The Neurologic Assessment in Neuro-Oncology (NANO) scale: A tool to assess neurologic function for integration into the Response Assessment in Neuro-Oncology (RANO) criteria

Lakshmi Nayak, Lisa M. Deangelis, Alba A. Brandes, David M. Peereboom, Evanthia Galanis, Nancy U. Lin, Riccardo Soffietti, David R. MacDonald, Marc Chamberlain, James Perry, Kurt Jaeckle, Minesh Mehta, Roger Stupp, Alona Muzikansky, Elena Pentsova, Timothy Cloughesy, Fabio M. Iwamoto, Joerg Christian Tonn, Michael A. Vogelbaum, Patrick Y. WenMartin J. Van Den Bent, David A. Reardon

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background. The Macdonald criteria and the Response Assessment in Neuro-Oncology (RANO) criteria defne radiologic parameters to classify therapeutic outcome among patients with malignant glioma and specify that clinical status must be incorporated and prioritized for overall assessment. But neither provides specifc parameters to do so. We hypothesized that a standardized metric to measure neurologic function will permit more effective overall response assessment in neuro-oncology. Methods. An international group of physicians including neurologists, medical oncologists, radiation oncologists, and neurosurgeons with expertise in neuro-oncology drafted the Neurologic Assessment in Neuro-Oncology (NANO) scale as an objective and quantifable metric of neurologic function evaluable during a routine offce examination. The scale was subsequently tested in a multicenter study to determine its overall reliability, interobserver variability, and feasibility. Results. The NANO scale is a quantifable evaluation of 9 relevant neurologic domains based on direct observation and testing conducted during routine offce visits. The score defnes overall response criteria. A prospective, multinational study noted a >90% inter-observer agreement rate with kappa statistic ranging from 0.35 to 0.83 (fair to almost perfect agreement), and a median assessment time of 4 minutes (interquartile range, 3-5). Conclusion. The NANO scale provides an objective clinician-reported outcome of neurologic function with high inter-observer agreement. It is designed to combine with radiographic assessment to provide an overall assessment of outcome for neuro-oncology patients in clinical trials and in daily practice. Furthermore, it complements existing patient-reported outcomes and cognition testing to combine for a global clinical outcome assessment of well-being among brain tumor patients.

Original languageEnglish (US)
Pages (from-to)625-635
Number of pages11
JournalNeuro-Oncology
Volume19
Issue number5
DOIs
StatePublished - May 1 2017

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Nervous System
Outcome Assessment (Health Care)
Observer Variation
Brain Neoplasms
Glioma
Cognition
Multicenter Studies
Observation
Clinical Trials
Prospective Studies
Physicians

