Clinician-assessed eastern cooperative oncology group performance status vs. patient-reported health-related quality of life: Insights from malignant lymphoma

Abstract Background: The patient-reported health-related quality-of-life (HRQoL) is an important indicator for measuring the clinical outcome of lymphoma, however, the evaluation of HRQoL in real-world clinical practice is often lacking. Instead, the Eastern Cooperative Oncology Group performance status (ECOG-PS) is commonly employed by the clinicians to assess the physical abilities of lymphoma patients. This study aimed to evaluate the association between clinician-assessed ECOG-PS and patient-reported HRQoL in lymphoma patients. Methods: Lymphoma patients were recruited from a leading tertiary hospital in China. Demographic and clinical information were retrieved from the medical records. Two clinicians independently assessed the ECOG-PS of all patients who in turn completed the EuroQoL-5 Dimensions-5 Levels (EQ-5D-5L) questionnaire to obtain the self-reported HRQoL. Variables were compared among ECOG-PS ratings using ANOVA and Chi-squared test. The relationship of clinician-assessed ECOG-PS and patient-reported HRQoL were further evaluated by regression analysis. Results: Of the 381 lymphoma patients, 268, 72, and 41 were ECOG-PS of 1, ECOG-PS of 2, ECOG-PS of 3 or 4, respectively. Patient-reported EQ-5D-5L utility scores (P < 0.001) and EQ-VAS scores (P < 0.001) varied significantly across different ECOG-PS ratings. The EQ-5D-5L dimensions also significantly correlated with ECOG-PS (all P < 0.001). The clinician-assessed ECOG-PS and patient-reported HRQoL were associated with the same clinical characteristics, including relapsed or refractory disease, second or later lines of treatment, prior hematopoietic stem cell transplantation, and comorbidities. Moreover, regression analysis observed that worse clinician-assessed ECOG-PS significantly predicted lower patient-reported HRQoL (P < 0.001). Conclusion: The clinician-assessed ECOG-PS relates strongly with the patient-reported HRQoL, especially the physical functioning aspects.