Aims: Computerised adaptive tests (CATs) have been proposed as an alternative to static patient-reported outcome measures (PROMs) due to several potential advantages. However, the use of CAT in cancer clinical trials in limited, partly due to a small, but developing, evidence base with few attempts to synthesise evidence. The aim of this systematic review was to compare the psychometric properties of CATs with static PROMs in cancer patients.
Methods: Four databases (MEDLINE, CINAHL, EMBASE and PsycINFO) were searched up to March 2024. Studies involving cancer patients and reported psychometric comparisons between a static PROM and CAT were included. Psychometric properties were defined using Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) criteria. The study protocol is registered in the International Prospective Register of Systematic Review (PROSPERO:CRD42024518077).
Results: 22 articles were included. The studies were cross-sectional (n=14) or prospective (n=8), and involved populations with various cancer types and stages. The most commonly used CAT was the EORTC CAT (n=9), followed by the PROMIS CAT (n=8). These CATs were typically compared against their static counterparts (i.e., EORTC QLQ-C30 scales and PROMIS short forms). Fatigue and depression were the most frequently assessed domains. Convergent validity was often assessed, using Spearman’s correlations and area under the receiver operating curve. There was sufficient evidence for construct validity of CATs compared with static PROMs. Evaluations also indicated that CAT could reduce sample size requirements without compromising power.
Conclusion: Developing research has improved our understanding of the construct validity of CATs in cancer patients, demonstrating that CATs reflect scores obtained by static PROMs. However, advanced methods, such as item response theory, are needed to validate CATs in populations different from those used in their original development. Further longitudinal studies in international settings are required to extend the use of CAT in cancer clinical trials globally.