Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
J Pain Symptom Manage. 2018 Jun;55(6):1500-1508. doi: 10.1016/j.jpainsymman.2018.02.015. Epub 2018 Feb 26.
Performance status measures are increasingly completed by patients in outpatient cancer settings, but are not well validated for this use.
We assessed performance of a patient-reported functional status measure (PRFS, based on the Eastern Cooperative Oncology Group [ECOG]), compared with the physician-completed ECOG, in terms of agreement in ratings and prediction of survival.
Patients and physicians independently completed five-point PRFS (lay version of ECOG) and ECOG measures on first consultation at an oncology palliative care clinic. We assessed agreement between PRFS and ECOG using weighted Kappa statistics, and used linear regression to determine factors associated with the difference between PRFS and ECOG ratings. We used the Kaplan-Meier method to estimate the patients' median survival, categorized by PRFS and ECOG, and assessed predictive accuracy of these measures using the C-statistic.
For the 949 patients, there was moderate agreement between PRFS and ECOG (weighted Kappa 0.32; 95% CI: 0.28-0.36). On average, patients' ratings of performance status were worse by 0.31 points (95% CI: 0.25-0.37, P < 0.0001); this tendency was greater for younger patients (P = 0.002) and those with worse symptoms (P < 0.0001). Both PRFS and ECOG scores correlated well with overall survival; the C-statistic was higher for the average of PRFS and ECOG scores (0.619) than when reported individually (0.596 and 0.604, respectively).
Patients tend to rate their performance status worse than physicians, particularly if they are younger or have greater symptom burden. Prognostic ability of performance status could be improved by using the average of patients and physician scores.
在门诊癌症环境中，患者越来越多地完成体能状态评估，但针对这种用途，其尚未得到充分验证。
我们评估了患者报告的功能状态评估（PRFS，基于东部肿瘤协作组[ECOG]）与医生完成的 ECOG 在评估结果一致性和预测生存方面的表现。
患者和医生在肿瘤姑息治疗诊所首次就诊时，分别独立完成五分量表的 PRFS（ECOG 的简化版）和 ECOG 评估。我们使用加权 Kappa 统计来评估 PRFS 和 ECOG 之间的一致性，并使用线性回归来确定与 PRFS 和 ECOG 评分差异相关的因素。我们使用 Kaplan-Meier 方法估计患者的中位生存时间，根据 PRFS 和 ECOG 进行分类，并使用 C 统计来评估这些指标的预测准确性。
对于 949 名患者，PRFS 和 ECOG 之间存在中度一致性（加权 Kappa 0.32；95%CI：0.28-0.36）。平均而言，患者对体能状态的评估结果比医生的评估结果差 0.31 分（95%CI：0.25-0.37，P<0.0001）；这种趋势在年轻患者中更大（P=0.002），且在症状更严重的患者中更大（P<0.0001）。PRFS 和 ECOG 评分均与总生存相关良好；PRFS 和 ECOG 评分平均值的 C 统计值（0.619）高于单独报告时的 C 统计值（分别为 0.596 和 0.604）。
患者往往比医生对自己的体能状态评估更差，尤其是在他们更年轻或症状负担更重的情况下。通过使用患者和医生评分的平均值，体能状态的预后能力可能会得到改善。
