Actigraphy as an assessment of performance status in patients with advanced lung cancer

2019 ◽  
Vol 17 (5) ◽  
pp. 574-578 ◽  
Author(s):  
Daisuke Fujisawa ◽  
Jennifer S. Temel ◽  
Joseph A. Greer ◽  
Areej El-Jawahri ◽  
Lara Traeger ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Performance Status ◽  
Small Cell ◽  
Small Cell Lung ◽  
Trial Outcome Index ◽  
Therapy Trial ◽  
Outcome Index ◽  
Time Awake ◽  
Ecog Ps

AbstractObjectiveWearable devices such as a wrist actigraph may have a potential to objectively estimate patients’ functioning and may supplement performance status (PS). This proof-of-concept study aimed to evaluate whether actigraphy data are significantly associated with patients’ functioning and are predictive of their survival in patients with metastatic non-small cell lung cancer.MethodWe collected actigraphy data for a three-day period in ambulatory patients with stage IV non-small cell lung cancer. We computed correlations between actigraphy data (specifically, proportion of time spent immobile while awake) and clinician-rated PS, subjective report of physical activities, quality of life (the Functional Assessment of Cancer Therapy – Trial Outcome Index), and survival.ResultActigraphy data (the proportion of time awake spent immobile) were significantly correlated with Functional Assessment of Cancer Therapy – Trial Outcome Index (r = −0.53, p < 0.001) and with the Eastern Cooperative Oncology Group PS (ECOG PS) (r = 0.37, p < 0.001). The proportion of time awake spent immobile was significantly associated with worse survival. For each 10% increase in this measure, the hazard ratio (HR) was 1.48 (95% confidence interval [CI95%] = 1.06, 2.06) for overall mortality, and odds ratio was 2.99 (CI95% = 1.27, 7.05) for six-month mortality. ECOG PS was also associated with worse survival (HR = 2.80, CI95% = 1.34, 5.86). Among patients with ECOG PS 0-1, the percentage of time awake spent immobile was significantly associated with worse survival, HR = 1.93 (CI95% = 1.10, 3.42), whereas ECOG PS did not predict survival.Significance of ResultsActigraphy may have potential to predict important clinical outcomes, such as quality of life and survival, and may serve to supplement PS. Further validation study is warranted.

scholarly journals Outcomes to first-line pembrolizumab in patients with PD-L1-high (≥50%) non–small cell lung cancer and a poor performance status

2020 ◽  
Vol 8 (2) ◽  
pp. e001007 ◽  
Author(s):  
Joao V Alessi ◽  
Biagio Ricciuti ◽  
Elizabeth Jiménez-Aguilar ◽  
Fangxin Hong ◽  
Zihan Wei ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Clinical Outcomes ◽  
Systemic Therapy ◽  
Performance Status ◽  
Small Cell ◽  
Second Line ◽  
Small Cell Lung ◽  
First Line ◽  
Ecog Ps

BackgroundPatients with non–small cell lung cancer (NSCLC) and a poor Eastern Cooperative Oncology Group Performance Status (ECOG PS) have been excluded from phase III immunotherapy clinical trials. We sought to evaluate clinical outcomes to first-line pembrolizumab in patients with advanced NSCLC, a PD-L1 Tumor Proportion Score (TPS) of ≥50%, and an ECOG PS of 2.MethodsWe performed a multicenter retrospective analysis of patients with metastatic NSCLC and a PD-L1 TPS of ≥50% (negative for genomic alterations in EGFR and ALK) who received treatment with first-line pembrolizumab. Clinical outcomes were compared in patients based on ECOG PS.ResultsAmong the 234 patients, 83.3% (n=195) had an ECOG PS of 0 or 1, and 16.7% (n=39) had an ECOG PS of 2. The baseline clinicopathological characteristics were balanced between the ECOG PS 0–1 vs 2 groups in terms of age, sex, tobacco use, histology, KRAS mutation status, presence of other potentially targetable driver mutations (BRAF, MET, HER2, RET), presence of brain metastases, and PD-L1 TPS distribution. Compared with patients with an ECOG PS of 0 or 1, patients with an ECOG PS of 2 had a significantly lower objective response rate (43.1% vs 25.6%; p=0.04), a numerically shorter median progression-free survival (6.6 months vs 4.0 months; HR 0.70 (95% CI 0.47 to 1.06); p=0.09), and a significantly shorter median overall survival (20.3 months vs 7.4 months; HR 0.42 (95% CI 0.26 to 0.68); p<0.001). On disease progression, patients with an ECOG PS of 2 were significantly less likely to receive second-line systemic therapy compared with patients with an ECOG PS of 0–1 (65% vs 22.2%, p=0.001).ConclusionsA subset of patients with NSCLC and an ECOG PS of 2 can respond to first-line pembrolizumab. However, clinical outcomes in this population are often poor and use of second-line systemic therapy is infrequent.

