Discrepancies between genitourinary cancer patients' and clinicians' characterization of the Eastern Cooperative Oncology Group performance status

Background Patient‐reported outcomes have been used to assess treatment effectiveness and actively engage patients in their disease management. This study was designed to describe the patient‐reported performance status (PS) and the provider‐reported PS. Methods Patients with metastatic genitourinary cancers were recruited from a single cancer center before the initiation of a new line of treatment. PS (Eastern Cooperative Oncology Group [ECOG]), quality of life (Functional Assessment of Chronic Illness Therapy–General), and distress (Patient‐Reported Outcomes Measurement Information System Anxiety and Depression) were self‐reported by patients. Clinical data (eg, age, sex, diagnosis, and physician‐reported ECOG PS) were extracted from medical records. Multivariate analysis was used to determine the association between PS, quality of life, and psychological symptoms. Results One hundred forty‐five patients were enrolled (76.6% male, 70.3% White, 81.4% married, and 76.6% well educated). The median age was 67 years; 66.9% were diagnosed with renal cell carcinoma, 20.0% were diagnosed with urothelial carcinoma, and 13.1% were diagnosed with prostate cancer. Clinicians more frequently classified patients' ECOG PS as 0 in comparison with the patients themselves (92.4% vs 64.1%; P = .001). Higher clinician‐reported ECOG PS was associated with poorer physical and functional well‐being and higher rates of depression (P < .01), whereas higher patient‐reported ECOG PS was associated with worse psychosocial outcomes (P < .01). Conclusions Discrepancies were noted between the patient‐ and provider‐reported ECOG PS, with clinicians overestimating the ECOG PS in comparison with the patients themselves. This study's findings suggest that patients incorporate their social and emotional well‐being into their PS score in addition to their physical well‐being. This information is not immediately accessible to most clinicians from just a standard patient interview and likely accounts for the overestimation of the patients' ECOG PS by the clinicians. Clinicians appear to overestimate the Eastern Cooperative Oncology Group performance status in comparison with patients' self‐ratings. This study shows that the clinician‐reported performance status is unrelated to patients' ratings of their social/family well‐being and anxiety symptoms.