A Comprehensive Assessment of Cancer Patient Performance Status Documentation in a Large, Multicentre Hospital System

Abstract

Background: The performance status (PS) is an indicator of a cancer patient's ability to perform everyday activities and plays a key role in oncology. Research suggests that the documentation of PS scores in electronic health records (EHR) is deficient.

Methods: We analysed PS score documentation (Karnofsky or ECOG/Zubrod/WHO) in the hospital, consultation, and multidisciplinary team meeting (MDT) records of patients newly referred for a cancer at a large, public, multisite hospital system, between 1 January 2019 and 1 June 2021. We developed a regular expression (RegEx) to automatically identify PS in documents and assessed what patient and hospital characteristics were associated with PS documentation.

Results: Our RegEx achieved accuracy, and weighted- and macro-average F1 score, > 0.95 for all document types. We included 68,479 patients. 35% had a documented PS between -90 and +365 days of their first ICD-10 cancer code. 18% of MDT reports contained a PS score. In multivariate analysis, without accounting for metastatic status at diagnosis, odds ratios (ORs) for PS documentation in patient files varied by cancer type, from 0.47 (95% confidence interval: [0.42; 0.52]) for genitourinary to 3.30 [3.00; 3.61] for lung cancer, and hospital, from 0.27 [0.23; 0.33] to 3.38 [3.14; 3.63]. Male patients were more likely to have a documented PS (OR = 1.08 [1.04; 1.13]), as well as older patients. The number of each type of document was positively correlated with the presence of a score. When adding metastatic status at diagnosis, the OR for metastatic status was large (3.29 [3.13; 3.46]), but associations with other covariates were not noticeably affected. Documented PS close to diagnosis was associated with poorer 1-year survival (25% of patients with PS died within 1 year, vs 12% without PS).

Conclusion: PS score documentation was variable and generally low. Improved documentation is required if EHRs are to be used as a source of real-world data.

Keywords: Karnofsky performance status; cancer; electronic health records; routinely collected health data.