Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, Canada.
Support Care Cancer. 2010 May;18(5):609-16. doi: 10.1007/s00520-009-0700-9. Epub 2009 Jul 23.
Performance status (PS) scales are used widely in oncology practice and research. We compared inter-rater agreement, between nurses and physicians, for three commonly used PS scales.
Patients attending an oncology palliative care clinic were assessed by a physician and nurse who blindly completed Eastern Cooperative Oncology Group (ECOG), Karnofsky PS (KPS), and palliative PS (PPS) scales. Patients completed the Edmonton symptom assessment system (ESAS).
Inter-rater agreement (weighted kappa) for the 457 patients was 0.67 for the ECOG, 0.74 for the KPS, and 0.72 for the PPS. There was no difference between proportions of physicians' vs. nurses' ratings of KPS, >60 vs. <or=60 (McNemar's test, p = 0.33); however, physicians were more likely to rate patients as having better PS for the ECOG (77% in the 0-2 range vs. 70% for nurses, p = 0.0003) and PPS (63% in the 70-100 range vs. 54% for nurses, p = 0.0001). Physician and nurse scores of ECOG, KPS, and PPS were all correlated with ESAS distress score (Pearson correlation, r = 0.4-0.5).
Although inter-rater agreement was good for all three scales, physicians tended to rate patients as healthier for the PPS and ECOG. The KPS may provide greater consistency of PS ratings by different oncology professionals in clinical and research settings.
在肿瘤学实践和研究中广泛使用了体能状态（PS）量表。我们比较了护士和医生对三种常用 PS 量表的评分一致性。
在肿瘤姑息治疗诊所就诊的患者由医生和护士进行评估，他们盲法完成了东部肿瘤协作组（ECOG）、卡氏功能状态量表（KPS）和姑息性 PS 量表（PPS）。患者完成了埃德蒙顿症状评估系统（ESAS）。
对 457 例患者的评分者间一致性（加权 kappa）为 ECOG 为 0.67，KPS 为 0.74，PPS 为 0.72。医生和护士对 KPS 评分的比例没有差异，>60 与≤60（McNemar 检验，p=0.33）；然而，医生更倾向于对 ECOG（0-2 范围的 77%与护士的 70%相比，p=0.0003）和 PPS（70-100 范围的 63%与护士的 54%相比，p=0.0001）的患者进行更好的 PS 评估。ECOG、KPS 和 PPS 的医生和护士评分均与 ESAS 痛苦评分相关（Pearson 相关，r=0.4-0.5）。
尽管所有三种量表的评分者间一致性都很好，但医生倾向于对 PPS 和 ECOG 的患者进行更健康的评估。在临床和研究环境中，KPS 可能为不同肿瘤专业人员提供更一致的 PS 评分。
