Studies using >3 measurement tools. EORTC = European Organization for Research and Treatment of Cancer Quality of Life Questionnaire; SF-36 = Medical Outcomes Study 36-Item Health Survey Questionnaire; VAS = visual analog scale.

 

Appendix 3.

Measurement Tools for Screening^a

	Impairments
Type of Cancer	Primary	Secondary	Measurement Tool 1	Measurement Tool 2	Measurement Tool 3
Brain	ADLs/IADLs/extended IADLs		Karnofsky Performance Scale (KPS)	Eastern Cooperative Oncology Group performance scale (ECOG)
	HRQOL	ADLs/IADLs/extended IADLs	EORTC QLQ-C30	EORTC modules	MD Anderson Symptom Inventory
Breast	ADLs/IADLs/extended IADLs		Life Satisfaction Questionnaire-11 (LiSat-11)	Other self-developed tools
	Fatigue	HRQOL	SF-36	ECOG
		Pain	Therapy-Related Symptom Checklist (TRSC)	Linear Analogue Self-Assessment (LASA)	Daily Activities Rating Scale (DARS)
	HRQOL		EORTC QLQ-C30	SF-36
			Health Utilities Index	SF-36
			Other self-developed tools	EORTC QLQ-C30	SF-36
			SF-36	ECOG
			World Health Organization Quality of Life-100 (WHOQOL-100)	EORTC modules
		ADLs/IADLs/extended IADLs	EORTC QLQ-C30	EORTC modules
		Fatigue	EORTC QLQ-C30	EORTC modules	Fatigue visual analog scale (VAS)
					Other self-developed tools
		Sexual function	General Health Questionnaire (GHQ)	SF-36	Watts Sexual Function Questionnaireb
	Lymphedema	ADLs/IADLs/extended IADLs	Lymphedema Symptom Intensity and Distress Survey–Arm (LSIDS-A)
			Water displacement	Pain VAS	Arm symptom VASb
		HRQOL	EORTC QLQ-C30	EORTC modules	Water displacement
		Upper limb function	Upper Extremity Functional Index (UEFI)	QuickDASH	Pain VAS
		Pain	AROM	Swelling	QuickDASHb
	Neuropathy	ADLs/IADLs/extended IADLs	Neurotoxicity score	ECOG	SF-36
	Return to work		Self-Focused Emotional Labor Scale	Work Ability Index	Work Limitations Questionnaireb
	Pain	ADLs/IADLs/extended IADLs	Brief Pain Inventory (BPI)	WOMAC Index	DASHb
			SF-36	Pain VAS
	Cardiorespiratory fitness		SF-36	TUG Test	30-seconds sit to stand
	Sexual function	HRQOL	Pelvic Floor Distress Inventory	ECOG
Colon	HRQOL		EORTC QLQ-C30	EORTC modules
				ECOG
		ADLs/IADLs/extended IADLs	SF-36	ECOG
		Fatigue	EORTC QLQ-C30	EORTC modules
	Neuropathy		EORTC modules	ECOG	Total Neuropathy Score
		Fatigue	Other self-developed tools	Fatigue VAS
		HRQOL	Common Toxicity Criteria for Adverse Events, Version 3	Total Neuropathy Score	World Health Organization Quality of Life instrumentb
Gynecological	ADLs/IADLs/extended IADLs		ECOG
			World Health Organization International Classification of Functioning, Disability and Health (ICF)	Other self-developed tools
	Fatigue	HRQOL	Fatigue Questionnaire	Patient Health Questionnaire-9	EORTC QLQ-C30b
			Fatigue VAS	Other self-developed tools
	Fecal incontinence		Other self-developed tools	Fecal Incontinence Severity Index
	HRQOL	Fatigue	EORTC QLQ-C30	SF-36
			SF-36
		Pain	KPS	EORTC QLQ-C30
	Neuropathy	Balance	Chemotherapy-Induced Peripheral Neuropathy Assessment Tool (CIPNAT)	TUG Test	Fullerton Advanced Balance (FAB)
		HRQOL	Other self-developed tools	ECOG
	Cardiorespiratory fitness		Peak oxygen consumption	Fatigue VAS
	Sexual function	Fatigue	EORTC QLQ-C30	CALGB Sexual Functioning Scale	Other self-developed tools
		HRQOL	KPS	Fatigue Symptom Inventory Revised (FSI TDI)	Short Form-12 (SF-12)b
	Urinary incontinence	Fecal incontinence	ECOG
			Incontinence Severity Index questionnaire	Questionnaire for Urinary Incontinence Diagnosis (qUID)	Fecal Incontinence Severity Indexb
Head and neck	ADLs/IADLs/extended IADLs		EORTC QLQ-C30	EORTC modules	University of Washington Quality of Life Questionnaire (UW-QOL)
	Fatigue	Pain	Distress thermometer
	HRQOL		EORTC QLQ-C30
				EORTC modules
					EORTC QLQ-H&N35
					Other self-developed tools
			Other self-developed tools	EORTC modules	EORTC QLQ-C30
			PSS-HN	XeQOLs	EQ-5D-3 L
			SF-36	EORTC QLQ-C30	EORTC modulesb
			UW-QOL
		ADLs/IADLs/extended IADLs	6MWT	30-seconds chair stands	Push-up test
		Joint mobility	EORTC QLQ-C30	EORTC modules
		Speech and swallowing	UW-QOL	MD Anderson Dysphagia Inventory (MDADI)
		Pain	SF-36
	Joint mobility	Speech and swallowing	Penetration and Aspiration Scale	Functional Oral Intake Scale	TheraBite Range of Motion Scaleb  ,  c
	Speech and swallowing		Brief ICF Core Set for HNC	BCSQ-H&N	UW-QOL
			MDADI
				Fiberoptic Endoscopic Evaluation of Swallowing (FEES)	Swallowing performance using water swallow test
				UW-QOL
Hematological			Other self-developed tools	Vanderbilt Head and Neck Symptom Survey, version 2.0 (VHNSS 2.0)
	ADLs/IADLs/extended IADLs		Pain VAS	ROM
		Pain	Health Utilities Index Mark 3 (HUI3)	Pain VAS
	Balance		Bruininks-Oseretsky Test of Motor Proficiency Second Edition (BOT-2)	Movement Assessment Battery for Children, version 2 (MABC-II)	University of Quebec in Chicoutimi-University of Quebec in Montreal (UQAC-UQAM) Test Batteryb
		ADLs/IADLs/extended IADLs	Ankle tendon reflexes	Sensory Organization Test (SOT)	TUG Test
	Cardiorespiratory fitness		6MWT
		HRQOL	SF-36	EuroQol EQ-5D
	Fatigue		Fatigue Questionnaire	SF-36
		HRQOL	Fatigue Questionnaire	SF-36	Other self-developed tools
		Pain	SF-36	Rotterdam Symptom Checklist (RSCL)
	HRQOL	Fatigue	Lee Chronic Graft-vs-Host Disease Symptom Scale	Self-assessed KPS	Other self-developed tools
		Pain	SF-36	EuroQol EQ-5D	Global Rating Scale
				Other self-developed tools
	Neuropathy		Neuropathy Impairment Score	Total Neuropathy Score	BOT-2b
Lung	ADLs/IADLs/extended IADLs	Fatigue	EORTC QLQ-C30	EORTC modules	Other self-developed tools
	Fatigue	Cardiorespiratory fitness	Brief Fatigue Inventory (BFI)	Perceived Self-Efficacy for Fatigue Self-Management	Activities-Specific Balance Confidence Scale
	HRQOL		EORTC QLQ-C30	EORTC modules
		ADLs/IADLs/extended IADLs	SF-36	EORTC QLQ-C30	Other self-developed tools
				KPS	BPIb
		Cardiorespiratory fitness	SF-36	Dyspnea Index
Melanoma	ADLs/IADLs/extended IADLs	Weakness	ECOG
Other gastrointestinal	ADLs/IADLs/extended IADLs		Balducci Frailty Criteria, ADL subscale	ECOG	Cumulative Illness Rating Scale–Geriatrics (CIRS-G)
	Fecal incontinence	Sexual function	City of Hope Quality of Life–Colorectal Cancer (COHQOL)
			Memorial Sloan-Kettering Cancer Center (MSKCC) Bowel Function Instrument	EORTC QLQ-C30	EORTC modules
	HRQOL	Fatigue	EORTC QLQ-C30
				Pain VAS	Fatigue VAS
Pediatric brain tumor	ADLs/IADLs/extended IADLs		Other self-developed tools
	Fatigue	Pain	None reported
	HRQOL		PedsQL
				HUI3	Child Health Questionnaireb
				SF-36	Child Health Questionnaire Parent Form-50
Prostate	Fatigue	Pain	Fatigue Questionnaire	Brief Sexual Function Inventory	SF-12b
	HRQOL		Patient-Reported Outcomes Measurement Information System (PROMIS)
		Pain	EORTC QLQ-C30	EORTC modules
		Sexual function	Expanded Prostate Cancer Index Composite (EPIC)
			SF-36	UCLA Prostate Cancer Index (UCLA-PCI)	KPS
		Urinary incontinence	Health Utilities Index	Patient Oriented Prostate Utility Scale	Prostate Cancer Index
			SF-36	UCLA-PCI
	Sexual function	Urinary incontinence	EORTC QLQ-C30	EORTC modules
			EPIC
			Other self-developed tools	Attitudes and Practice Survey
	Urinary incontinence	Fecal incontinence	SF-12	Brief Sexual Function Inventory	EPICb
Sarcoma	HRQOL		Toronto Extremity Salvage Score (TESS)	PedsQL	Other self-developed tools
Various	ADLs/IADLs/extended IADLs		ECOG	KPS
			Medical Expenditures Panel Survey (MEPS)
			Musculoskeletal Tumor Society Rating Scale (MSTS)
			Other self-developed tools	ECOG
				Sit to stand
			SF-36	Other self-developed tools
		Fatigue	EORTC QLQ-C30	EORTC modules
			SF-36	BFI
		HRQOL	Other self-developed tools	Sit to stand	Satisfaction With Life Scale
		Pain	EQ-5D-5 L	Other self-developed tools
			SF-36	Pain VAS	Other self-developed tools
	Balance	ADLs/IADLs/extended IADLs	SF-36
	Cardiorespiratory fitness		Comprehensive Geriatric Assessment	TUG Test	Gait speed
	Fatigue		BFI	EORTC QLQ-C30	Fatigue Severity Scaleb
		HRQOL	EORTC QLQ-C30	EORTC modules
		Weakness	TUG Test	Peak isometric knee extension force
	HRQOL		Other self-developed tools	SF-36
			PedsQL	HUI3	Child Health Questionnaireb
			SF-12	Brief Symptom Inventory 18 (BSI-18)	Other self-developed tools
			SF-36
				15D (15 dimensions)
				Impact of Cancer Questionnaire	City of Hope Quality of Life–Cancer Survivors
				SF-12
		ADLs/IADLs/extended IADLs	Functional Living Index–Cancer	Rotterdam Symptom Checklist (RSCL)	Cancer Rehabilitation Evaluation Systemb
		Fatigue	None reported
			SF-36
				EORTC QLQ-C30	Impact of Cancer (IOC) Scale
		Pain	PedsQL
			SF-36
		Sexual function	SF-36	HUI3	UCLA-PCIb
		Urinary incontinence	SF-36	SF-12
		Weakness	Handgrip strength	TUG Test	5-minutes maximum walk speedb
	Neuropathy	ADLs/IADLs/extended IADLs	Community Healthy Activities Model Program for Seniors	Charlson Comorbidity Index	1-RMb
			Modified Total Neuropathy Score	TUG Test	6MWTb
		Balance	KPS	Other self-developed tools	Semmes-Weinstein monofilament testb
			Semmes-Weinstein monofilament test	Neurotipsd	Tip Therm rodb  ,  e
	Pain	ADLs/IADLs/extended IADLs	Pain VAS	SF-36	Pain Disability Indexb
	Cardiorespiratory fitness	Fatigue	Brief Cancer Impact Assessment (BCIA)	BSI-18	Perceived Stress Scale (PSS)
		Weakness	20-m gait speed	400-m walk	Handgrip strength

