Prognostic value of ECOG performance status in lung cancer assessed by patients and physicians.

Abstract

8103 Background: Physician-reported Eastern Cooperative Oncology Group (ECOG) performance status (MD-PS) is a reliable prognostic factor of overall survival (OS) and has a major influence on treatment decisions. MD-PS is also used to quantify cancer patients' general well-being and activities of daily life. The extent and prognostic importance of disagreements between MD-PS and cancer patients' self-reported ECOG PS (Pt-PS) have not been adequately evaluated. Methods: Four hundred and sixty consecutive patients with lung cancer (LC) were referred to the Dept. of Oncology at Herlev University Hospital, Denmark, from February 1 2012 to January 31 2013. Three hundred and forty-seven (75%) of these patients were enrolled in a prospective, longitudinal, LC biomarker study, “LUCAS”. Patients assessed their own Pt-PS in a questionnaire at first visit. Treating physicians scored the MD-PS at first visit. Results: Fifty-four (16%) LUCAS patients had missing PS data (39 no Pt-PS; 14 no MD-PS; 1 neither). LUCAS patients were significantly younger than the total LC population (mean age, 68.1 vs. 71.1; t-test: p < 0.01). The MD-PS and Pt-PS were distributed differently in the LUCAS cohort: PS=0 (121 vs. 76), PS=1 (147 vs. 145), PS=2 (39 vs. 54), PS=3 (25 vs. 30), PS=4 (0 vs. 2) (X2 test: p < 0.01). In 170 (58%) cases the physician and patient were in concordance. In 24 (8%) cases the MD-PS scored the patient in poorer PS compared to the Pt-PS. In 99 (34%) cases the MD-PS scored the patient in better PS than the Pt-PS. In 11 (4%) cases the physician scored a PS value more than 1 different from the patient; all were towards a better PS. The median OS in the total cohort (460 patients) was 9.7 months. MD-PS and Pt-PS were both effective in predicting OS. For patients with MD-PS = 0, a poorer Pt-PS did not significantly predict worse outcome. However, for patients with MD-PS = 1, there was a trend (HR 1.98, p = 0.08; log rank test) towards worse outcome if Pt-PS was > 1. Conclusions: Oncologists and patients frequently disagree regarding PS. The physicians tend to note a better PS score than the patients. The differences between MD-PS and Pt-PS could influence the prognostic value. It may be beneficial in clinical practice to involve patients in PS assessments.