What is an estimand & how does it relate to quantifying the effect of treatment on patient-reported quality of life outcomes in clinical trials?

作者：Rachael Lawrance, Evgeny Degtyarev, Philip Griffiths, Peter C. Trask, Helen Lau, Denise D’Alessio, Ingolf Griebsch, G. Wallenstein, Kim Cocks, Kaspar Rufibach · 发表于：Journal of Patient-Reported Outcomes · 年份：2020 · DOI：10.1186/s41687-020-00218-5 · 被引用次数：66 · 研究领域：Cancer survivorship and care、Statistical Methods in Clinical Trials、Health Systems, Economic Evaluations, Quality of Life

BACKGROUND: Published in 2019, a new addendum to the ICH E9 guideline presents the estimand framework as a systematic approach to ensure alignment among clinical trial objectives, trial execution/conduct, statistical analyses, and interpretation of results. The use of the estimand framework for describing clinical trial objectives has yet to be extensively considered in the context of patient-reported outcomes (PROs). We discuss the application of the estimand framework to PRO objectives when designing clinical trials in the future, with a focus on PRO outcomes in oncology trial settings as our example. MAIN: We describe the components of an estimand and take a naïve PRO trial objective to illustrate how to apply attributes described in the estimand framework to inform construction of a detailed clinical trial objective and its related estimand. We discuss identifying potential post-randomization events that alter the interpretation of the endpoint or render its observation impossible (also defined as intercurrent events) in the context of PRO endpoints, and the implications of how to handle intercurrent events in the construction of the PRO objective. Using a simple objective statement, "What is the effect of treatment X on patient's quality of life?", we build up an example estimand statement and also use a previously published phase III oncology clinical trial to illustrate how an estimand for a PRO objective could have been written to align to the estimate framework. CONC...