Performance status agreement assessed by the patient and clinician in a rapid access lung cancer service: Can either predict completion of treatment?

INTRODUCTION: Clinician-rated performance status (C-PS) is used routinely to predict whether patients are fit enough to undergo treatment for lung cancer. However, a good proportion of those with seemingly good C-PS do not go on to receive, let alone complete treatment. The value of C-PS in accurately predicting this is unclear, as is the merit of evaluating patient-rated PS (P-PS). OBJECTIVES: Our aim was to prospectively assess Eastern Cooperative Oncology Group (ECOG) and Karnofsky C-PS and P-PS in patients attending a rapid access lung cancer service (RALCS), the agreement between these scores, and whether any score could predict receipt and completion of multidisciplinary team (MDT)-planned treatment. RESULTS: ECOG and Karnofsky scores were highly correlated (Spearman's rho -0.79 for C-PS and -0.828 for P-PS, both p < 0.001). There was poor agreement between C-PS and P-PS scores (kappa statistics 0.275 for ECOG and 0.172 for Karnofsky); however, clinicians did not tend to consistently under- or overestimate patients' scores. ECOG P-PS showed an association with completion of MDT-planned treatment (p = 0.007), but C-PS did not. CONCLUSION: Clinician-rated PS was not associated with completion of MDT-planned treatment, but there may be a role for patient-rated PS. C-PS and P-PS were poorly correlated in a RALCS.