Comparing clinician- and patient-rated performance status and association with psychosocial status in advanced genitourinary cancer.

Abstract

195 Background: Assessing patient-reported outcomes (PROs) is a critical element of comprehensive cancer care. Performance status (PS) is a widely used clinical measure to assess patients’ general well-being and, in clinical trials, provide insight into patients’ quality of life (QOL). This study compared PS as reported by clinicians and by patients, and explored whether associations between PS, QOL and psychological symptoms differed by patient or provider. Methods: This cross-sectional survey study enrolled patients with metastatic genitourinary cancers at a single institution. Patients completed measures assessing their PS (self-reported version of the Eastern Cooperative Oncology Group, ECOG), QOL (FACT-G) and psychiatric symptoms (PROMIS-Anxiety and Depression). Clinical data, including ECOG PS by physician rating, was extracted from medical records. Multivariate analysis was used to determine the association between PFS, QOL and psychological symptoms. Results: A total of 83 patients were enrolled. Median age was 67 (range, 31-91), 74% were male and 74% were married. Patients were diagnosed with advanced renal cell carcinoma (RCC; 54%), urothelial cancer (UC; 23%), or prostate cancer (PC; 23%) and were predominantly receiving first (39%) or second line (25%) therapy. Physicians were more likely to classify patients as ECOG PS 0 as compared to patients themselves (90% versus 63%, P = 0.01). Worse ECOG PS by patient-report was significantly associated with poorer psychosocial outcomes, including increased anxiety and decreased social well-being (P = 0.001 for each). In contrast, there was no association between physician-reported PS and these outcomes. Conclusions: This is the first study comparing PS as reported by clinicians and patients. Physicians appeared to overestimate ECOG PS when compared to patient self-rating, and this may have a downstream impact on the accuracy of PS for other psychosocial outcomes. This has potential implications for clinical trials in which PS is used for eligibility/stratification. This phenomenon will be examined prospectively in an upcoming SWOG trial in advanced RCC.