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Summary The ECOG Scale of Performance Status (PS) is widely used to quantify the functional status of cancer patients, and is an important factor determining prognosis in a number of malignant conditions. The PS describes the status of symptoms and functions with respect to ambulatory status and need for care. PS 0 means normal activity, PS 1 means some symptoms, but still near fully ambulatory, PS 2 means less than 50%, and PS 3 means more than 50% of daytime in bed, while PS 4 means completely bedridden. An inter-observer variability study of PS assessment has been carried out to evaluate the non-chance agreement among three oncologists rating 100 consecutive cancer patients. Total unanimity was observed in 40 cases, unanimity between two observers in 53 cases, and total disagreement in seven cases. Kappa statistics reveal the ability of the observers compared to change alone and were used to evaluate non-chance agreement. Overall Kappa was 0.44, (95% confidence limits 0.38-0.51). The Kappa for PS 0 was 0.55 (0.44-0.67), while those for PS 1, 2, 3 and four were 0.48 (0.37-0.60), 0.31 (0.19-0.42), 0.43 (0.32-0.55), and 0.33 (0.33-0.45), respectively. If one observer allocated patients to PS 0-2, then another randomly selected observed placed the patients in the same category with a probability of 0.92. For patients with PS 3-4 the probability that the same category would be chosen was 0.82. Overall, the non-chance agreement between observers was only moderate, when all ECOG Performance Status groups were considered. However, agreement with regard to allocation of patients to PS 0-2 versus 3-4 was high. This is of interest because this cut-off is often used in clinical studies.

Objective: To determine the effect of a shared care programme on the attitudes of newly referred cancer patients towards the healthcare system and their health related quality of life and performance status, and to assess patients' reports on contacts with their general practitioner (GP). Setting: Department of Oncology at Aarhus University Hospital and general practices. Design: Randomised controlled trial in which patients completed questionnaires at three time points. The shared care programme included transfer of knowledge from the oncologist to the GP, improved communication between the parties, and active patient involvement. Participants: 248 consecutive cancer patients recently referred to the department. Main outcome measures: Patients' attitudes towards the healthcare services, their health related quality of life, performance status, and reports on contacts with their GPs. Results: The shared care programme had a positive effect on patient evaluation of cooperation between the primary and secondary healthcare sectors. The effect was particularly significant in men and in younger patients (18-49 years) who felt they received more care from the GP and were left less in limbo. Young patients in the intervention group rated the GP's knowledge of disease and treatment significantly higher than young patients in the control group. The number of contacts with the GP was significantly higher in the intervention group. The EORTC quality of life questionnaire and performance status showed no significant differences between the two groups. Conclusions: An intersectoral shared care programme in which GPs and patients are actively involved has a positive influence on patients' attitudes towards the healthcare system. Young patients and men particularly benefit from the programme. P atients with cancer may feel uncertain about what is going to happen when they are referred to hospital and they may experience psychological morbidity and dissatisfaction with the provision of information and care.1 They have stressed the importance of the following aspects in their contact with the healthcare service: doctors' technical competence, communication skills, continuity of care, family care, and financial circumstances.2 Most patients with cancer are treated as outpatients and may therefore feel left alone at crucial moments. At such times they often consult their general practitioner (GP) for further advice, information, and repetition of information. These contacts place the GP in a key position in which s/he may have problems due to lack of specific knowledge of cancer and lack of collaboration with the oncologists. [3][4][5] This situation occurs frequently and may be remedied by sharing the care between GPs and oncologists.Shared care has been defined as "care [which] applies when the responsibility for the health care of the patient is shared between individuals or teams who are part of separate organisations, or where substantial organisational boundaries exist".6 It implies personal communication and organised trans...

The Danish experience shows that a national quality management system including national guidelines, a database with high data quality, frequent reports, audit and commitment from all stakeholders can contribute to improve clinical practice, improve core results, and reduce regional differences.

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Timing of CI did not significantly influence the incidence of in-field recurrences, CNS recurrences, or overall survival.

Establishment of a national lung cancer group with the primary tasks to implement updated national guidelines and to secure valid registration of clinical baseline data and quality parameters has been a contributory factor to significantly improve the quality of lung cancer surgery.

This article describes the Danish National Indicator Project that aims to document and improve the quality of care at national level. Specific clinical indicators, standards, and prognostic factors have been developed for eight diseases (e.g. lung cancer). It has been implemented in all clinical departments in Denmark. Participation is mandatory. Results related to lung cancer are presented and discussed. The experiences from 2000 to 2008 indicate that the quality of care related to the eight diseases improve over time and that that performance and outcome measurement will get paid in terms of quality improvement.