All Science Journal Classification (ASJC) codes

  • Oncology
  • Clinical Neurology
  • Cancer Research

Cite this

Nayak, Lakshmi ; Deangelis, Lisa M. ; Brandes, Alba A. ; Peereboom, David M. ; Galanis, Evanthia ; Lin, Nancy U. ; Soffietti, Riccardo ; MacDonald, David R. ; Chamberlain, Marc ; Perry, James ; Jaeckle, Kurt ; Mehta, Minesh ; Stupp, Roger ; Muzikansky, Alona ; Pentsova, Elena ; Cloughesy, Timothy ; Iwamoto, Fabio M. ; Tonn, Joerg Christian ; Vogelbaum, Michael A. ; Wen, Patrick Y. ; Van Den Bent, Martin J. ; Reardon, David A. / The Neurologic Assessment in Neuro-Oncology (NANO) scale : A tool to assess neurologic function for integration into the Response Assessment in Neuro-Oncology (RANO) criteria. In: Neuro-Oncology. 2017 ; Vol. 19, No. 5. pp. 625-635.
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title = "The Neurologic Assessment in Neuro-Oncology (NANO) scale: A tool to assess neurologic function for integration into the Response Assessment in Neuro-Oncology (RANO) criteria",
abstract = "Background. The Macdonald criteria and the Response Assessment in Neuro-Oncology (RANO) criteria defne radiologic parameters to classify therapeutic outcome among patients with malignant glioma and specify that clinical status must be incorporated and prioritized for overall assessment. But neither provides specifc parameters to do so. We hypothesized that a standardized metric to measure neurologic function will permit more effective overall response assessment in neuro-oncology. Methods. An international group of physicians including neurologists, medical oncologists, radiation oncologists, and neurosurgeons with expertise in neuro-oncology drafted the Neurologic Assessment in Neuro-Oncology (NANO) scale as an objective and quantifable metric of neurologic function evaluable during a routine offce examination. The scale was subsequently tested in a multicenter study to determine its overall reliability, interobserver variability, and feasibility. Results. The NANO scale is a quantifable evaluation of 9 relevant neurologic domains based on direct observation and testing conducted during routine offce visits. The score defnes overall response criteria. A prospective, multinational study noted a >90{\%} inter-observer agreement rate with kappa statistic ranging from 0.35 to 0.83 (fair to almost perfect agreement), and a median assessment time of 4 minutes (interquartile range, 3-5). Conclusion. The NANO scale provides an objective clinician-reported outcome of neurologic function with high inter-observer agreement. It is designed to combine with radiographic assessment to provide an overall assessment of outcome for neuro-oncology patients in clinical trials and in daily practice. Furthermore, it complements existing patient-reported outcomes and cognition testing to combine for a global clinical outcome assessment of well-being among brain tumor patients.",
author = "Lakshmi Nayak and Deangelis, {Lisa M.} and Brandes, {Alba A.} and Peereboom, {David M.} and Evanthia Galanis and Lin, {Nancy U.} and Riccardo Soffietti and MacDonald, {David R.} and Marc Chamberlain and James Perry and Kurt Jaeckle and Minesh Mehta and Roger Stupp and Alona Muzikansky and Elena Pentsova and Timothy Cloughesy and Iwamoto, {Fabio M.} and Tonn, {Joerg Christian} and Vogelbaum, {Michael A.} and Wen, {Patrick Y.} and {Van Den Bent}, {Martin J.} and Reardon, {David A.}",
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Nayak, L, Deangelis, LM, Brandes, AA, Peereboom, DM, Galanis, E, Lin, NU, Soffietti, R, MacDonald, DR, Chamberlain, M, Perry, J, Jaeckle, K, Mehta, M, Stupp, R, Muzikansky, A, Pentsova, E, Cloughesy, T, Iwamoto, FM, Tonn, JC, Vogelbaum, MA, Wen, PY, Van Den Bent, MJ & Reardon, DA 2017, 'The Neurologic Assessment in Neuro-Oncology (NANO) scale: A tool to assess neurologic function for integration into the Response Assessment in Neuro-Oncology (RANO) criteria', Neuro-Oncology, vol. 19, no. 5, pp. 625-635. https://doi.org/10.1093/neuonc/nox029

The Neurologic Assessment in Neuro-Oncology (NANO) scale : A tool to assess neurologic function for integration into the Response Assessment in Neuro-Oncology (RANO) criteria. / Nayak, Lakshmi; Deangelis, Lisa M.; Brandes, Alba A.; Peereboom, David M.; Galanis, Evanthia; Lin, Nancy U.; Soffietti, Riccardo; MacDonald, David R.; Chamberlain, Marc; Perry, James; Jaeckle, Kurt; Mehta, Minesh; Stupp, Roger; Muzikansky, Alona; Pentsova, Elena; Cloughesy, Timothy; Iwamoto, Fabio M.; Tonn, Joerg Christian; Vogelbaum, Michael A.; Wen, Patrick Y.; Van Den Bent, Martin J.; Reardon, David A.

In: Neuro-Oncology, Vol. 19, No. 5, 01.05.2017, p. 625-635.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The Neurologic Assessment in Neuro-Oncology (NANO) scale

T2 - A tool to assess neurologic function for integration into the Response Assessment in Neuro-Oncology (RANO) criteria

AU - Nayak, Lakshmi

AU - Deangelis, Lisa M.

