Doctors assess lung cancer patients ECOG performance status (ECOG PS). It is a good prognostic measure that is used in stage IV to decide which patients are fit to treatment. Still there is some debate in the reliability of the assessment specially made by patients. We compare ECOG PS scored by two groups of doctors and patients.
Patients with a diagnosis of lung cancer, were asked to access their ECOG PS score. Patients scores (PTS) were compared to the score by senior doctors (SDS) and young doctors (YDS). We evaluate score reliability, correlation with survival and accuracy. Statistics were: descriptive, kappa statistics for inter observer agreement, Spearman rho for correlations, Kaplan Meyer for survival and Unvaried Cox regression to evaluate which score was a better fit for survival.
119 patients (87 male), mean age 66y, with lung cancer (95 in stage IIIB or IV) assessed their ECOG PS. There was a good agreement in the assessment between PTS and SDS (δ=0.636) PTS and YDS (δ=0.699) and between doctors (δ=0.649). ECOG PS was correlated with age and disease stage when assessed by all three observers(p < 0.05). ECOG PS was significantly associated with survival in all the stages whether assessed by PTS (p < 0.001), SDS (p < 0.0001) or YDS (p < 0.0001) and in stage IIIb /IV: PTS (p = 0.019), SDS (p = 0.020) and YDS (p < 0.0001). In the evaluation of which measured score is the better fit to the observed survival the values of -2ll were: 621,6 for SDS, 619,6 for YDS and for 624,7 for PTS.
Patients and doctors assess their ECOG PS similarly. Performance status correlates with stage and ages. Performance Status correlates with survival in all stages and in stage IIIB and IV, whether assessed by patients or by doctors.
Medical assessment of performance status should continue to be part of daily practice. Patient involvement in the score may enlighten their concerns and fitness and help reduce medical bias in treatment decision.
Maria Teresa Almodovar, No Financial Disclosure Information; No Product/Research Disclosure Information