^a ADLs = activities of daily living; AROM = active range of motion; BCSQ-H&N = Brief Core Set Questionnaire-Head & neck; CALGB = Cancer and Leukemia Group B; DASH = Disabilities of Arm, Shoulder, and Hand; EORTC = European Organization for Research and Treatment of Cancer; EQ-5D-3 L = 3-level version of the EuroQol −5 descriptive system; EQ-5D-5 L = 5-level version of the EuroQol −5 descriptive system; EQ-5D = EuroQol−5 descriptive system; HNC = head and neck cancer; HRQOL = health-related quality of life; IADLs = instrumental ADLs; 6MWT = 6-minute walk test; EORTC QLQ-H&N35 = European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head & Neck 35. PedsQL = Pediatric Quality of Life Inventory; PSS-HN = Performance Status Scale for Head and Neck Cancer; QLQ-C30 = Quality of Life Questionnaire-Cancer 30 QuickDASH = Quick Disabilities of Arm, Shoulder and Hand Questionnaire; 1-RM = 1-repetition maximum; ROM = range of motion; SF-36 = Medical Outcomes Study 36-Item Health Survey Questionnaire; TUG = Timed “Up & Go”; WOMAC = Western Ontario and McMaster Universities Osteoarthritis Index; XeQoLS = Xerostomia Quality of Life Scale.

^b Studies using >3 measurement tools.

^c CranioRehab.com, Denver, Colorado, USA.

^d Owen Mumford Ltd, Brook Hill, Woodstock, Oxfordshire, United Kingdom.

^e Tip Therm GmbH, Dorsten, Germany.

 

Appendix 4.

Assessment of Physical Function

Most Frequently Reported Tools (>5 Studies)  a	No. of Studies
Medical Outcomes Study 36-Item Health Survey Questionnaire	186
EORTC Quality of Life Questionnaire–Cancer 30	139
Other self-developed tools	77
EORTC modules	69
6-Minute walk test	39
Disabilities of Arm, Shoulder, and Hand	31
Short Form-12	28
Patient-Reported Outcomes Measurement Information System	21
Timed “Up & Go” Test	19
Karnofsky Performance Scale	18
Brief Symptom Inventory	16
Handgrip strength	16
Pediatric Quality of Life Inventory	13
Gait speed	12
Range of motion	12
Toronto Extremity Salvage Score	12
Eastern Cooperative Oncology Group	11
Musculoskeletal Tumor Society Rating Scale	11
Expanded Prostate Cancer Index Composite	11
Pain VAS	11
Body mass index	10
Sit and reach	10
Brief Pain Inventory	8
Cancer Rehabilitation Evaluation System	8
UCLA Prostate Cancer Index	8
European Quality of Life EQ-5D-5 L (5-level version of the EuroQol −5 descriptive system)	8
Performance Status Scale for Head and Neck	8
Quality of Life in Adult Cancer Survivors	8
Pittsburgh Sleep Quality Index	7
Multidimensional Fatigue Inventory	7
Quality of Life for Cancer Survivors yes	7
Impact of Cancer Scale	7
European Prospective Investigation into Cancer Physical Activity Questionnaire	7
Fatigue VAS	6
University of Washington Quality of Life Questionnaire	6
Short Physical Performance Battery	6
Brief Fatigue Inventory	6
Sexual Functioning Questionnaire	6
Late Life Function Disability Index	5
Lawton-Brody Index of Instrumental Activities of Daily Living	5
Shoulder Pain and Disability Index	5
Common Terminology Criteria for Adverse Events	5
1-Repetition maximum	5
Chair stand test	5
Charlson Comorbidity Index	5
Functional Independence Measure	5
Impact of Event Scale	5
Supportive Care Needs Survey	5

^a Studies using >3 measurement tools. EORTC = European Organization for Research and Treatment of Cancer; VAS = visual analog scale.

 

Appendix 5.

