Discrepancies in performance status scores as determined by cancer patients and oncologists: are they influenced by depression?

Objective: In previous research studies, performance status as determined by cancer patients themselves frequently did not agree with that determined by their oncologists. However, only a few studies have evaluated the reasons for this discrepancy. Methods: One hundred eleven cancer patients attending the Comprehensive Cancer Center of Seoul National University Hospital were asked to complete a questionnaire that included questions on sociodemographic and medical status, Eastern Cooperative Oncology Group (ECOG) performance status score and the Hospital Anxiety and Depression Scale (HADS). Medical oncology records were reviewed to obtain information and oncologist-assessed ECOG performance status scores. Results: Patients and oncologists agreed in 59 cases (53.2%; weighted kappa=0.17). There were no statistically significant gender-, cancer-type-or cancer-stage-related differences in agreement rates. Hierarchical logistic regression analyses showed that HADS depression subscale was the only variable that significantly contributed to patient-assessed performance status scores (beta=0.50, P=.0005), whereas cancer stage was the only variable that significantly contributed to oncologist-assessed performance status scores (beta=434, P=.0004). The mean of HADS depression subscale and the depression rates were highest in patients who rated themselves as most impaired on ECOG performance. Conclusions: Depression was found to be significantly associated with patients who rated their performance status as more impaired than with the oncologist-assessed score. (c) 2007 Elsevier Inc. All rights reserved.