Poor performance status: should chemotherapy still be given?

The authors examined whether chemotherapy can benefit metastatic colorectal cancer patients (patients whose cancer has spread from the colon or rectum to distant sites) with high ECOG scores.

The ECOG scoring system measures how much the cancer is impacting a patient’s daily living abilities (performance status). Patients’ performance is graded from 0 to 5. Grade 0 indicates that the patients is fully active and able. Grade 1 indicates that the patient is able to do light work or activity. Grade 2 indicates that the patient cannot carry out any work but is up for more than 50% of waking hours. Grade 3 indicates that the patient is only able to do a limited amount of self-care and is confined to the bed or a chair for more than 50% of waking hours. Finally, grade 4 indicates that the patient cannot carry out any self-care and is totally confined to a bed or chair. The risks and benefits of chemotherapy in patients with an ECOG score of 3 or 4 have not been properly evaluated.

The authors analyzed medical records from 240 patients who had started their first chemotherapy treatment for metastatic colorectal cancer. Each patients’ performance status was graded from 0 to 4 using the ECOG classification. Patients either received chemotherapy or best supportive care (the use of drugs and other treatments to improve quality of life). Patients’ survival time was measured.

41.7% of patients had an ECOG score of 0/1, 31.3% of patients had an ECOG score of 2, and 27% of patients had an ECOG score of 3/4. On average patients with an ECOG score of 0/1 who received chemotherapy survived for 18.4 months. Patients with an ECOG score of 2 survived for 10.8 months and patients with an ECOG score of 3/4 survived for 6.8 months.

89% of patients with ECOG grade 2 received chemotherapy. 57% of patients with ECOG grade 3/4 received chemotherapy. Roughly half of patients with an ECOG score of 2 or more benefited from chemotherapy. Chemotherapy also non-significantly increased the average patient survival time (6.8 months) compared to best supportive care (2.3 months) for patients with an ECOG score of 3/4. Severe toxicities (side effects) were seen in 34.3% of patients with an ECOG grade 2, and 21.7% of patients with an ECOG score of 3/4.

The authors concluded that chemotherapy may benefit certain metastatic colorectal cancer patients with high ECOG scores.