Measurement Tools for Assessment^a

	Impairments
Type of Cancer	Primary	Secondary	Measurement Tool 1	Measurement Tool 2	Measurement Tool 3
Bladder	HRQOL	Urinary incontinence	EORTC QLQ-C30	EORTC modules	Bladder Cancer Index
	Urinary incontinence	Fecal incontinence	Bladder Cancer Index
		Sexual function	Semistructured interview
	Weakness	Pain	Leg power on dominant side using Nottingham Leg Extensor Power Rigb
Bone	ADL/IADL/extended IADLs		Musculoskeletal Tumor Society Rating Scale (MSTS)
Brain	ADL/IADL/extended IADLs		Bruininks-Oseretsky Test of Motor Performance (BOT-2)
			Functional Independence Measure (FIM)	Perceived Impact Problem Profile (PIPP)	Cancer Rehabilitation Evaluation System–Short Form
			Health Utilities Index Mark 2/3 (HUI2/3)
			Karnofsky Performance Scale (KPS)
			Other self-developed tools
			Romberg Test	Childhood Orientation and Amnesia Test
		HRQOL	Eastern Cooperative Oncology Group performance scale (ECOG)	Resource Utilization Groups Activities of Daily Living (RUG-ADL)
			HUNT-3–based measures	BMI
		Other	Brigance Diagnostic Comprehensive Inventory of Basic Skills–Revised
	Balance	Other	Zurich Neuromotor Assessment	Visuomotor integration (VMI)
	Fatigue	Neuropathy	Other self-developed tools
	HRQOL		Distress thermometer
			EORTC QLQ-C30	EORTC modules
			Pediatric Quality of Life Inventory (PedsQL)
			SF-36
				EORTC modules
		ADL/IADL/extended IADLs	EORTC QLQ-C30
			European Quality of Life–5 Dimensions (EQ-5D)	EORTC QLQ-C30	EORTC modules
			Minneapolis-Manchester Quality of Life (MMQL) Questionnaire
		Cardiorespiratory fitness	GLTEQ	12-lead ECG	Expired gas analysis
			Vo  2 max	SF-36	Satisfaction With Life Scale
		Fatigue	EORTC QLQ-C30	BN20	KPS
		Pain	PROMIS	Day Rehabilitation Outcome Scale
Breast	ADL/IADL/extended IADLs		6MWT
			Canadian Occupational Performance Measure (COPM)	Model of Human Occupation (MOHO)	Person-environment-occupation-performance model
			DASH
				Penn Shoulder Score	Shoulder Disability Questionnaire–Dutch
				SPADI	Shoulder Rating Questionnaire
			ECOG	Katz Index of ADLs
			Geriatric Assessment	Adult Comorbidity Evaluation Index (ACE-27)	Charlson Comorbidity Index
			Inventory of Functional Status for Cancer (IFSA-Ca)	Multidimensional Scale of Perceived Social Support (MSPSS)
			Medical Research Council Scale (muscle power)	Pain visual analog scale (VAS)	Limb girth
			Other self-developed tools
			Personal Role Domain Scale	Late Life Function and Disability Index (LLFDI)	Other self-developed tools
			ROM	Strength	Other self-developed tools
			SF-12	Other self-developed tools
			SF-36
				6MWT	12MWT
			Short Physical Performance Battery (SPPB)	Standing from a chair test	Gait speed
			Work Limitation Questionnaire (WLQ)	Return to work VAS
		Fatigue	LLFDI	Satisfaction With Life Scale (SWLS)
		HRQOL	12MWT
			DASH	SF-36	1-RM
			EORTC QLQ-C30
			Fordyce Happiness Measure	Rosenberg Self-Esteem Scale	Cohen 10-Item Perceived Stress Scale
			Katz Index of ADLs	Lawton-Brody Index of IADLs	ECOG
			Maximal aerobic fitness	6MWT	12MWT
			Pain VAS	Walking diary	WOMAC
			QuickDASH
			SF-36	LLFDI
		Joint mobility	DASH	ROM
			SPADI	ROM
		Lymphedema	DASH
		Pain	Breast Cancer Treatment Outcome Scale	EORTC QLQ-C30
		Weakness	TUG Test	1-RM	Back scratch test
	Balance		Tinetti-POMA	Gait speed	TUG Test
	Cardiorespiratory fitness		KPS
		ADL/IADL/extended IADLs	EORTC QLQ-C30
			Functional Impairment Test–Hand and Neck/Shoulder/Arm (FITHaNSA)	International Physical Activity Questionnaire (IPAQ)	DASH
		Fatigue	ECOG	Physical Activity Readiness Questionnaire (PAR-Q)	Physical Activity Readiness Medical Examination (PARmed-X)
		HRQOL	Scottish Physical Activity Questionnaire-2 (SPAQ)	12MWT	BMI
			SF-36
		Other	SF-36	Personal Habits Questionnaire
		Pain	WOMAC
		Weakness	Naughton protocol estimated fitness submaximal treadmill test
	Fatigue		SF-36
		ADL/IADL/extended IADLs	SF-36
		HRQOL	Piper Fatigue Scale	SF-36	Cancer Inventory of Problem Situations (CIPS)
		Other	Cancer Survivor Profile
		Pain	SF-36	7-Day Physical Activity Recall Questionnaire (7-DPARQ)
	HRQOL		EORTC QLQ-C30
				EORTC modules
					SF-36
				PROMIS	SF-36
				Questionnaire on Stress in Cancer Patients	EORTC modules
				SF-36
			Long Term Quality of Life–Breast Cancer (LTQOL-BC) Scale
			Other self-developed tools
			Psychosocial Adjustment to Illness Scale–Self-Report (PAIS-SR)	SF-36
			SF-8
			SF-12
			SF-36
				Impact of Cancer (IOC) Scale
				Other self-developed tools
				Pittsburgh Sleep Quality Index (PSQI)
				Subjective well-being
		ADL/IADL/extended IADLs	Chair stand test
			DASH
				Lymphedema functioning	Lymphedema Functioning, Disability and Health Questionnaire (Lymph-ICF)
			EORTC QLQ-C30	EORTC modules	CTCAE
			Fatigue VAS	SF-12	Social Provisions Scale for Exercise (SPSE)
			Katz Index of ADLs	Lawton-Brody Index of IADLs	EORTC QLQ-C30
			Other self-developed tools
			PHQ-9	EORTC QLQ-C30
			SF-36
				2-min step test	8-ft get up & go test
				PROMIS PF-10	PSQI
				VR-12
				World Health Organization Quality of Life-100 (WHOQOL-100)
				Women’s Health Initiative	BMI
			WHOQOL assessment
		Fatigue	EORTC QLQ-C30	EORTC modules
				Impact of Event Scale (IES)	Fatigue Symptom Inventory (FSI)
				SF-36
			SF-36	Harvard Alumni Health Study Physical Activity Questionnaire (HPAQ)	QuickDASH
		Other	SF-36	Ladder of Life	Perceived Efficacy in Patient-Physician Interactions
				PSQI	Symptom Experience Report (SER)
		Pain	EORTC QLQ-C30	EORTC modules
			Other self-developed tools
		Sexual function	National Surgical Adjuvant Breast and Bowel Project Breast Cancer Prevention Trial (BCPT) Hormonal Symptom Checklist	Modifiable Activity Questionnaire	Cancer Rehabilitation Evaluation System
		Weakness	EORTC QLQ-C30	EORTC modules	Handgrip strength
	Joint mobility		DASH	Penn Shoulder Scale	ROM
		ADL/IADL/extended IADLs	Other self-developed tools
			QuickDASH
		Lymphedema	AROM	Pain VAS	Circumferential arm measures
		Pain	Breast-Q	DASH	Upper Extremity Functional Index (UEFI)
			DASH	ROM	Pain VAS
	Lymphedema		Psychosocial Adjustment to Illness Scale (PAIS)	SF-36
		ADL/IADL/extended IADLs	DASH
			Kwan Arm Problem Scale	EORTC modules	SF-36
			Penn Shoulder Score	Lymph-ICF	Volumeter
		Fatigue	ISL staging criteria for lymphedema
		HRQOL	SF-36	Armer Self-Reported Lymphedema Symptom Scale
		Pain	DASH	McGill Pain Questionnaire–Short Form	Social Impact of Arm Morbidity (SIAM) Questionnaire
			Short-Form McGill Pain Questionnaire	DASH	SIAM Questionnaire
	Neuropathy	ADL/IADL/extended IADLs	Functional reach	Sit and reach	Berg Balance Test
		Balance	Functional reach	Sit and reach
					Patient-Specific Functional Scale (PSFS)
		Pain	Monofilament set
	Pain	ADL/IADL/extended IADLs	Arthritis Self-Efficacy Scale (ASE)	Pain VAS
			Brief Pain Inventory
			KPS	Self-Administered Comorbidity Questionnaire	NPRS
		HRQOL	Pain VAS	SF-36
		Joint mobility	DASH	SF-36
		Weakness	DASH	Norman Lymphedema Questionnaire	Lymphedema Breast Cancer Questionnaire
	Sexual function		Menopause-Specific Quality of Life Questionnaire
		ADL/IADL/extended IADLs	None recommended
		Other	Female Sexual Function Index (FSFI)	Other self-developed tools
		Urinary incontinence	SF-36
	Urinary incontinence	Sexual function	PROMIS
	Weakness	ADL/IADL/extended IADLs	6MWT	ROM	Handgrip strength
			AROM	DASH	Penn Shoulder Score
			Squat test	DASH	6MWT
		Cardiorespiratory fitness	None recommended
			Vo  2 max	Upper extremity strength	Sit and reach
		HRQOL	Constant-Murley Score	Rowe Score	DASH
		Joint mobility	Selective Functional Movement Assessment (SFMA)
			Upper Body Strength and Endurance (UBSE)	DASH
Colon	ADL/IADL/extended IADLs		European Prospective Investigation into Cancer Physical Activity Questionnaire	EORTC QLQ-C30
			Other self-developed tools
		HRQOL	EORTC QLQ-C30	SF-36
		Joint mobility	6MWT	30-s chair stands	8-ft get up & go test
