Risk factors for poor performance status in cancer patients: A multivariate analysis in 3,585 patients

Abstract

9628 Background: Poor performance status (PPS) is an important determinant of clinical outcomes in cancer patients. Few studies have attempted to identify independent risk factors associated with PPS. Our aim was to identify independent risk factors for PPS. Methods: A prospective observational study was done. All patients referred to our Clinical Nutrition Service in 2006 and 2007 were interviewed by research dieticians using structured questionnaire. Continious and categorical data pertaining to multiple risk factors were collected from each patient and was collated into a database. Malnutrition was graded by the Subjective Global Assessment (SGA) and performance status was graded by the ECOG scale. Multivariate analysis was performed to identify independent risk factors for PPS after converting the ECOG scores in to dichotomous variables: Good PS (ECOG-0&1) and PPS (ECOG 2–4). Results: There were 2,373 men and 1,382 women aged 1 to 95 (median 52) years. Cancer sites included: Hemato-lymphoid (121), breast (225), head and neck (1,096), GI- Tract (1,451), thorax (608), uterus and ovary (117), urinary (61) and other sites (76). Univariate analysis revealed a strong association of PPS and malnutrition [SGA-C (OR=153.7) and SGA-B (OR=17.2)]. Significant risk factors for PPS and their odds ratio by multivariate analysis in 3585 patients were: SGA-C (17.8); reduced food intake (4.1); SGA-B (2.6); age > 65 years (1.90; moderate weight loss (1.9); albumin<3.1 G/dl (1.8); BMI <20.0 Kg/M2 (1.3); male gender (0.7) and private care (0.7) (p<0.003). Several variables such as hemoglobin <10.0 G/dl, co-morbid illness, tobacco use, vegetarian and previous cancer treatments that were significant on univariate analysis, were not found to have significant association with PPS in the multivariate regression model. Conclusions: PPS is associated with several independent risk factors many of which are amenable for treatment. Moderate to severe anemia was not associated with PPS and may be a marker of malnutrition. The SGA scores have strong association with the ECOG scores and needs to be evaluated for its usefulness in identifying patients at risk well as in predicting clinical outcomes such as overall survival in future trials. No significant financial relationships to disclose.