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 k 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. Performance statusDavid A Karnofsky and colleagues described the first performance status (PS) score in 1948 (Karnofsky et al, 1948). It was introduced for assessing patients receiving nitrogen mustard chemotherapy for primary lung carcinoma. Each patient was given a score on a linear scale between 0 (dead) and 100 (normally active), summarising their ability to perform daily activities, and the level of assistance they required in order to do so. This scoring system was subsequently used throughout oncology practice as a numerical guide to patients' general health. In 1960, the Eastern Co-operative Oncology Group (ECOG) introduced a simpler 'ECOG performance status' scale, similar to the Karnofsky PS (KPS) scale, with only five points. This is now termed the ECOG/ WHO score (Oken et al, 1982) having been expanded to comprise of six points with the addition of PS 5 (Figure 1).In a Medline Search using the terms 'clinical trial and Karnofsky/WHO or ECOG performance status', 233 and 84 authors used the ECOG and Karnofsky scores, respectively. Generally, the two scores have been proven to be interchangeable (Taylor et al, 1999), although the ECOG is often preferred for its simplicity. Interobserver agreementA score is reliable if there is good concordance between observers, and low rates of inter-and intraobserver variability. Studies of this have been conflicting. When health professionals were asked to assess the KPS of 75 cancer patients, Yates et al (1980) found moderate agreement (correlation coefficient 0.69) between nurses and social workers. Oncologists and psychiatrists or psychologists had greater agreement with a correlation coefficient of 0.79. Roila et al (1991) showed very high interobserver correlation between two oncologists in assessing both the Karnofsky (coefficient 0.92) and ECOG (coefficient 0.91) scores in 209 canc...

The Incidence of Hyponatraemia and Its Effect on the ECOG Performance Status among Lung Cancer Patients

“…This correlation would not always signify the causation. A high ECOG score meant a poor performance status, which was often correlated with an advanced stage of lung cancer in many studies [20]. The clinical stage of the lung cancer also showed a positive correlation with the ECOG score at admission in our study.…”

“…in their studies, commented that the performance score was highly correlated with the stage (and age) and in this study, it represented the "best prognostic factor" in the clinical practice [23,24].…”

Association of Nutritional Status with Quality of Life in Breast Cancer Survivors

“…ECOG is a 6-point scale ranging from 0 (fully active) to 5 (dead) that assesses the patient's ability for self-care and ambulation. Higher scores reflect worse function (Blagden et al, 2003).…”

Implication of Murphy's Law in Clinical Trials

“…One of criteria intended to select those patients that are fit enough for anti-cancer therapy, is assessment of performance status (PS). Correlation of PS with survival has been well documented for different types of malignancies [3][4][5], and considering that overall survival is the most reliable and preferred cancer endpoint [6], accurate assessment of PS is a powerful tool for appropriate selection of study subjects. Besides not unanimous agreement on the general results of PS scales with variable inter-expert agreement in a wide range from kappa=0.19 to kappa=0.92 [2], the methodology of assessment does not suggest well-defined criteria and is based on the ability to perform working and self-service activities [7].…”