Outcomes to first-line pembrolizumab in patients with PD-L1-high (≥50%) non-small-cell lung cancer and a poor performance status.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 9568-9568
Author(s):  
Joao Victor Machado Alessi ◽  
Biagio Ricciuti ◽  
Elizabeth Jimenez Aguilar ◽  
Fangxin Hong ◽  
Zihan Wei ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Clinical Outcomes ◽  
Systemic Therapy ◽  
Performance Status ◽  
Small Cell ◽  
Second Line ◽  
Small Cell Lung ◽  
First Line ◽  
Ecog Ps

9568 Background: Patients with non-small cell lung cancer (NSCLC) and a poor Eastern Cooperative Oncology Group performance status (ECOG PS) have been excluded from immunotherapy clinical trials. We sought to evaluate clinical outcomes to first-line pembrolizumab in patients with advanced NSCLC, a PD-L1 tumor proportion score (TPS) of ≥50%, and an ECOG PS of 2. Methods: We performed a multicenter retrospective analysis of patients with metastatic NSCLC and a PD-L1 tumor proportion score (TPS) of ≥50% (negative for genomic alterations in EGFR and ALK) who received treatment with first-line commercial pembrolizumab. Clinical outcomes were compared in patients based on ECOG PS. Results: Among 234 patients, 83.3% (N = 195) had an ECOG PS of 0 or 1, and 16.7% (N = 39) had an ECOG PS of 2. The baseline clinicopathological characteristics were balanced between the ECOG PS 0-1 vs 2 groups in terms of age, sex, tobacco use, histology, KRAS mutation status, presence of other potentially targetable driver mutations ( BRAF, MET, HER2, RET), history of central nervous system (CNS) disease, and PD-L1 TPS distribution. Compared to patients with an ECOG PS of 0-1, patients with an ECOG PS of 2 had a significantly lower objective response rate (ORR 43.1% vs 25.6%; P = 0.04), a numerically shorter median progression free survival (mPFS 6.6 months vs 4.0 months; P = 0.09), and a significantly shorter median overall survival (mOS 20.3 months vs 7.4 months; P < 0.001). Upon disease progression, patients with an ECOG PS of 2 were significantly less likely to receive second-line systemic therapy compared to patients with an ECOG PS of 0-1 (55.5% vs 14.3%, P < 0.001). Conclusions: Although a subset of patients with an ECOG PS of 2 can respond first-line pembrolizumab, clinical outcomes in this population are poor, and use of second-line systemic therapy is infrequent.

Ifosfamide, Carboplatin, and Etoposide With Midcycle Vincristine Versus Standard Chemotherapy in Patients With Small-Cell Lung Cancer and Good Performance Status: Clinical and Quality-of-Life Results of the British Medical Research Council Multicenter Randomized LU21 Trial

2005 ◽  
Vol 23 (33) ◽  
pp. 8371-8379 ◽  
Author(s):  
Nicholas Thatcher ◽  
Wendi Qian ◽  
Peter I. Clark ◽  
Penelope Hopwood ◽  
Robert J. Sambrook ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Overall Survival ◽  
Small Cell Lung Cancer ◽  
Performance Status ◽  
Small Cell ◽  
Control Group ◽  
Small Cell Lung ◽  
Standard Chemotherapy

Purpose Ifosfamide, carboplatin, etoposide, and vincristine, alone and in combination, are highly active against small-cell lung cancer (SCLC). This trial was designed to investigate whether survival could be improved by a regimen of all four drugs (ICE-V) compared with standard chemotherapy in patients with SCLC and good performance status, and to assess the patients’ quality of life (QL). Patients and Methods Patients were randomly assigned to receive six cycles of either ICE-V at 4-week intervals without dose reduction or standard chemotherapy administered according to local practice. The recommended standard control regimens were cyclophosphamide, doxorubicin, and etoposide; and cisplatin and etoposide. Results A total of 402 patients were randomly assigned, and 350 (87%) patients have died. Overall survival was longer in the ICE-V group (hazard ratio, 0.74; 95% CI, 0.60 to 0.91; P = .0049), median survival was 15.6 months in the ICE-V group and 11.6 months in the control group, and 2-year survival rates were 20% and 11%, respectively. There was no evidence that the relative survival benefit for ICE-V was less in extensive-stage than in limited-stage patients. An increased rate of septicemia was reported in the ICE-V group (15% v 7% in the control group), but this did not result in an increase in reported treatment-related deaths (four patients [2%] in both groups). The findings on QL were broadly similar in both groups, with some benefit in favor of ICE-V. Conclusion Compared with standard chemotherapy, the ICE-V regimen improves overall survival without QL penalties, despite an increased but manageable level of toxicity.