	Cardiorespiratory fitness	ADL/IADL/extended IADLs	6MWT
	Fatigue	Pain	EORTC QLQ-C30	Other self-developed tools
	HRQOL		EORTC QLQ-C30	EORTC modules
			European Prospective Investigation into Cancer Physical Activity Questionnaire	EORTC QLQ-C30
			Modified City of Hope Quality of Life–Ostomy (mCOH-QOL-O)
			SF-36
		ADL/IADL/extended IADLs	EORTC QLQ-C30
				European Prospective Investigation into Cancer Physical Activity Questionnaire
				World Health Organization Disability Assessment
			European Prospective Investigation into Cancer Physical Activity Questionnaire	EORTC QLQ-C30
			SF-12
				Other self-developed tools
			Short Questionnaire to Assess Health-Enhancing Physical Activity (SQUASH)
		Fatigue	EORTC QLQ-C30
			Fatigue Assessment Scale (FAS)	EORTC QLQ-C30	Self-Administered Comorbidity Questionnaire (SCQ)
			SF-36	Community Healthy Activities Model
				FAS	BMI
	Neuropathy	ADL/IADL/extended IADLs	EORTC QLQ-C30	EORTC modules
		HRQOL	Chemotherapy-Induced Peripheral Neuropathy Assessment Tool (CIPNAT)	SF-36
	Pain		SF-12	Brief Pain Inventory (BPI)
		HRQOL	EuroQoL Visual Analog Scale	Other self-developed tools
	Sexual function	HRQOL	EORTC QLQ-C30
				EORTC modules
Germ cell	HRQOL	Neuropathy	EORTC QLQ-C30
Gynecological	ADL/IADL/ extended IADLs		6MWT
			National Health Interview Survey
			National Surgery Quality Improvement Database Questionnaire
			Other self-developed tools
		HRQOL	MD Anderson Symptom Inventory (MDASI) Interference Scale	Symptom Representation Questionnaire (SRQ)
		Lymphedema	SF-12
		Pain	Paffenbarger Physical Activity Questionnaire	Brief Pain Inventory (BPI)	FSI
		Sexual function	Supportive Care Needs Survey–Gynecologic Version (SCNS-gyne)	Sexual Function-Vaginal Changes Questionnaire (SVQ)
		Weakness	6MWT	30-s chair stands	30-s arm curls
	Cardiorespiratory fitness		Modified Balke protocol	Vo  2 peak
			Other self-developed tools
	HRQOL		EORTC QLQ-C30	EORTC modules
				Hornheide Questionnaire (HFK-B)
			SF-36
		ADL/IADL/extended IADLs	EORTC QLQ-C30	EORTC modules	McGill Quality of Life Questionnaire
					SF-36
			SF-36
		Cardiorespiratory fitness	EORTC QLQ-C30	KPS	Spirometer
		Fatigue	SF-36
				EORTC modules	SCQ
		Pain	EORTC QLQ-C30
		Sexual function	EORTC QLQ-C30	EORTC modules	SF-36
			FSFI	Menopausal Rating Scale (MRS)
			SF-36
				Quality of Life in Adult Cancer Survivors (QLACS)
		Urinary incontinence	EORTC QLQ-C30
			SF-36	Other self-developed tools
	Lymphedema	Other	Limb volume perometry	Gynecologic Cancer Lymphedema Questionnaire
	Pain	Sexual function	Other self-developed tools
	Sexual function	Other	EORTC QLQ-C30	SF-36	FSFI
	Urinary incontinence	Fecal incontinence	Sandvik Incontinence Severity Index	Wexner Fecal Incontinence Scale	Epidemiology of Prolapse and Incontinence Questionnaire
		Fatigue	SF-12
		Fecal incontinence	EORTC QLQ-C30	EORTC modules
		Joint mobility	UW-QOL	Performance Status Scale for Head and Neck Cancer\ (PSS-HN) \
					General Self-Efficacy Scale (GSES)
	Lymphedema	HRQOL	None recommended
	Speech and swallowing		GRBAS Rating System (severity rating of voice quality; grade/overall severity of dysphonia)	V-RQOL	VHI
			MD Anderson Dysphagia Inventory (MDADI)	PSS-HN
Hematological	ADL/IADL/extended IADLs		6MWT	TUG Test
			Dizziness Handicap Inventory	Brief Fatigue Inventory	Migraine Disability Assessment Scale (MIDAS)
			Fundamental Movement Skills Test Battery
			Knee Society Score (KSS)
			Urogenital Distress Inventory (UDI)
	Weakness		Pelvic floor strength
Head and neck	ADL/IADL/extended IADLs		6MWT
			KPS
			Neck Disability Index (NDI)	Shoulder Pain and Disability Index	University of Washington Quality of Life Questionnaire (UW-QOL)
		Other	KPS	ECOG	Penn Shoulder Score
	Communication	ADL/IADL/extended IADLs	Communication Participation Item Bank (CPIB)	PROMIS	Neuro-QoL
	HRQOL		EORTC QLQ-C30	EORTC modules
			UW-QOL
			WHOQOL-BREF instrument	Australian Therapy Outcomes Measures (AusTOMs)
			MSTS
			Other self-developed tools
			PedsQL	Child Health Questionnaire	Child Health Ratings Inventories
			Pepper Assessment Tool for Disability	SPPB	Grip strength
			PROMIS
			SF-36	Other self-developed tools
			UQAC-UQAM test battery
		Weakness	6MWT	TUG Test	Handgrip strength
	Balance	ADL/IADL/extended IADLs	Modified Total Neuropathy Score	Sensory Organization Test (SOT)	TUG Test
	Cardiorespiratory fitness	Weakness	Handgrip strength
	Fatigue		SF-36	Fatigue Questionnaire
		ADL/IADL/extended IADLs	SF-36	EORTC QLQ-C30
		Pain	AQoL-6D	Other self-developed tools
			Physical Distress by Symptom Distress Scale (SDS)
			PROMIS
	HRQOL
			Cancer Rehabilitation and Evaluation System (CARES)	SF-36	Distress thermometer
			EORTC QLQ-C30
			Family Environment Scale	Brief Symptom Inventory	Parent Protection Scale
			None recommended
			PedsQL
			SF-12	EORTC modules
			SF-36
				Charlson Comorbidity Index
				ECOG
				EORTC QLQ-C30
				General Health Questionnaire (GHQ-12)
				Human Activities Profile (HAP)
				Other self-developed tools
				Other self-developed tools
				QLACS
		ADL/IADL/extended IADLs	Brief Symptom Inventory	CARES	EORTC QLQ-C30
			Child Health Questionnaire (CHQ-PF50)
			EORTC QLQ-C30
				Sickness Impact Profile	Other self-developed tools
			SF-6D
			SF-36
		Fatigue	EORTC QLQ-C30	Lawton-Brody Index of IADLs	2MWT
			Schedule for the Evaluation of Individual Quality of Life–Direct Weighting (SEIQoL-DW)	SF-36
			SF-36
		Pain	SF-12	EORTC QLQ-C30	EORTC modules
	Joint mobility	Pain	SF-36	Fatigue Symptom Inventory
	Pain	ADL/IADL/extended IADLs	FMA
			HUI3
		Weakness	Neck Disability Index (NDI)	Checklist Individual Strength-20 (CIS-20)	Other self-developed tools
	Sexual function	Fatigue	Quality of Life Questionnaire for Survivors (QLQ-S)	EORTC QLQ-C30	Other self-developed tools
		HRQOL	BSFI
			Sexual Activity Questionnaire	Prostate Cancer Outcomes Study	Sexual Functioning Questionnaire
	Weakness	ADL/IADL/extended IADLs	Grip strength
		Balance	Other self-developed tools
Lung	ADL/IADL/extended IADLs		SF-36	Other self-developed tools
	Cardiorespiratory fitness		CPET	6MWT	Stair Climbing Test (SCT)
		Fatigue	6MWT	EORTC QLQ-C30	EORTC modules
	Fatigue	HRQOL	Brief Fatigue Inventory	EORTC QLQ-C30
	HRQOL		EORTC QLQ-C30	EORTC modules
			SF-8	Lung Cancer Symptoms Scale (LCSS)
			SF-36
		ADL/IADL/extended IADLs	EORTC QLQ-C30
			SF-36
		Fatigue	Brief Fatigue Inventory	KPS	GLTEQ
		Other	EORTC QLQ-C30	Other self-developed tools
		Pain	Edmonton Symptom Scale	Other self-developed tools
	Joint mobility	Pain	Northwick Park Neck Pain Questionnaire (NPNPQ)	Neck Pain and Disability Scale (NPDS)	Pain VAS
	Weakness	ADL/IADL/extended IADLs	1-RM	Respiratory pressure meter	TUG Test
Melanoma	HRQOL		SF-36	IOC Scale
		ADL/IADL/extended IADLs	SF-36
				Other self-developed tools
		Fatigue	Hornheide Questionnaire, 9-item short form (HQ-S)	EORTC QLQ-C30	EORTC modules
		Lymphedema	EORTC QLQ-C30	EORTC modules
Neuroendocrine	HRQOL		SF-36	IES	GSES
Other gastrointestinal	ADL/IADL/extended IADLs		Other self-developed tools
	Fatigue	Pain	Other self-developed tools
	Fecal incontinence	HRQOL	EORTC QLQ-C30
		Sexual function	EORTC QLQ-C30
	HRQOL		EORTC QLQ-C30
				EORTC modules
					Brief Illness Perception Questionnaire
			SF-36	KPS
		ADL/IADL/extended IADLs	Accelerometer	6MWT	Timed sit to stand
			ECOG	EORTC QLQ-C30	EORTC modules
			EORTC QLQ-C30	EORTC modules	EQ-5D
			FSFI	EORTC QLQ-C30	EORTC modules
		Fatigue	EORTC QLQ-C30
				EORTC modules
		Fecal incontinence	mCOH-QOL-O	SF-12	Duke-UNC Functional Social Support Questionnaire (FSSQ)
		Other	EORTC QLQ-C30
		Pain	EORTC QLQ-C30	EORTC modules
	Sexual function		Other self-developed tools
Prostate	ADL/IADL/extended IADLs		TUG Test	Repeated chair stands	Handgrip strength
		Fatigue	PROMIS
		Weakness	400-m walk	6MWT	TUG Test
	HRQOL		EORTC modules	EORTC modules	EQ-5D
				UCLA Prostate Cancer Index (UCLA-PCI)	PCQoL
