A recent study examined the degree to which the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scale is applicable to outcomes for patients in a real-world cohort. Results of this study were presented at the 2022 ASCO Annual Meeting by Deepika Kumar, MD, of Kaiser Permanente in San Francisco and colleagues.

The study included adult patients seen across 18 cancer centers of the Kaiser Permanente Northern California system. Patient characteristics and ECOG-PS scores, as rated by nurses, were used in predictive analyses of adverse clinical outcomes. These included 1-month rates of emergency department (ED) visits and hospitalizations, in addition to 6-month mortality.

The analysis included 21,730 patients. Of these patients, an ECOG-PS score of 0 was identified in 42.5%, an ECOG-PS score of 1 in 42.5%, an ECOG-PS score of 2 in 10.5%, an ECOG-PS score of 3 in 4%, and an ECOG-PS score of 4 in 0.4%. Higher ECOG-PS scores were more common in patients who were African American, male, older, had stage IV cancer, or had a higher Charlson comorbidity index (P <.001 for each).

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A multivariable analysis showed that, compared with an ECOG-PS score of 0, a score of 3 or 4 was linked to a higher risk of mortality (adjusted hazard ratio [aHR], 7.34; 95% CI, 6.64-8.11). An ECOG-PS score of 3 or 4 also was associated with greater risks of hospitalizations (aHR, 4.70; 95% CI, 4.12-5.36) and ED visits (aHR, 3.85; 95% CI, 3.47-4.26).

Multivariable analysis also revealed other features with apparent relationships to the adverse clinical outcomes examined in this study. For example, compared with breast cancer, upper gastrointestinal cancer was associated with a greater risk of mortality (aHR, 3.37; 95% CI, 2.97-3.81), a greater risk of hospitalization (aHR, 2.67; 95% CI, 2.27-3.13), and a greater risk of ED visits (aHR, 2.39; 95% CI, 2.12-2.68).

Additionally, compared with stage I cancer, stage IV cancer was associated with higher mortality risk (aHR, 1.82; 95% CI, 1.68-1.98), higher hospitalization risk (aHR, 1.51; 95% CI, 1.35-1.68), and a higher risk of ED visits (aHR, 1.31; 95% CI, 1.21-1.42).

Advanced age was not linked to mortality risk, risks of hospitalization, or ED visits. Interactions were seen between some features, with a result that ECOG-PS showed greater predictive value for adverse outcomes in patients who were younger and in patients who had breast cancer.

Dr Kumar and colleagues concluded that ECOG-PS, cancer type, and cancer stage were factors that were predictive of the adverse clinical outcomes examined in this study, with advanced age not being a predictor. Also, they found that ECOG-PS had greater predictive value of these outcomes with certain subsets of patients.

Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Kumar D, Neeman E, Zhu S, Sun H, Kotak D, Liu R. Contemporary real-world associations between performance status and clinical outcomes in cancer patients: a retrospective cohort study. J Clin Oncol. 2022;40(suppl 16;abstr 6578). doi:10.1200/JCO.2022.40.16_suppl.6578