Performance status score: do patients and their oncologists agree?

Abstract

Oncologists traditionally assess their patients' ECOG performance status (PS), and few studies have evaluated the accuracy of these assessments. In this study, 101 patients attending a rapid access clinic at Papworth Hospital with a diagnosis of lung cancer were asked to assess their own ECOG PS score on a scale between 0 and 4. Patients' scores were compared to the PS assessment of them made by their oncologists. Of 98 patients with primary non-small-cell lung cancer (NSCLC) and small-cell lung cancer (SCLC), weighted kappa statistics showed PS score agreement between patient and oncologist of 0.45. Both patient- and oncologist-assessed scores reflected survival duration (in NSCLC and SCLC) as well as disease stage (in NSCLC), with oncologist-assessed scores being only marginally more predictive of survival. There was no sex difference in patient assessment of PS scores, but oncologists scored female patients more pessimistically than males. This study showed that, with few exceptions, patients and oncologists assessed PS scores similarly. Although oncologists should continue to score PS objectively, it may benefit their clinical practice to involve their patients in these assessments.

Figure 1

The ECOG PS score used in this study.

Figure 2

Kaplan–Meier graph showing cumulative survival of 81 study patients with a diagnosis of NSCLC according to the pathological stage of their disease at diagnosis. Survival taken from date of trial entry until death or completion of study (if alive).

Figure 3

Kaplan–Meier graph showing cumulative survival in patients with NSCLC according to their patient-assessed PS scores (data: Table 2). Survival correlated with PS, P=0.001.

Figure 4

Kaplan–Meier graph showing cumulative survival in patients with NSCLC according to their oncologist-assessed performance status scores (data: Table 2). Survival correlated with PS, P<0.001.

Figure 5

Overall survival of 170 (nonstudy) patients with NSCLC enrolled in the two-stop clinic in 1998 compared with survival of 81 (study) patients with NSCLC. There was no statistical difference in survival between them. P=0.83.