			EORTC QLQ-C30
				EORTC modules
			European Prospective Investigation into Cancer Physical Activity Questionnaire	Brief Symptom Inventory
			SF-12	Expanded Prostate Cancer Index Composite (EPIC)	Appraisal of Illness Scale (AIS)
					Satisfaction With Life Scale
			SF-36
		ADL/IADL/extended IADLs	EORTC QLQ-C30	Walking distance	Sit and reach
			GLTEQ	SF-36	400-m walk
			SF-12
			SF-36	UCLA-PCI
		Fatigue	European Prospective Investigation into Cancer Physical Activity Questionnaire	SF-12	Other self-developed tools
		Pain	UCLA-PCI
		Sexual function	EPIC
			QLQ-S	SF-36	EPIC
		Urinary incontinence	EORTC QLQ-C30	EQ-5D-5 L
			EPIC	Supportive Care Needs Survey (SCNS-SF34)	Modified Self-Efficacy Scale
			Patient-Oriented Prostate Utility Score (PORPUS)	International Prostate Symptom Score	International Index of Erectile Function
			PORPUS	5-item International Index of Erectile Function (IIEF)	International Prostate Symptom Score (IPSS)
			SF-12	EPIC
			UCLA-PCI	EPIC
				Other self-developed tools
	Sexual function	Urinary incontinence	EPIC
	Urinary incontinence		UCLA-PCI
		Fecal incontinence	EORTC QLQ-C30	EQ-5D-5 L
			UCLA-PCI	SF-36
	Weakness	ADL/IADL/extended IADLs	Bench and leg press tests	Seniors’ Fitness Test	SF-36
Sarcoma	ADL/IADL/extended IADLs		Assessment of Motor and Process Skills (AMPS)
			MSTS
			MSTS
			Toronto Extremity Salvage Score (TESS)
				Reintegration into Normal Living Index (RNL)
			UCLA sports activity score
		Cardiorespiratory fitness	6MWT	Brief Symptom Inventory	Physical Assessment Battery
		HRQOL	6MWT	Sit and reach	Balance
			MSTS	TESS	SF-36
			Other self-developed tools
		Pain	MSTS
			Other self-developed tools
		Sexual function	TESS
	HRQOL		EORTC QLQ-C30	SF-36	MSTS
			MSTS	TESS	SF-36
			TESS
		ADL/IADL/extended IADLs	SF-36	TESS	Timed sit to stand
			TESS	EORTC QLQ-C30	SF-36
				SF-36	Brief Symptom Inventory (BSI)
Testicular	HRQOL		Cancer Assessment for Young Adults (CAYA)
			SF-36
		ADL/IADL/extended IADLs	SF-36
		Fatigue	SF-36
Various	ADL/IADL/extended IADLs		6MWT
			Brief Symptom Inventory	Global Rating Severity Scale	CCSS Neurocognitive Scale
			Canadian Occupational Performance Measure (COPM)	Adolescent Activity Card Sort (AACS)
			DASH
			Duke Activity Status Index	BMI	Physical Performance Test (PPT)
			EORTC QLQ-C30	SF-12	SF-36
			FIM
			Grooved pegboard	Other self-developed tools
			Nagi Performance Limitations Index
			National Disability Database query
			Occupational Self-Assessment (Version 2.2)
			Other self-developed tools
				Gait speed
			Patient Neurotoxicity Questionnaire
			PROMIS	Other self-developed tools
			Return-to-work statistics
			Rosow-Breslau Questionnaire
				Gait speed
			Patient Neurotoxicity Questionnaire
			PROMIS	Other self-developed tools
			Return-to-work statistics
			Rosow-Breslau Questionnaire
			SF-36	Brief Symptom Inventory	CCSS Neurocognitive Scale
				Other self-developed tools
			SF-36	OARS	KPS
			SPPB
			Useful Field of View (UFOVc)	WAIS Digit Symbol Substitution	Timed Instrumental Activities of Daily Living
			Vulnerable Elders Survey (VES)
				Comprehensive Geriatric Assessment	Barthel Index
			Work-related activity limitation questions
		Cardiorespiratory fitness	EORTC QLQ-C30	Other self-developed tools
			Handgrip strength	SF-36
			Other self-developed tools
			SF-36
		Fatigue	Geriatric Assessment	Mini-Mental State Examination	Katz Index of ADLs
			SQUASH	Accelerometer
		HRQOL	AM-PAC	PROMIS	ECOG
			Childhood Cancer Survivor Study Questionnaire
			DASH
			EORTC QLQ-C30	SF-36
			KPS	ECOG	SF-36
					Vo  2 max
			PROMIS	SF-36
			SF-36	Physical Performance Test (PPT)	6MWT
				TESS	Quality of Life for Cancer Survivors
		Other	Modified Activity Card Sort (ACSm)
			Other self-developed tools
		Pain	Behavioral Risk Factor Surveillance System Survey Questionnaire	Brief Symptom Inventory
			Other self-developed tools
			Supportive Care Needs Survey Long Form (SCNSLF59)
		Sexual function	ICF Cancer Survivor Core Set
		Weakness	6MWT
			SPPB
			Sit to stand	Lateral step-up test	PedsQL
			TUG Test
				6MWT	Strength
	Balance	HRQOL	Functional Comorbidity Index	Gait speed	BESTest
	Cardiorespiratory fitness	ADL/IADL/extended IADLs	6MWT	PFTs	SF-36
		HRQOL	6MWT
			Vo  2 max
	Fatigue		Other self-developed tools
		ADL/IADL/extended IADLs	Multidimensional Fatigue Symptom Inventory–Short Form
			WHODAS 2.0
		HRQOL	EORTC modules	EORTC QLQ-C30	ECOG
			EORTC QLQ-C30	EORTC modules	SF-36
			Modified Tampa Scale for Kinesiophobia–Fatigue	EORTC QLQ-C30
			SF-36	Fatigue Questionnaire	Other self-developed tools
		Pain	6MWT	SF-36	Fatigue Symptom Inventory (FSI)
			Memorial Symptom Assessment Scale
		Sexual function	2010 LiveStrong Foundation Survey
		Weakness	Stair Climbing Leg Power Test	Fatigue VAS
	HRQOL		CARES	EORTC QLQ-C30	EORTC modules
			EORTC modules	European Prospective Investigation into Cancer Physical Activity Questionnaire	Prostate Cancer Symptom Indices
			EORTC QLQ-C30	EORTC modules
				Rosenberg Self-Esteem Scale (RSES)	Personal Resource Questionnaire (PRQ)
				SF-12	EORTC modules
				SF-36
			EQ-5D	Cancer Survivors’ Unmet Needs (CaSUN) Measure
			IOC-AYA	SF-36	Brief Symptom Inventory (BSI)
			Minneapolis-Manchester Quality of Life Survey–Adolescent Form	PedsQL
			Other self-developed tools
			PedsQL	GLTEQ
				Hopkins Symptom Checklist-10 (HSCL-10)
			PROMIS	SF-36
			Quality of Life for Cancer Survivors	QLACS	SF-36
			QLQ-S	QLACS	SF-36
			SF-12	EQ-5D-5 L	EORTC QLQ-C30
			SF-36	7-DPARQ
				EORTC QLQ-C30	EORTC modules
				EORTC QLQ-C30	Distance walked
					Fatigue VAS
				IOC Scale
				Other self-developed tools
				Quality of Life Index (QLI)	Assessment of Survivor Concerns (ASC)
				SF-12
		ADL/IADL/extended IADLs	EORTC QLQ-C30	EORTC modules
					Multidimensional Fatigue Inventory
				FAS	EORTC modules
			Pediatric Camp Outcome Measure (PCOM)
			PedsQL	Multidimensional Fatigue Scale
			PROMIS
			SF-12
			SF-36	Brief Symptom Inventory
				LLFDI	Community Healthy Activities Model Program for Seniors questionnaire
			SCNS-SF34
		Cardiorespiratory fitness	EORTC QLQ-C30	Aastrand 6-Minute Cycle Test	Handgrip strength
				Electrically braked cycle ergometer (CPET)
			PFTs	6MWT
		Fatigue	EORTC QLQ-C30
				SF-36	Tampa Scale for Kinesiophobia
			Other self-developed tools	SF-8
			Problems and Goals (P&G) Assessment
			Satisfaction With Life Domains Scale–Cancer	Modified Rotterdam Symptom Checklist
			SF-36	EORTC QLQ-C30	SF-12
				Multidimensional Fatigue Inventory 20 (MFI-20)	THYCA-QoL
		HRQOL	EORTC QLQ-C30
			SF-36	VR-12
		Other	Brief Symptom Inventory	SF-36
			SF-36	Brief Symptom Inventory	BMI
				Other self-developed tools
		Pain	Brief Pain Inventory	John Henryism Active Coping Scale (JHACS)	Barriers Questionnaire (BQ-II)
		Urinary incontinence	SF-36	SF-12
		Weakness	6MWT	400-m walk	Stair climb
			SF-36	Strength
	Joint mobility	Cardiorespiratory fitness	SEIQoL-DW
	Lymphedema		Other self-developed tools
		Cardiorespiratory fitness	SPPB	6MWT	SF-36
	Neuropathy	HRQOL	CTCAE, Version 3	Total Neuropathy Score	EORTC QLQ-C30
		Pain	MD Anderson Symptom Inventory–Traditional Chinese Medicine (MDASI-TCM)	SF-36
	Pain	Fatigue	Other self-developed tools
		HRQOL	EORTC QLQ-C30	KPS
	Sexual function		5 P’s of Sexual History Taking
		HRQOL	Sexual Functioning Questionnaire (SFQ)	Women’s Health Questionnaire (WHQ)	Sexual Self-Schema (SSS) for women
			SF-12	PedsQL	Multidimensional Fatigue Scale
			UCLA-PCI	UCLA-PCI	International Index of Erectile Function
		Pain	Pain VAS	Quick Scale for Sexual Function
	Urinary incontinence	Fecal incontinence	Other self-developed tools
		Sexual function	Other self-developed tools
	Weakness		Lower limb muscle strength	Lawton-Brody Index of IADLs	Brief Fatigue Inventory
		ADL/IADL/extended IADLs	Sit to stand	1-RM	Muscle endurance
		Balance	BOT-2	M-ABC balance subtest	Berg Balance Test