scholarly journals Influence of Performance Status on the Effectiveness of Pembrolizumab Monotherapy in First-Line for Advanced Non-Small-Cell Lung Cancer: Results in a Real-World Population

Biology ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 890
Author(s):  
Rocío Jiménez Jiménez Galán ◽  
Elena Prado-Mel ◽  
María Antonia Pérez-Moreno ◽  
Estefanía Caballano-Infantes ◽  
Sandra Flores Moreno
Keyword(s):  
Lung Cancer ◽  
Clinical Trial ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Real World ◽  
Performance Status ◽  
Small Cell ◽  
Small Cell Lung ◽  
First Line ◽  
Ecog Ps

The KEYNOTE-024 clinical trial showed promising results for pembrolizumab in the first-line of treatment of advanced non-small-cell lung cancer (NSCLC). However, the profile of patients in real-world practice differs from those included in this clinical trial. Here, an observational single-center retrospective study was performed through a comparative analysis of clinical outcomes after pembrolizumab therapy according to the Eastern Cooperative Oncology Group Stage Performance Status (ECOG PS). Moreover, univariate and multivariate analyses were carried out to detect prognostic factors. In our cohort, 63.7% of patients had an ECOG PS of 0–1. Regarding response rate, 31.8% of patients had a partial response (PR), 19.3% had stable disease (SD) and 23.9% had progression disease. On the other hand, patients with ECOG PS ≥ 2 showed a significantly lower rate of PR and SD to pembrolizumab than patients with a PS of 0–1. The rate of response, median overall survival (OS) and progression-free survival (PFS) were significantly higher in patients with ECOG PS 0–1 than in those with ECOG PS ≥ 2. In the current study, we found ECOG PS as the only independent predictor of OS and PFS. Due to the ECOG PS scale being a subjective parameter, other tools are needed to identify treatment effectiveness to each patient.

Chemoimmunotherapy for the treatment of extensive-stage small cell lung cancer (ES-SCLC) in patients with an Eastern Cooperative Group (ECOG) performance status (PS) of two or greater.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 8569-8569
Author(s):  
Daniel Almquist ◽  
Blake Langlais ◽  
Nathan Y Yu ◽  
Terence Tai Weng Sio ◽  
Panos Savvides ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Performance Status ◽  
Small Cell ◽  
Cooperative Group ◽  
Small Cell Lung ◽  
Ecog Performance Status ◽  
Platinum Sensitive ◽  
Line Therapy ◽  
Extensive Stage ◽  
Ecog Ps

