Relationship between physician and patient assessment of performance status and survival in a large cohort of patients with haematologic malignancies

Liu, Michael A.; Hshieh, Tammy T.; Condron, Nolan B.; Wadleigh, Martha; Abel, Gregory A.; Driver, Jane A.

doi:10.1038/bjc.2016.260

Cited by 24 publications

(25 citation statements)

References 8 publications

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“…We extracted disease and treatment characteristics from chart review to include as covariates in our analyses. Hematologic malignancies were categorized as aggressive (diffuse large B‐cell lymphoma, mantle cell lymphoma, multiple myeloma, AML) or indolent (marginal zone lymphoma, follicular lymphoma, chronic lymphocytic leukemia, monoclonal gammopathy of unknown significance, MDS, myeloproliferative neoplasm/myeloproliferative disease, and hairy‐cell leukemia) . Regarding treatment, patients were first categorized on whether they received treatment prior to enrollment (“prior treatment”: yes or no).…”

Section: Methodsmentioning

confidence: 99%

“…Hematologic malignancies were categorized as aggressive (diffuse large B-cell lymphoma, mantle cell lymphoma, multiple myeloma, AML) or indolent (marginal zone lymphoma, follicular lymphoma, chronic lymphocytic leukemia, monoclonal gammopathy of unknown significance, MDS, myeloproliferative neoplasm/myeloproliferative disease, and hairy-cell leukemia). 17,28 Regarding treatment, patients were first categorized on whether they received treatment prior to enrollment ("prior treatment": yes or no). Next, current or new treatments ("current/new treatment") prescribed within 3 months after enrollment were categorized as intensive (eg, "RCHOP" and triplet therapy regimens for lymphoma and multiple myeloma, respectively), reduced intensity (eg, significantly dose-reduced chemotherapy or hypomethylating agents), or supportive (eg, surveillance or only receiving erythropoiesis-stimulating agents and/or blood transfusions).…”

Section: Disease Covariatesmentioning

confidence: 99%

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Function, Survival, and Care Utilization Among Older Adults With Hematologic Malignancies

DuMontier

Liu

Murillo

et al. 2019

J American Geriatrics Society

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BACKGROUND/OBJECTIVES Cancer‐focused organizations now recommend routine assessment of instrumental activities of daily living (iADLs) for all older patients with cancer, along with assessment of basic activities of daily living (ADLs) if possible. However, little is known regarding the role of iADLs in predicting survival and acute‐care utilization in populations of older adults with different hematologic malignancies. DESIGN Prospective cohort study. SETTING AND PARTICIPANTS A screening geriatric assessment was conducted for adults 75 years and older with hematologic malignancies (n = 464) presenting for initial consultation at a large tertiary cancer hospital in Boston, MA. MEASUREMENTS Univariable and multivariable analyses assessed the association of dependency in ADLs and dependency in iADLs with survival and care utilization (emergency department [ED] visits and unplanned hospitalizations). RESULTS Subjects were a mean age of 79.7 years and had a mean follow‐up of 13.8 months. Overall, 11.4% had dependency in ADLs and 26.7% had dependency in iADLs. Only iADL dependency was associated with higher mortality (hazard ratio = 2.34 [95% confidence interval [CI] = 1.46‐3.74]) independently of age, comorbidity, cancer aggressiveness, and treatment intensity. The effect was dose dependent, and impairments in shopping, meal preparation, and housework were all independently associated with a higher hazard of death. iADL dependency was also associated with higher odds of ED visits (odds ratio [OR] = 2.76 [95% CI = 1.30‐5.84]) and hospitalizations (OR = 2.89 [95% CI = 1.37‐6.09]). Several geriatric domain impairments, including probable cognitive impairment and physical dysfunction, were associated with iADL dependency. CONCLUSION These findings suggest that older adults with hematologic malignancies and iADL dependency experience higher mortality and acute‐care utilization, arguing that iADLs should be formally assessed as part of routine oncology care. J Am Geriatr Soc 67:889–897, 2019.

