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Clinician- vs Patient-Reported Performance Status for Predicting Patient Outcomes

February 11, 2021

A recent study recognized that both clinician-assessed performance status and patient-reported performance status are useful for predicting morbidity and mortality in patients with advanced cancer receiving chemotherapy (JCO Oncol Pract. 2021; OP2000515. doi:10.1200/OP.20.00515).

“Performance status is assessed during cancer treatment to determine clinical trial eligibility, appropriateness for treatment, and need for supportive care,” wrote William Wood, MD, MPH, University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, and colleagues, adding that there is increased interest for patients to report this information directly.

This led Dr Wood and colleagues to conduct an analysis exploring whether clinician- and patient-reported performance status were equally associated with mortality and service utilization among patients with cancer.

A total of 441 patients with advanced cancer who received radiotherapy plus chemotherapy, and a clinician-reported performance status were included.

Agreement between clinician-reported performance status and patient-reported performance status were measured through simple kappa statistics. Cox regression, competing risk regression, and Fisher’s exact test evaluated the association of performance status with emergency department (ED) and hospital visits and overall survival. 

A weak correlation was observed between clinician-reported and patient-reported performance status (kappa = 0.27). Survival, ED visits, and hospitalizations were associated with both patient-reported and clinician-reported performance status, however, once adjusted, only clinician-reported status remained associated (survival: HR, 1.75; P <.0001).

The first available clinician-reported performance status was a stronger predictor of mortaility than the first available patient-reported status. In addition, repetition of patient questionnaires performed over time was associated with stronger outcomes.

This study supports the considerations of both clinician-reported and patient-reported performance status for determining eligibility for clinical trials and routine care in patients with advanced cancer receiving chemotherapy.—Marta Rybczynski

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