Ratings of patient performance status using the Eastern Cooperative Oncology Group-Performance Status (ECOG-PS) score correlate more closely with patient clinical outcomes when performed by nurses compared with oncologists. The findings from this study were published in Oncology.
Evaluations of patient performance status are fundamental to guiding treatment decisions and providing estimates of prognosis for patients with cancer.
“The use of such a simple and convenient, yet somewhat crude, tool in making crucial, ethically charged medical decisions relies on the premise that it faithfully reflects the functional status of the patient and is in fact prognostic of important clinical outcomes,” the study authors noted.
Previous studies have shown discrepancies between performance status assessments performed by nurses and those by oncologists, with the latter group more likely to provide “healthier” scores relative to the former. However, whether evaluations of performance status by these 2 clinician groups differ with respect to their ability to predict patient clinical outcomes remains unclear.
Included in this retrospective cohort study were 311 adult patients with solid tumor cancers and a median age of 64 years treated at the Cedars-Sinai Medical Center Samuel Oschin Comprehensive Cancer Institute in Los Angeles, California. These patients were randomly selected from a larger group of patients included in a previously conducted prospective study performed in 2014 in which both prescribing oncologists and chemotherapy infusion nurses independently assessed performance status of patients receiving intravenous chemotherapy with either palliative or curative intent on the day that the chemotherapy was administered using ECOG-PS; all treatment decisions were made by the oncologists. ECOG-PS scores were retrospectively collected, and data related to patient demographics, the incidence of serious adverse effects within 1 month, the hospitalization rate within 1 month, and the occurrence of death or hospice referral within 6 months of chemotherapy administration were assessed from the patient medical records by blinded reviewers.
Overall, ECOG-PS scores were in agreement between nurses and oncologists in 70.7% of cases. However, significant correlations between ECOG-PS scores provided by nurses and the incidence of grade 3/4 adverse events occurring at 1 month (odds [OR], 1.44; 95% CI, 1.06-1.96; P =.021), as well as the 1-month hospitalization rate (OR, 1.57; 95% CI, 1.02-2.42; P =.041) were noted, whereas assessments performed by oncologists did not significantly correlate with these 2 clinical outcomes.
With respect to 6-month mortality or hospice referral, there was a significant correlation between ECOG-PS scores provided by both nurses (OR, 3.29; CI, 2.10–5.16;P <.0001) and oncologists (OR, 2.71; CI, 1.54–4.76, P =.001).