^a ADLs = activities of daily living; AM-PAC = activity measure post acute care; AQoL-6D = Assessment of Quality of Life- 6 Dimensions; AROM = active range of motion; 5 Ps = past STDs, pregnancy plans and history, sexual practices, sexual partners, prevention of STDs/HIV; BMI = body mass index; EORTC QLQ-BN20 = European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Brain Metastases 20; CCSS = Childhood Cancer Survivor Study Neurocognitive Questionnaire; CPET = Cardiopulmonary Exercise Testing; CTCAE = Common Terminology Criteria for Adverse Events; DASH = Disabilities of Arm, Shoulder, and Hand; ECG = electrocardiogram; EORTC = European Organization for Research and Treatment of Cancer; EQ-5D-5 L = 5-level version of the EuroQol −5 descriptive system; EuroQoL = European Quality of Life; FMA = Functional Movement Assessment; GLTEQ = Godin Leisure-Time Exercise Questionnaire; GRBAS Rating System = Grade, Roughness, Breathiness, Asthenia and Strain voice quality; HR-QOL = health-related quality of life; HUNT-3 = Health Study in Nord-Trondelag; IADLs = instrumental ADLs; ICF = International Classification of Functioning, Disability and Health; IOC-AYA = Impact of Cancer for Adolescent and young Adult; ISL = International Society of Lymphology; MABC = Movement Assessment Battery for Children; max = maximum; M-PAC = Activity Measure Post Acute Care; 2MWT, 6MWT, and 12MWT = 2-min, 6-min, and 12-min walk tests, respectively; Neuro-QoL = Quality of Life in Neurological Disorders; NPRS = numerical pain rating scale; OARS ADL Scale = Older Americans Resources and Services Activities of Daily Living Scale; PCRT-PCQoL = Prostate Cancer Radiation Late Toxicity – Prostate Cancer Quality of Life; PROMIS PF-10 = Patient Reported Outcomes measurement Information System Physical Function-10; PFTs = Pulmonary Functional Tests; PHQ-9 = Patient Health Questionnaire-9; POMA = Tinetti Performance Oriented Mobility Assessment; PROMIS = Patient-Reported Outcomes Measurement Information System; QLQ-C30 = European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Cancer 30; QuickDASH = Quick Disabilities of Arm, Shoulder and Hand Questionnaire; 1-RM = 1-repetition maximum; ROM = range of motion; SF-12 = Medical Outcomes Study Short Form 12- Item Health Survey Questionnaire; SF-8 = Medical Outcomes Study Short Form 8- Item Health Survey Questionnaire; SF-36 = Medical Outcomes Study 36-Item Health Survey Questionnaire; SF-6D = Medical Outcomes Study Short Form 6 Dimensions; SPADI = Shoulder Pain and Disability Index; THYCA-QoL = European Organization for Research and Treatment of Cancer Thyroid Cancer – Quality of Life:TUG = Timed “Up & Go”; UQAC-UQAM = University of Quebec in Chicoutimi-University of Quebec in Montreal test battery; VHI = Voice Handicap Index; Vo  ₂ = oxygen consumption; VR-12 = Veterans Rand 12-item health survey; V-RQOL = Voice Related Quality of Life; WAIS = Wechsler Adult Intelligence Scale; WHODAS = World Health Organization Disability Assessment Schedule; WHOQOL = World Health Organization Quality of Life; WHOQOL-BREF = shorter version of WHOQOL; WOMAC = Western Ontario and McMaster Universities Osteoarthritis Index.

