Katie Kerrigan, MD
As oncologists, we try to remain both optimistic and realistic in patient care, but clearly, our tendency to “hope for the best and prepare for the worst” may affect our judgment and objectivity. Karnofsky Performance Status (KPS) and ECOG performance status (PS) alone leaves a lot to be desired for the practicing oncologist and as a community, we can improve upon this measurement with the routine incorporation of patient-reported outcomes (PROs).
KPS and PS are physician-synthesized compilations of a patient’s symptoms, self-care ability, symptom burden, and mobility. PS is evaluated at each oncology clinic visit and used as a tool to quantify a patient’s physiologic reserve and level of function. Thus, PS is an important element in routine clinical practice, guiding cancer treatment recommendations and determining eligibility in clinical trials.
Oncologists employ PS rigorously to determine prognosis. Data suggest that an individual’s PS is likely a more accurate prognostic indicator than biologic age, medical comorbidities, or even cancer stage.1
This was nicely demonstrated in a single institution study performed in Canada, where 10 physicians determined ECOG, KPS, and the Palliative Performance Scale scores at the end of an initial consultation for 1655 patients and then developed a simple prognostic model using PS. Survival analyses using the Kaplan-Meier method demonstrated a significant decline in median overall survival (OS) for each worsening performance level, with a median OS of 293, 104, and 25.5 days for ECOG 0, ECOG 2, and ECOG 4 patients, respectively.2
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