Is performance status related to functional capacity in patients with non small cell lung cancer (NSCLC)?

Abstract

7224 BackgroundPerformance status (PS) is a key factor in determining patient eligibility for clinical trials, predicting treatment toxicity and prognosis. Despite the importance of this clinical measurement tool, PS is subjective and interobserver variability high. The objective of this study was to evaluate functional capacity in ambulatory patients (PS 0–3) with NSCLC and compare results with physician assigned ECOG values. MethodsA series of sixty-one (61) patients with NSCLC (Stage III A, B and IV)referred to CNRP, age 42 to 89, were evaluated with standardized clinical tests including cardiopulmonary exercise capacity, hand grip strength (Jamar Dynamometer), and lower limb endurance capacity(Chair Rise Test) .Individual test results were compared to age and sex matched population data and weighted (0–3), according to severity of functional limitation ( mild, moderate, severe). Global scores (0–9) were calculated and correlated with physician assigned ECOG values. ResultsSixty percent (60%) of patients with PS 0–1 and 76% of those with PS 2–3 recorded significant cardiopulmonary limitations including high resting heart rate (>100), low HR reserve, low exercise capacity and poor recovery following exercise testing. All patients scored below the 50th percentile for hand grip strength and endurance capacity. Median upper and lower limb scores were at the 25th percentile in PS 0–1 and below the 10th percentile in PS 2–3 compared to age and sex matched populations. Global functional scores ranged from 0–9, with a median score of 4 in PS 0–1 and 8 in PS 2–3. There was a statistically significant difference (Wilcoxon Signed Rank Test) between ECOG performance status and objective measurement of functional capacity (P<.001).ConclusionsPatients traditionally scored to have good PS may in fact perform poorly on tests of functional capacity. The majority of our patients would have had difficulty with simple activities of daily living. Further studies are required to determine whether these tests more accurately risk stratify patients than tools such as the ECOG PS. No significant financial relationships to disclose.