^b University of Nottingham Medical School, Queen’s Medical Centre, Nottingham, UK.

^c Visual Awareness Research Group, Sarasota, FL (USA).

 

Appendix 6.

Intervention for Physical Function

Most Frequently Reported Tools (>5 Studies)  a	No. of Studies
Medical Outcomes Study 36-Item Health Survey Questionnaire	57
EORTC Quality of Life Questionnaire–Cancer 30	40
6-Min walk test	33
Anthropometric measures	21
Other self-developed tools	16
Handgrip strength	14
Timed “Up & Go” Test	11
Multidimensional Fatigue Inventory	9
Pediatric Quality of Life Inventory	9
Range of motion	9
Disabilities of Arm, Shoulder, and Hand	9
VO2 max	8
Gait speed	8
Brief Fatigue Inventory	8
Pain VAS	7
Chair stand test	7
Community Healthy Activities Model Program for Seniors	7
Fatigue VAS	7
Pittsburgh Sleep Quality Index	7
Profile of Moods State	6
Godin Leisure-Time Exercise Questionnaire	6
Short Form-12	6
EORTC modules	6
MD Anderson Dysphagia Inventory	5
Performance Status Scale for Head and Neck Cancer	5
Piper Fatigue Scale	5
State-Trait Anxiety Index	5

^a Studies using >3 measurement tools. EORTC = European Organization for Research and Treatment of Cancer; VAS = visual analog scale; VO₂ = maximum oxygen consumption.

 

Appendix 7.

