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Background Physician-reported performance status (PS) is an important prognostic factor, and frequently influences treatment decisions. The extent, prognostic importance, and predictors of disagreements in PS assessment between physicians and patients have not been adequately examined. Methods Using NCCTG clinical trial data from 1987–1990, we compared PS (ECOG and Karnofsky [KPS]) and nutrition scores reported by physicians and patients individually. Differences were analyzed using paired t-test and degree of disagreement by kappa statistic. Effect of disagreement on overall survival was determined by Kaplan-Meier method and Cox regression analysis. Predictors of disagreement were identified by logistic regression. Results 1,636 patients with advanced lung and colorectal cancer had a median survival of 9.8 months (95% CI, 9.4 to 10.4). Percent disagreement between patients and physicians about KPS, ECOG PS, and nutrition score was 67.1%, 56.6% and 58.0% respectively. Physicians were more likely to rate patients better than individual patients were to rate themselves: ECOG (Mean 0.91 vs. 1.30, p<.0001), KPS (Mean 83.3 vs. 81.7, p<0.0001), nutrition score (Mean 1.6 vs. 2.1, p<0.0001). Disagreement between patients and their physicians was associated with increased risk of death: KPS (HR 1.16, 95% CI 1.04 to 1.30, p=0.008) and nutrition scores (HR 1.44, 95% CI 1.29 to 1.61, p<0.0001) after adjustment for covariates. Patient socio-demographic factors that predict disagreement were identified. Conclusions Physicians and patients frequently disagree about PS and nutritional status. Disagreement is associated with an increased risk of death in patients with advanced malignancies. These findings illustrate the limitations of physician-only assessed PS.

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