AU - Brandes, Alba A.

AU - Peereboom, David M.

AU - Galanis, Evanthia

AU - Lin, Nancy U.

AU - Soffietti, Riccardo

AU - MacDonald, David R.

AU - Chamberlain, Marc

AU - Perry, James

AU - Jaeckle, Kurt

AU - Mehta, Minesh

AU - Stupp, Roger

AU - Muzikansky, Alona

AU - Pentsova, Elena

AU - Cloughesy, Timothy

AU - Iwamoto, Fabio M.

AU - Tonn, Joerg Christian

AU - Vogelbaum, Michael A.

AU - Wen, Patrick Y.

AU - Van Den Bent, Martin J.

AU - Reardon, David A.

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Background. The Macdonald criteria and the Response Assessment in Neuro-Oncology (RANO) criteria defne radiologic parameters to classify therapeutic outcome among patients with malignant glioma and specify that clinical status must be incorporated and prioritized for overall assessment. But neither provides specifc parameters to do so. We hypothesized that a standardized metric to measure neurologic function will permit more effective overall response assessment in neuro-oncology. Methods. An international group of physicians including neurologists, medical oncologists, radiation oncologists, and neurosurgeons with expertise in neuro-oncology drafted the Neurologic Assessment in Neuro-Oncology (NANO) scale as an objective and quantifable metric of neurologic function evaluable during a routine offce examination. The scale was subsequently tested in a multicenter study to determine its overall reliability, interobserver variability, and feasibility. Results. The NANO scale is a quantifable evaluation of 9 relevant neurologic domains based on direct observation and testing conducted during routine offce visits. The score defnes overall response criteria. A prospective, multinational study noted a >90% inter-observer agreement rate with kappa statistic ranging from 0.35 to 0.83 (fair to almost perfect agreement), and a median assessment time of 4 minutes (interquartile range, 3-5). Conclusion. The NANO scale provides an objective clinician-reported outcome of neurologic function with high inter-observer agreement. It is designed to combine with radiographic assessment to provide an overall assessment of outcome for neuro-oncology patients in clinical trials and in daily practice. Furthermore, it complements existing patient-reported outcomes and cognition testing to combine for a global clinical outcome assessment of well-being among brain tumor patients.

AB - Background. The Macdonald criteria and the Response Assessment in Neuro-Oncology (RANO) criteria defne radiologic parameters to classify therapeutic outcome among patients with malignant glioma and specify that clinical status must be incorporated and prioritized for overall assessment. But neither provides specifc parameters to do so. We hypothesized that a standardized metric to measure neurologic function will permit more effective overall response assessment in neuro-oncology. Methods. An international group of physicians including neurologists, medical oncologists, radiation oncologists, and neurosurgeons with expertise in neuro-oncology drafted the Neurologic Assessment in Neuro-Oncology (NANO) scale as an objective and quantifable metric of neurologic function evaluable during a routine offce examination. The scale was subsequently tested in a multicenter study to determine its overall reliability, interobserver variability, and feasibility. Results. The NANO scale is a quantifable evaluation of 9 relevant neurologic domains based on direct observation and testing conducted during routine offce visits. The score defnes overall response criteria. A prospective, multinational study noted a >90% inter-observer agreement rate with kappa statistic ranging from 0.35 to 0.83 (fair to almost perfect agreement), and a median assessment time of 4 minutes (interquartile range, 3-5). Conclusion. The NANO scale provides an objective clinician-reported outcome of neurologic function with high inter-observer agreement. It is designed to combine with radiographic assessment to provide an overall assessment of outcome for neuro-oncology patients in clinical trials and in daily practice. Furthermore, it complements existing patient-reported outcomes and cognition testing to combine for a global clinical outcome assessment of well-being among brain tumor patients.

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U2 - 10.1093/neuonc/nox029

DO - 10.1093/neuonc/nox029

M3 - Article

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