Measurement Tools for Intervention^a

	Impairments
Type of Cancer	Primary	Secondary	Measurement Tool 1	Measurement Tool 2	Measurement Tool 3
Brain	ADL/IADL/extended IADLs	Balance	Bruininks-Oseretsky Test of Motor Proficiency Second Edition (BOT-2)	Vo  2 peak
	Fatigue		Eastern Cooperative Oncology Group performance scale (ECOG)	Fatigue Severity Scale
	Weakness		Functional Independence Measure (FIM)	Barthel Index	Karnofsky Performance Scale (KPS)
Breast	ADL/IADL/extended IADLs		DASH	Other self-developed tool	Other self-developed tools
			EORTC QLQ-C30	ROM	Psychological Adjustment Scale
			Handgrip strength	6MWT	Life Satisfaction Inventory
			Other self-developed tools
		Cardiorespiratory fitness	SF-36	Vo  2 max
		HRQOL	6MWT	Short Form-12 (SF-12)	Arm volume
			Fordyce Happiness Measure	Rosenberg Self-Esteem Scale (RSES)	Center for Epidemiology Studies Depression Scale (CES-D)
			SF-12	Pain visual analog scale (VAS)	Sit and reach
			SF-36	Level of physical activity
		Pain	Patient-Reported Outcomes Measurement Information System (PROMIS)
		Weakness	DASH	12MWT	ROM
	Balance	Weakness	Charlson Comorbidity Index	Short Physical Performance Battery (SPPB)	5-times chair stands
	Cardiorespiratory fitness		Bruce Protocol	Flowmate Spirometerb	Piper Fatigue Inventory
			Global Rating Scale
			Physical activity recall	6MWT	EORTC QLQ-C30
		ADL/IADL/extended IADLs	Breast Cancer Prevention Trial Checklist	Symptom Distress Scale	CES-D
		Cardiorespiratory fitness	GLTEQ	Body mass index (BMI)
		HRQOL	Minutes of moderate to vigorous physical activity
			Vo  2 max	Dual-energy x-ray absorptiometry	Multidimensional Fatigue Inventory
		Weakness	4 MWT	Chair stand test	1-leg stance
			6MWT	Fatigue Severity Scale	EORTC QLQ-C30
			Accelerometer	GLTEQ	Submaximal treadmill testing
	Fatigue		Multidimensional Fatigue Inventory	PROMIS fatigue
			SF-36
		ADL/IADL/extended IADLs	Cancer Fatigue Scale	PSQI	EORTC QLQ-C30
		HRQOL	5-times sit to stand	6MWT	Gait speed
			6MWT	Upper extremity ROM
			Multidimensional Fatigue Inventory	SF-36	PSQI
			SF-36
		Pain	SF-36
	HRQOL		Brief Pain Inventory (BPI)	CES-D	State-Trait Anxiety Inventory
			EORTC QLQ-C30
				Constant-Murley Score	DASH
			International Physical Activity Questionnaire	EORTC QLQ-C30	Brief Fatigue Inventory (BFI)
			Memorial Symptom Assessment Scale	SF-36	Sense of coherence
			Post Traumatic Growth Inventory	Ten Rules for Highly Effective Health Behavior	EORTC QLQ-C30
			SF-12
			SF-36
				Body Image and Relationships Scale (BIRS)	1-RM
		ADL/IADL/extended IADLs	Concerns About Recurrence Scale	State-Trait Anxiety Inventory	CES-D
			EORTC QLQ-C30
			PHQ-9	Minnesota Physical Activity Questionnaire	BFI
			SF-36	EORTC QLQ-C30	EORTC modules
				WOMAC	Strength testing
		Cardiorespiratory fitness	EORTC QLQ-C30	SF-36
		Fatigue	Physical Activity Readiness Questionnaire	GLTEQ	1-RM
			SF-36	Coopersmith Self-Esteem Inventory (SEI)	Fatigue Symptom Inventory
	Lymphedema		Lymphedema Symptom Intensity and Distress Survey–Arm (LSIDS-A)	Functional Assessment Screening Questionnaire (FASQ)	BMI
		HRQOL	SF-36
	Pain	Weakness	Mini-Mental State Examination	FIM
	Sexual function	HRQOL	Pain VAS	Sexual Activity Questionnaire	Female Sexual Function Index (FSFI)
	Weakness	Balance	Biodex System 3 Proc velocity spectrum evaluation	Timed backward tandem walk	Other self-developed tools
		Cardiorespiratory fitness	DASH
			Strength	6MWT	Vo  2 max
			Vo  2 max	Timed sit-to-stand test	Sit and reach
Colon	ADL/IADL/extended IADLs		6MWT
	Balance	Weakness	TUG Test	Modified Clinical Test of Sensory Interaction on Balance (mCTSIB)	Dynamic Gait Index
	Cardiorespiratory fitness	ADL/IADL/extended IADLs	Tecumseh step test
		Fatigue	EORTC QLQ-C30	Multidimensional Fatigue Inventory	National Comprehensive Cancer Network (NCCN) distress thermometer
			Other self-developed tools
			Physical activity level	Fatigue VAS	POMS
		HRQOL	Senior Fitness Test	SF-36	CES-D
			Sit to stand
		Weakness	SF-36	Fatigue Symptom Inventory
	HRQOL		EORTC QLQ-C30	6MWT	Vo  2 max
			SF-36
		ADL/IADL/extended IADLs	Other self-developed tools
		Fatigue	SF-36
	Sexual function		Index of Sexual Satisfaction (sexual distress)	FSFI	International Index of Erectile Functioning
Gynecological	Cardiorespiratory fitness	ADL/IADL/extended IADLs	6MWT
	HRQOL	ADL/IADL/extended IADLs	National Health and Nutrition Survey
		Cardiorespiratory fitness	Brief Symptom Inventory-18	SF-36	Accelerometer
		Neuropathy	SF-36
	Lymphedema	ADL/IADL/extended IADLs	Water displacement	Circumferential measurements	BMI
Head and neck	ADL/IADL/extended IADLs		SPADI	Neck Dissection Impairment Index
	Balance	ADL/IADL/extended IADLs	1-leg stance	6MWT
	Cardiorespiratory fitness	Weakness	Anthropometric measures	Handgrip strength	30-s sit to stand
	HRQOL		EORTC QLQ-C30	EORTC modules
			SF-36	Neck Dissection Impairment Index	SF-12
	Joint mobility		MD Anderson Dysphagia Inventory (MDADI)	Performance Status Scale for Head and Neck Cancer	Functional Oral Intake Scale
			ROM	SF-36
	Speech and swallowing		Modified barium swallow test	MDADI	Performance Status Scale for Head and Neck Cancer
			Other self-developed tools
			Penetration and Aspiration Scale	Oropharyngeal swallow efficiency	Hyoid excursion
		HRQOL	EORTC QLQ-C30	EORTC modules	Danish Head & Neck Cancer Group dysphagia score
			Videofluroscopy	Mouth opening ROM	Functional Oral Intake Scale
	Weakness		AROM	SPADI	Neck Dissection Impairment Index
Hematological	ADL/IADL/extended IADLs	Balance	BOT-2	Tandem gait	Hopping on 1 leg
		Weakness	6MWT	Muscle strength	Ankle ROM
	Cardiorespiratory fitness	Weakness	PedsQL general	PedsQL cancer
	HRQOL	ADL/IADL/extended IADLs	SF-36
				Patient-Specific Functional Scale (PSFS)
		Fatigue	Pain VAS	KPS	EORTC QLQ-C30
	Weakness	ADL/IADL/extended IADLs	TUG Test	Timed up and down stairs	Checklist Individual Strength (CIS)
Lung	Fatigue	HRQOL	Fatigue VAS	EORTC QLQ-C30	Distress thermometer
	HRQOL		SF-36
		Cardiorespiratory fitness	SF-36	6MWT
Prostate	ADL/IADL/extended IADLs	Weakness	6MWT	1-RM	30-s sit to stand
			EORTC QLQ-C30	Late Life Function and Disability Index (LLFDI)	Schwartz Cancer Fatigue Scale
	Body weight	Fatigue	Anthropometric measures	Fatigue Severity Scale	6MWT
	Cardiorespiratory fitness	Fatigue	BMI	Senior Fitness Test Battery	Pedometer
	HRQOL	ADL/IADL/extended IADLs	EORTC QLQ-C30	Sit to stand	2MWT
			Expanded Prostate Cancer Index Composite (EPIC)	Risk for Distress Scale
			SF-36	Chair rise test	1-RM
	Urinary incontinence	HRQOL	UCLA Prostate Cancer Index	EPIC
				Incontinence VAS	SF-3 PCS
	Weakness	ADL/IADL/extended IADLs	1-RM chest press and leg press	SPPB	SF-36
		Urinary incontinence	Pelvic floor strength measures
Sarcoma	ADL/IADL/extended IADLs		Musculoskeletal Tumor Society Rating Scale (MSTS)
Various	ADL/IADL/extended IADLs		KPS	ECOG	Comprehensive Geriatric Assessment
			FIM
			PedsQL
			SF-36	EORTC QLQ-C30
				LLFDI	EORTC QLQ-C30
		Fatigue	BOT-2	GLTEQ	TUG Test
			Short Questionnaire to Assess Health-Enhancing Physical Activity (SQUASH)	Accelerometer
			Sickness Impact Profile	Vo  2 max	CIS
		HRQOL	SF-36	LLFDI
		Joint mobility	EORTC QLQ-C30	6MWT	SF-36
		Neuropathy	Berg Balance Scale (BBS)	Static-dynamic posturography	mCTSIB
	Balance		Fullerton Advanced Balance Scale	Balance Efficacy Scale	Other self-developed tools
			5-times sit to stand	Single heel raises
		Weakness	Charlson Comorbidity Index	Community Healthy Activities Model Program for Seniors (CHAMPS)	1-RM
	Cardiorespiratory fitness		6MWT
				Oxford Happiness Questionnaire	RSES
			EORTC QLQ-C30
		ADL/IADL/extended IADLs	SF-36	CHAMPS	BMI
		Fatigue	Duke Activity Status	6MWT
			Handgrip strength	Chair stand test	Multidimensional Fatigue Inventory
			Patient Health Questionnaire-9	Schwartz Cancer Fatigue Scale	Dartmouth Cooperative Functional Assessment Charts
		HRQOL	Accelerometer	Handgrip strength	Sit-ups/push-ups
			EORTC QLQ-C30	6MWT	SF-36
			PedsQL	Physical Activity Self-Efficacy
			SF-36
		Weakness	BMI	Anthropometric measures	SF-12
	Fatigue		Fatigue VAS	Ecological Momentary Assessment	Rhoten Fatigue Scale
			Oncology Nursing Society (ONS) Fatigue Scale
		ADL/IADL/extended IADLs	CIS	Sickness Impact Profile	Sleep Quality Scale
			Fatigue Symptom Inventory
		Balance	ECOG	Tinetti Mobility Test	TUG Test
		Cardiorespiratory fitness	BFI	30-s chair stands	Modified Bruce Protocol
			GLTEQ	International Physical Activity Questionnaire	7-d physical activity recall
		HRQOL	Fatigue Assessment Questionnaire	EORTC QLQ-C30	General Self-Efficacy Scale
			EORTC QLQ-C30	12MWT
			SF-36	Other self-developed tools	PSQI
	HRQOL		Cancer Rehabilitation Evaluation System	EORTC QLQ-C30	Quality of Life Index for Cancer Patients
			EORTC QLQ-C30	EORTC modules
				PSQI	Physical Activity Scale for Elders
			PedsQL
		ADL/IADL/extended IADLs	Edmonton Symptom Assessment Scale	6MWT	Timed sit-to-stand test
			TUG Test	SF-36
			SF-36
				EORTC QLQ-C30	EORTC modules
				LLFDI	CHAMPS questionnaire
		Cardiorespiratory fitness	EORTC QLQ-C30	Aastrand 6-Minute Cycle Test	Handgrip strength
			GLTEQ	6MWT	SF-36
			SF-36	Other self-developed tools
		Fatigue	EORTC QLQ-C30	EORTC modules	Piper Fatigue Inventory
			SF-36
	Joint mobility	ADL/IADL/extended IADLs	DASH	BPI	Pain VAS
	Neuropathy	Pain	SF-36	MD Anderson Symptom Inventory (MDASI)	BPI
	Sexual function		PCI/EPIC
	Weakness	Cardiorespiratory fitness	Anthropometric measures	Handgrip strength	6MWT
		Fatigue	SF-36	BIRS	Vo  2 peak

^a ADLs = activities of daily living; AROM = active range of motion; DASH = Disabilities of Arm, Shoulder, and Hand; EORTC = European Organization for Research and Treatment of Cancer; GLTEQ = Godin Leisure-Time Exercise Questionnaire; HRQOL = health-related quality of life; IADLs = instrumental ADLs; max = maximum; 2MWT, 4 MWT, 6MWT, and 12MWT = 2-, 4-, 6-, and 12-minute walk tests, respectively; PCI = Prostate Cancer Index; PedsQL = Pediatric Quality of Life Inventory; PHQ-9 = Patient Health Questionnaire-9; POMS = Profile of Moods State; PSQI = Pittsburgh Sleep Quality Index; EORTC QLQ-C30 = European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Cancer 30; 1-RM = 1-repetition maximum; ROM = range of motion; SF-36 = Medical Outcomes Study 36-Item Health Survey Questionnaire; SF-36 PCS = Physical Component Summary; SPADI = Shoulder Pain and Disability Index; TUG = Timed “Up & Go”; Vo  ₂ = oxygen consumption; WOMAC = Western Ontario and McMaster Universities Osteoarthritis Index.

^b Spirometrics, Gray, ME (USA).

^c Biodex Medical Systems, Inc, Shirley, NY (USA).