8569 Background: Immune checkpoint inhibitor (atezolizumab or durvalumab) combined with platinum-etoposide is the standard first-line therapy for patients with extensive-stage small cell lung cancer (ES-SCLC). The phase III clinical trials that led to the approval of chemoimmunotherapy in ES-SCLC, excluded patients with an Eastern Cooperative Group (ECOG) Performance Status (PS) of Two or Greater. Therefore, data on efficacy of this combination in this subgroup of ES-SCLC patients whose performance status two or greater is limited. Methods: A retrospective analysis was performed of patients diagnosed with ES-SCLC who received chemoimmunotherapy (atezolizumab or durvalumab) within the Mayo Clinic Health System between January 2016 and January 2021. Cases were identified from clinical databases at Mayo Clinic. Data on demographics, ECOG-PS, date of diagnosis, date of progression, whole brain radiation, CNS involvement, liver involvement, stereotactic body radiation, chest consolidation, platinum sensitivity, lines of therapy and last follow up date were extracted. Overall Survival (OS) and progression free survival (PFS) for ECOG-PS 2-3 were compared to patients with an ECOG-PS 0-1. Results: A total of 84 patients were identified with a median age of 68.2 (48-88) years old. Of these, 54 patients were identified with an ECOG-PS 0-1 and 30 patients with an ECOG-PS 2-3. The median PFS for the ECOG PS 0-1 cohort was 5.2 months (95% CI 4.6-6.1) while the median PFS for the ECOG-PS 2-3 cohort was 6.0 months (95% CI 4.2-7.7; logrank p = 0.93). The median OS for the ECOG-PS 0-1 cohort was 10.8 months (95% CI 8.5-12.9) while the median OS for the ECOG-PS 2-3 cohort was 10.3 months (95% CI 6.0-14.1; logrank p = 0.39). Hazard ratios of ECOG-PS 0-1 versus 2-3 showed no tendency of increased PFS or OS for either group within cox proportional hazards models. Forty-three percent of ECOG-PS 0-1 achieved a partial response (PR) and 57% of patients who had ECOG-PS 2-3 also achieved a PR (Fisher’s exact p = 0.23). A complete response was found in 4% of ECOG-PS 0-1 compared to 3% in the ECOG-PS 2-3 cohort. For patients who responded to initial therapy, 46% of ECOG-PS 2-3 patients had a platinum sensitive relapse while only 33% of ECOG-PS 0-1 were still platinum sensitive at the time of relapse. Five ECOG-PS 2-3 patients were able to receive a second-line therapy. Conclusions: To our knowledge, this is the first study to evaluate chemoimmunotherapy in the subgroup of ES-SCLC patients with an ECOG-PS 2 or greater. This retrospective study demonstrated no significant difference in PFS, OS, and ability to achieve a least a PR in ECOG-PS 2-3 cohort when compared to ECOG-PS 0-1. Therefore, chemoimmunotherapy should not be reserved for only an ECOG-PS of 0-1 but should be considered for all treatment eligible patients.

The humanistic burden of advanced non-small cell lung cancer on patients and their caregivers.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 220-220
Author(s):  
Gavin Taylor-Stokes ◽  
Robert Wood ◽  
Michael Lees ◽  
Bill Malcolm ◽  
Oana Chirita
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Group Performance ◽  
Small Cell ◽  
Small Cell Lung ◽  
Ecog Ps ◽  
Humanistic Burden

220 Background: A diagnosis of advanced non-small cell lung cancer (aNSCLC) presents significant physical, emotional and financial challenges for patients and their caregivers. This study provides insight into the humanistic burden on patients and their caregivers, as the disease progresses. Methods: Data were taken from a chart review and a cross-sectional study of a NSCLC patients and caregivers in France, Germany and Italy. Physicians provided data on patients’ age, sex, stage, line of therapy and ECOG (Eastern Cooperative Oncology Group) performance status (PS). The patient survey assessed the patients’ health state (EQ-5D), impact on work/activities (WPAI) and on quality of life (EORTC QLQ-C30). The caregiver survey included the WPAI and Zarit Burden Interview (ZBI). Patient and caregiver outcomes were stratified by the patients’ ECOG PS from 0 to 4 (best to worst status). Statistical significance was assessed using Kruskal-Wallis tests. Results: 1,030 patients completed the survey (mean (SD) age: 64.5 years (10.1), 65.9% male); the majority were stage IV (88.4%) and most (70.5%) were receiving 1st line therapy. Caregiver forms were completed by 41.5% of patients’ caregivers; mean (SD) age: 53.5 years (12.5), 72.6% female; most were the patients’ partner (54.9%) or child (31.9%). In total, 19.4%, 43.5%, 27.4% and 9.7% of patients had a current ECOG PS of 0, 1, 2 or 3/4, respectively. All outcomes stratified by ECOG PS are reported below (all P < 0.0001). Conclusions: As patients’ functionality deteriorates, so do their outcomes relating to health utility, impairment and quality of life. This deterioration also increases the burden on the caregiver. This study was sponsored by Bristol-Myers Squibb. [Table: see text]

The humanistic burden of advanced non-small cell lung cancer: What are the key drivers of caregiver burden?

