Discrepancies between genitourinary cancer patients' and clinicians' characterization of the Eastern Cooperative Oncology Group performance status

Abstract

BackgroundPatient‐reported outcomes have been used to assess treatment effectiveness and actively engage patients in their disease management. This study was designed to describe the patient‐reported performance status (PS) and the provider‐reported PS.MethodsPatients with metastatic genitourinary cancers were recruited from a single cancer center before the initiation of a new line of treatment. PS (Eastern Cooperative Oncology Group [ECOG]), quality of life (Functional Assessment of Chronic Illness Therapy–General), and distress (Patient‐Reported Outcomes Measurement Information System Anxiety and Depression) were self‐reported by patients. Clinical data (eg, age, sex, diagnosis, and physician‐reported ECOG PS) were extracted from medical records. Multivariate analysis was used to determine the association between PS, quality of life, and psychological symptoms.ResultsOne hundred forty‐five patients were enrolled (76.6% male, 70.3% White, 81.4% married, and 76.6% well educated). The median age was 67 years; 66.9% were diagnosed with renal cell carcinoma, 20.0% were diagnosed with urothelial carcinoma, and 13.1% were diagnosed with prostate cancer. Clinicians more frequently classified patients' ECOG PS as 0 in comparison with the patients themselves (92.4% vs 64.1%; P = .001). Higher clinician‐reported ECOG PS was associated with poorer physical and functional well‐being and higher rates of depression (P < .01), whereas higher patient‐reported ECOG PS was associated with worse psychosocial outcomes (P < .01).ConclusionsDiscrepancies were noted between the patient‐ and provider‐reported ECOG PS, with clinicians overestimating the ECOG PS in comparison with the patients themselves. This study's findings suggest that patients incorporate their social and emotional well‐being into their PS score in addition to their physical well‐being. This information is not immediately accessible to most clinicians from just a standard patient interview and likely accounts for the overestimation of the patients' ECOG PS by the clinicians.

Who really knows the performance status: The physician or the patient?

“…The findings described by Bergerot et al 8 for discrepancies in provider‐ and patient‐rated ECOG scores could be due to a wide variety of contributory factors. In addition to physical status, providers must take care to consider a broader range of psychosocial factors such as mental health, social well‐being, and education level when evaluating the PS of a patient with cancer.…”

“…Emerging research calls this practice into question by demonstrating that provider ratings of PS may be discordant from patient ratings 6,7 . Bergerot et al 8 took a critical look at provider and patient reports of ECOG PS in patients with metastatic genitourinary cancer. They found that providers were more likely than patients to give an ECOG score of 0 (92.4% vs 64.1%; P = .001).…”

“…These can include cancer‐ or symptom‐specific rating scales, such as the UCLA Integrated Staging System for renal cell carcinoma or the International Prostate Symptom Score for prostate disease. Perhaps, as suggested by Bergerot et al, 8 we should more frequently use the ECOG PS as a patient‐reported metric in conjunction with other PROs that may capture a more comprehensive picture of PS.…”

“…Prior work has shown that mental health factors can contribute to differences in provider and patient ratings of PS 9 . Bergerot et al 8 used the Patient‐Reported Outcomes Measurement Information System Anxiety and Depression scales and the Functional Assessment of Chronic Illness Therapy–General to capture the physical, psychiatric, social, and emotional well‐being of patients 10,11 . They found that worse ECOG ratings by clinicians were associated with higher rates of depression (as corroborated by Patient‐Reported Outcomes Measurement Information System scores) and with poorer physical and functional well‐being (from the Functional Assessment of Chronic Illness Therapy–General scale).…”

“…Most historical studies or clinical trials using PS metrics do not include adequate information on sociodemographic characteristics or lack diversity in the population studied 15 . For instance, the study population in Bergerot et al 8 was 70.3% White, 81.4% married, and 76.6% male; 76.6% of the patients had a college‐level education or beyond (a number far exceeding the national average of 33%) 16 . In this cohort, they found that patient self‐reported PS was unaffected by sociodemographic characteristics, including education.…”