Impact of self-reported performance status on survival in advanced colorectal cancer

Abstract

3761 Background: Patients with advanced cancer are greatly concerned about their ability to carry out the activities of daily living. Eastern Cooperative Oncology Group (ECOG) scale has been widely used to quantify the performance status of cancer patients. ECOG captures patient-derived functional status data on a scale of 0 through 4; 0 being normal with no limitations and 4 being completely disabled and bedridden. The purpose of this investigation was to assess the impact of baseline ECOG scores on survival in patients with advanced colorectal cancer. Methods: A retrospective chart review was performed on a consecutive case series of 233 stages III and IV colorectal cancer patients treated at Cancer Treatment Centers of America at Midwestern Regional Medical Center between January 1995 and March 2001. The patient cohort was divided into 2 categories; newly diagnosed (63) and recurrent disease (170). Patients were also divided into 2 mutually exclusive classes of functional status, good (ECOG scores of 0 to 1) and poor (ECOG scores of 2 to 4). The Kaplan-Meier method was used to calculate survival which was defined as the time interval between date of first patient visit to the hospital and date of death from any cause or date of last contact. The log rank test statistic was used to evaluate the equality of survival distributions across the two ECOG strata. Results: Newly diagnosed patients with good ECOG scores had a median survival of 30.5 months (95% CI, 17.8 to 43.3; n = 47) while those with poor scores had 15.1 months (95% CI, 1 to 29.1; n = 10), the difference being statistically significant (p = 0.01). Similarly, patients with recurrent disease demonstrated a statistically significantly (p = 0.0002) better median survival for good ECOG scores (10.1 months; 95% CI, 8.1 to 12; n = 104) as compared to those with poor ECOG scores (5.1 months; 95% CI, 3.1 to 7.1; n = 53). Conclusions: In this cohort, we found that low ECOG scores (good performance status) versus high ECOG scores (poor performance status) identified patients with better survival outcomes. Further studies need to focus on more extensive investigation of the prognostic importance of the ECOG scores in clinical cancer settings. No significant financial relationships to disclose.