Introduction and Objectives Performance status assessment in lung cancer patients is essential to assess prognosis and plan management. Inter observer variability has been documented between oncologists, their patients and other professionals (Blagden et al 2003). No study has previously examined whether this variability also exists between respiratory physicians and oncologists. We hypothesised that performance status assessment would vary between respiratory physicians and oncologists. We also questioned whether frequency of outpatient contact with lung cancer patients or stage of training affected assessment.
Methods 8 case vignettes were sent to respiratory physicians, oncologists and speciality trainees using an online survey tool. The speciality, seniority and frequency of outpatient contact were recorded. The Eastern Co-operative Oncology Group Score (ECOG) was used due to greater familiarity and increased inter-observer reliability in previous studies.
Results 119 respondents completed the survey—62% were oncologists. 85% of respondents were consultants and 62% reviewed patients frequently (weekly) in outpatients. 20% saw lung cancer patients rarely or never. Individual assessments were broad, with seven case vignettes receiving 3 or more performance status (PS) ratings. 6 cases crossed the theurapeutic boundary between PS 2 and PS 3. In one case assessment ranged from PS 0 to PS 4. However, Krippendorfs α assessment (K α) (Hayes and Krippendorf, 2007) showed overall agreement at 0.59. This confirmed wide individual variation but closer group agreement. There was no difference in assessment between oncologists and respiratory physicians—K α 0.61 and 0.63 respectively. Equal K α values of 0.62 between Speciality trainees and Consultants showed stage of training had no impact. Frequency of review did not affect level of agreement with K α values of 0.62 and 0.64 for frequent reviewers vs non-frequent.
Conclusions Rating of performance status varies widely between individuals. This may negatively affect patients if only individual assessment is performed. However, respiratory physicians and oncologists exhibit statistically significant agreement in their assessments. This is not affected by stage of training or frequency of outpatient contact. This study highlights that review of performance status across specialities or by multiple assessors (The MDT) is likely to lead to more consistent assessment.
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