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Section: Methodsmentioning

confidence: 99%

Section: Disease Covariatesmentioning

confidence: 99%

Function, Survival, and Care Utilization Among Older Adults With Hematologic Malignancies

DuMontier

Liu

Murillo

et al. 2019

J American Geriatrics Society

Self Cite

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“…[39][40][41] In cancer patients, discordance between physician assessed and patient assessed performance status is associated with worse survival. 42,43 These factors decrease the sensitivity of performance status scores in predicting adverse health outcomes. Frailty assessment may provide more sensitive measure of functional status.…”

Section: Frailty Syndrome In Hsct Recipientsmentioning

confidence: 99%

Frailty: the missing piece of the pre- hematopoietic cell transplantation assessment?

Hegde

Murthy

2017

Bone Marrow Transplant

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Hematopoietic stem cell transplantation (HSCT) represents a curative option for those afflicted with numerous hematologic malignancies and bone marrow failure syndromes. Advances and refinement of the HSCT process have resulted in increasing number of transplants performed on older patients in the recent years. Pre-transplant assessments (PTA) function to risk stratify patients prior to undergoing HSCT in an effort to predict those at higher risk of treatment-related toxicity, to inform risk/benefit assessments and to aid clinical decision making. Traditionally used risk stratification parameters such as chronologic age, comorbidity and performance status may not fully capture physical function, physiologic fitness, highlighting a need for improvement in PTA. Incorporation of frailty measurements in pre-HSCT assessments, particularly in elderly transplant candidates, may result in improving predictive ability of existing tools such as the Hematopoietic Cell Transplantation Comorbidity Index and Karnofsky performance status. Here, we review existing pre-HSCT assessment tools, measures of frailty that may aid in risk stratification for patients undergoing HSCT and directions for future research using frailty in the pre-HSCT setting.

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“…A major disadvantage of C‐PS is that it is subjective, with only moderate agreement between physician, patient and nurse (Ando et al, ; Blagden, Charman, Sharples, Magee, & Gilligan, ; Sorensen, Klee, Palshof, & Hansen, ; Zimmermann et al, ). Patient‐rated PS (P‐PS) is used to reduce this subjectivity, and is strongly predictive of survival (Liu et al, ). In 1636 patients with advanced lung and colorectal tumours, two‐thirds had PS disagreements, in most of these cases C‐PS was rated better than P‐PS.…”

Section: Introductionmentioning

confidence: 99%

“…Patient-rated PS (P-PS) is used to reduce this subjectivity, and is strongly predictive of survival (Liu et al, 2016). In 1636 patients with advanced lung and colorectal tumours, two-thirds had PS disagreements, in most of these cases C-PS was rated better than P-PS.…”

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confidence: 99%

Performance status agreement assessed by the patient and clinician in a rapid access lung cancer service: Can either predict completion of treatment?

et al. 2019

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Introduction Clinician‐rated performance status (C‐PS) is used routinely to predict whether patients are fit enough to undergo treatment for lung cancer. However, a good proportion of those with seemingly good C‐PS do not go on to receive, let alone complete treatment. The value of C‐PS in accurately predicting this is unclear, as is the merit of evaluating patient‐rated PS (P‐PS). Objectives Our aim was to prospectively assess Eastern Cooperative Oncology Group (ECOG) and Karnofsky C‐PS and P‐PS in patients attending a rapid access lung cancer service (RALCS), the agreement between these scores, and whether any score could predict receipt and completion of multidisciplinary team (MDT)‐planned treatment. Results ECOG and Karnofsky scores were highly correlated (Spearman's rho −0.79 for C‐PS and −0.828 for P‐PS, both p < 0.001). There was poor agreement between C‐PS and P‐PS scores (kappa statistics 0.275 for ECOG and 0.172 for Karnofsky); however, clinicians did not tend to consistently under‐ or overestimate patients’ scores. ECOG P‐PS showed an association with completion of MDT‐planned treatment (p = 0.007), but C‐PS did not. Conclusion Clinician‐rated PS was not associated with completion of MDT‐planned treatment, but there may be a role for patient‐rated PS. C‐PS and P‐PS were poorly correlated in a RALCS.

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Relationship between physician and patient assessment of performance status and survival in a large cohort of patients with haematologic malignancies

Cited by 24 publications

References 8 publications

Function, Survival, and Care Utilization Among Older Adults With Hematologic Malignancies

Function, Survival, and Care Utilization Among Older Adults With Hematologic Malignancies

Frailty: the missing piece of the pre- hematopoietic cell transplantation assessment?

Performance status agreement assessed by the patient and clinician in a rapid access lung cancer service: Can either predict completion of treatment?

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