Should Patient-Rated Performance Status Affect Treatment Decisions in Advanced Lung Cancer?

Dajczman, Esther; Kasymjanova, G.; Kreisman, Harvey; Swinton, Nelda; Pepe, C.; Small, David

doi:10.1097/jto.0b013e318186a272

Cited by 73 publications

(63 citation statements)

References 15 publications

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“…For a screening or monitoring tool to be accepted in routine practice, it needs to be brief, relevant in its utility and simple enough to interpret while retaining the necessary specificity and sensitivity 5. What we need is to capitalise on an existing tool as a brief form of assessment that can function as a surrogate tool for screening depression and anxiety 7. The Eastern Cooperative Oncology Group (ECOG) performance status (PS) is one such measure.…”

Section: Introductionmentioning

confidence: 99%

Discrepancy in patient-rated and oncologist-rated performance status on depression and anxiety in cancer: a prospective study protocol: Table A1

et al. 2012

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ObjectivePsychological distress is common in patients with cancer. We need a rapid means of screening for and identifying depression and anxiety in patients with cancer. The present study evaluates the potential of the Eastern Cooperative Oncology Group (ECOG) performance status (PS) scoring as a brief screening tool to assess psychological distress in routine cancer care. The ECOG PS is widely used by oncologists and the WHO, as a standardised measure to assess general well-being in patients with cancer and quality of life in cancer trials. We examine the discrepancy between patient-rated and oncologist-rated PS scores on the ECOG in a comparative assessment against the Hospital Anxiety and Depression Scale (HADS).Methods and designThis is a prospective evaluation of approximately 500 ambulatory adult cancer patients from a large academic medical centre. Participants will be asked to assess their own ECOG PS on a scale of 0–4, which will be compared to ECOG PS as rated by their oncologists. Higher ECOG PS scores indicate poorer daily functioning. Both patient-rated and oncologist-rated ECOG PS and their absolute differences will be tested for predictive and concurrent validity against the HADS. A HADS cut-off ≥15 will be used. Ethics approval for this study has been secured from the institutional ethics board. Outcomes are re-evaluated at 4-week to 6-week and 1-year follow-up.ConclusionThis study holds practical significance for rapid screening of psychological distress in the cancer clinic with the use of the ECOG PS scoring. Given the high prevalence of anxiety and depression in patients with cancer, screening is important to increase its recognition, which will, in turn, help to direct referrals and deliver appropriate intervention. This study also generates greater insight into the association between psychosomatic complaints and psychological distress.Trial registration numberMEC 896.52.

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Section: Introductionmentioning

confidence: 99%

Discrepancy in patient-rated and oncologist-rated performance status on depression and anxiety in cancer: a prospective study protocol: Table A1

et al. 2012

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“…living alone or with a career. Further, comparison between clinician or patient-rated ECOG PS and physical activity level would be of interest given that patients tend to score themselves lower than professionals do [14].…”

Section: Discussionmentioning

confidence: 99%

Exploring physical activity level in patients with thoracic cancer: implications for use as an outcome measure

Maddocks

Wilcock

2012

Support Care Cancer

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“…Although ps was shown to be the "gold standard" prognostic measure, also evidenced in the present study, that standing does not support the notion that treatment should explicitly be withheld in patients with a poor ps 23,24 . In fact, ps is an entirely subjective evaluation, prone to considerable discrepancies, with clear inter-observer variabilities 25,26 . As such, ps could be overestimated, consequently leading to inappropriate treatment decisions and even lack of referral to an oncologist.…”

Section: Discussionmentioning

confidence: 99%

Factors Influencing Treatment Selection and Survival in Advanced Lung Cancer

et al. 2017

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Purpose Despite numerous breakthrough therapies, inoperable lung cancer still places a heavy burden on patients who might not be candidates for chemotherapy. To identify potential candidates for the newly emerging immunotherapy-based treatment paradigms, we explored the clinical and biologic factors affecting treatment decisions. MethodsWe retrospectively reviewed the records of patients diagnosed at our university-affiliated cancer centre between 1 January 2011 and 31 December 2013. Patient demographics, systemic treatment, and survival were examined.Results During the 3-year study period, 683 patients fitting the inclusion criteria were identified. First-line therapy was administered in 49.5% of patients; only 22.4% received further lines of therapy. The main reasons for withholding therapy were poor performance status [ps (43.2%)], rapidly deteriorating ps (31.9%), patient refusal of therapy (20.9%), and associated comorbidities (4%). Older age, the presence of brain metastasis at diagnosis, and non-small-cell histology were also associated with therapeutic restraint. Oncology referrals were infrequent in patients who did not receive therapy (32.2%). Older patients and those with a poor ps experienced superior survival when treatment was administered (hazard ratio: 0.25; 95% confidence interval: 0.16 to 0.38; and hazard ratio: 0.44; 95% confidence interval: 0.23 to 0.87 respectively; p < 0.001).Conclusions Advanced lung cancer still poses a therapeutic challenge, with a high proportion of patients being deemed unfit for therapy. This issue cannot be resolved until appropriate measures are taken to ensure the inclusion of older patients and those with a relatively poor ps in large clinical trials. Immunotherapy might be interesting in this setting, given that it appears to be more tolerable. Another consequential undertaking would be the deployment of strategies to reduce wait times during the diagnostic process for patients with a high index of suspicion for lung cancer.

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Should Patient-Rated Performance Status Affect Treatment Decisions in Advanced Lung Cancer?

Abstract: Pt-PS and MD-PS were not congruent in over half of the cases, with Pt-PS scores usually poorer. Almost half the patients would have excluded themselves from a hypothetical clinical trial (Pt-PS >/=2). This requires prospective evaluation.

Cited by 73 publications

References 15 publications

Discrepancy in patient-rated and oncologist-rated performance status on depression and anxiety in cancer: a prospective study protocol: Table A1

Discrepancy in patient-rated and oncologist-rated performance status on depression and anxiety in cancer: a prospective study protocol: Table A1

Exploring physical activity level in patients with thoracic cancer: implications for use as an outcome measure

Factors Influencing Treatment Selection and Survival in Advanced Lung Cancer

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