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 149-149 ◽  
Author(s):  
Robert Wood ◽  
Gavin Taylor-Stokes ◽  
Fiona Smith ◽  
Oana Christina Chirita ◽  
Carlos Chaib Torralba
Keyword(s):  
Lung Cancer ◽  
Caregiver Burden ◽  
Informal Caregiver ◽  
Performance Status ◽  
Small Cell ◽  
Small Cell Lung ◽  
Clinical Patient ◽  
Factors Associated ◽  
Key Drivers ◽  
Ecog Ps

149 Background: Advanced Non-Small Cell Lung Cancer (aNSCLC) impacts the lives of patients and their caregivers. This analysis aimed to provide insight into the clinical, patient and caregiver factors associated with increased caregiver burden. Methods: Data from a cross-sectional study of aNSCLC patients and informal (unpaid) caregivers in France, Germany and Italy, were collected from May 2015 to June 2016, consisting of a chart review and patient and caregiver surveys. Caregiver burden was assessed using the Zarit Burden Interview (ZBI), measured on a 0-88 scale. An ordinary least square regression model was constructed to assess clinical, patient and caregiver factors associated with ZBI. Measured at time of survey completion, covariates included: country, patient age, sex, body mass index, stage of NSCLC, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), disease duration, smoking status, presence of brain metastases, histology, comorbidities, chemotherapy treatment, caregiver age and sex, and the number of formal (paid) and informal caregiver hours provided per week by additional caregivers. A significance level of 0.05 was used. Results: 331 caregivers were analysed. Mean (SD) caregiver age was 53.8 years (12.4), 239 (72.2%) were female. Caregivers provided a mean (SD) of 17.8 (23.4) hours of care per week. Mean (SD) formal / informal caregiver hours provided by other caregivers was 3.9 (13.3) / 3.9 (12.0). Many caregivers did not receive support from additional formal (75.5%) or informal (68.6%) caregivers. Mean (SD) ZBI score was 31.3 (14.8). Significant independent predictors of ZBI were patient’s ECOG-PS and number of additional informal caregiver hours provided. ZBI scores for caregivers of patients with an ECOG-PS of 3-4 were 7.68 units higher compared to those with an ECOG-PS of 0-2 (p = 0.006). Also, ZBI scores increased by 0.16 units per hour of informal caregiver provided by additional caregivers (p = 0.008). Conclusions: The key drivers of caregiver burden found in the study reinforce the need to develop supportive and personalised interventions to maintain patient performance status by delaying progression, and reduce informal caregiver hours supporting the patient.

787 Performance status (PS) and quality of life (QoL) in patients with advanced non-small cell lung cancer responding to chemotherapy

Lung Cancer ◽  
1997 ◽  
Vol 18 ◽  
pp. 203
Author(s):  
D. Radosavljević ◽  
S. Jelić ◽  
S. Radulović ◽  
I. Popov ◽  
Z. Nikolić-Tomašević ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Performance Status ◽  
Small Cell ◽  
Small Cell Lung

scholarly journals PROGNOSIS IN ADVANCED NON-SMALL CELL LUNG CANCER - A RETROSPECTIVE STUDY EXAMINING ECOG PERFORMANCE STATUS SCORES OF PATIENTS

2017 ◽  
Vol 10 (9) ◽  
pp. 409
Author(s):  
Nida Sajid Ali Bangash ◽  
Natasha Hashim ◽  
Nahlah Elkudssiah Ismail
Keyword(s):  
Lung Cancer ◽  
Body Weight ◽  
Prognostic Factor ◽  
Small Cell Lung Cancer ◽  
Advanced Nsclc ◽  
Performance Status ◽  
Small Cell ◽  
Small Cell Lung ◽  
Ecog Ps ◽  
Nsclc Patients

  Objective: Increasing prevalence and poor survival of advanced incurable non-small cell lung cancer (NSCLC) make it a major health problem globally, especially in developing countries. This awakens need for identification of the strongest prognostic factor that helps in the selection of appropriate treatment and hence palliates symptoms and improves survival. Lung cancer treatment guidelines advise performance status (PS) as the most established prognostic factor in advanced NSCLC patients. This study investigated the prognostic significance of PS.Methods: An observational study was done for 163 advanced NSCLC adult Malaysian patients in Radiotherapy and Oncology Clinic, Hospital Kuala Lumpur, Malaysia. Demographic and clinical data were recorded. Kaplan-Meier test was used to measure median overall survival (OS) and Cox proportional hazard model to calculate the hazard ratio for different categories of Eastern Cooperative Oncology Group (ECOG) PS.Results: The mean age and body weight were 56.7±10.1 years old and 57.42±13.5 kg, respectively. Majority patients were male (68.7%), Stage IV NSCLC (65.0%), and ECOG PS score of 2 (41.1%). ECOG PS had a significant association with age and body weight. Median OS was least for ECOG PS score of 4 (253 days) and was statistically significant (p=0.003). ECOG PS was a significant independent prognostic factor for survival in advanced NSCLC patients (p<0.001).Conclusion: PS is a strong prognostic factor in advanced NSCLC.

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