Patients with a good performance status (KPS = 90%-100%) may have a significant and clinically relevant survival benefit from combination chemotherapy. By contrast, patients with a poor performance status (KPS < or = 80%) have no advantage from intensified therapy and should rather receive single-agent treatment. Publication types
Full Answer
Why do we measure chemotherapy performance status?
Chemotherapy may be given in several different ways, which are discussed below. Intravenous (IV) chemotherapy. Many drugs require injection directly into a vein. This is called intravenous or IV chemotherapy. Treatment takes a few minutes to a few hours. Some IV drugs work better if you get them over a few days or weeks.
Is chemotherapy harmful to patients with poor performance status?
Importance: Although many patients with end-stage cancer are offered chemotherapy to improve quality of life (QOL), the association between chemotherapy and QOL amid progressive …
Why is performance status important in cancer treatment?
Patients with this score can usually carry out housework and office work. 2 – Has symptoms and spends less than half of daytime in bed. Can get around but not work, 3 – Patient has severe …
Does chemotherapy near death improve QOD in end-stage cancer?
Unfit patients with a Karnofsky performance status (KPS) below 70% only have a marginal benefit from chemotherapy with gemcitabine (Gem) and may often benefit more from optimal …
How do oncologists decide treatment?
The patient's preference is increasingly considered as one of the main factors that determines which of the available treatment options will be included in the decision-making process. The choice of the best treatment option for a given patient depends on the patient's values and preferences.
How do you make a chemo decision?
Some aspects you'll want to consider for each treatment include:Side effects. Take time to review the side effects of each treatment and decide whether they'll be worth enduring or too much to handle. ... How treatment affects your life. ... The financial costs of treatment. ... Your health in general.
How do you make a cancer treatment decision?
Understand your diagnosis. ... Know your options. ... Understand the goals of treatment. ... Ask about the side effects of each treatment option. ... Consider the risks and benefits of each treatment option. ... Get a second opinion. ... Find help managing the cost of cancer care. ... Consult guidelines or other decision-making tools.More items...
How is the number of chemo treatments determined?
The length of chemotherapy treatment is determined by a variety of factors. These include the type of cancer, the extent of cancer, the types of drugs that are given, as well as the expected toxicities of the drugs and the amount of time necessary to recover from these toxicities.
How do you write a treatment decision?
Understanding Your Options and Making Treatment DecisionsKnow all treatment options.Talk about the details of each treatment option with your cancer care team.Learn as much as you can and understand the information being given to you.Are a partner with your doctor in making treatment decisions and planning your care.
What factors determine the treatment plan an oncologist chooses for a particular patient?
The seven factors were their age at the time of decision, having a partner, having children, inability to work due to side-effects of the treatment, the nature of the side-effects, disease-related life expectancy and baseline QOL.
Who decides cancer treatment?
An oncologist is a doctor who treats cancer and provides medical care for a person diagnosed with cancer. An oncologist may also be called a cancer specialist. The field of oncology has 3 major areas based on treatments: medical oncology, radiation oncology, and surgical oncology.
When do doctors decide not to treat cancer?
If the cancer cannot be cured If a cure is not possible and treatment aims to control the cancer, it may be difficult to decide whether to go ahead. If the cancer is advanced and has spread to other parts of the body, treatment may be able to control it, improving symptoms and quality of life.
Can you decline chemotherapy?
Can you refuse chemotherapy? Yes. Your doctor presents what he or she feels are the most appropriate treatment options for your specific cancer type and stage while also considering your overall health, but you have the right to make final decisions regarding your care.
Is there a limit to how much chemotherapy you can have?
There's no way to give an exact time limit. The answer depends entirely on your situation and many factors, such as: The type of cancer you have. The treatment schedule or plan.
How many courses of chemo is normal?
During a course of treatment, you usually have around 4 to 8 cycles of treatment. A cycle is the time between one round of treatment until the start of the next. After each round of treatment you have a break, to allow your body to recover.
How long can you delay chemotherapy?
Short, planned delays in chemotherapy for good-risk GCT patients (less than or equal to 7 days per cycle) appear to be acceptable since they may prevent serious toxicity in this curable patient population. Delays of longer than 7 days are strongly discouraged except in extraordinary life-threatening circumstances.
What is performance status?
Performance status is a measure of how well a person is able to carry on ordinary daily activities while living with cancer, and provides an estimate of what treatments a person may tolerate. 1 Performance status is most often mentioned in the setting of clinical trials, as many trials are designed for people who have ...
Why is performance status important?
Understanding performance status can help people with cancer and their oncologists weigh the potential benefits and risks of different options. This is even more important now that there are many more treatment choices than in the past.
Why do oncologists ask questions?
These questions are asked as a way to determine how well you are doing with your activities of daily living, or "ADLs." 2 By evaluating these activities your healthcare provider can figure out your "performance status" and this measure of performance status can be helpful in many ways:
What are some myths about clinical trials?
The popular comment about "being a guinea pig" is often said in jest, yet many people do not understand exactly what clinical trials involve or their importance in cancer research. It may help to realize that every cancer treatment available—every drug and every procedure—was once only used in clinical trials, and at that time, the only people who could stand to benefit from these trials were those who participated in the trials.
Why is it important to record performance status?
By recording performance status, healthcare providers are able to monitor the new treatments to see if they have a negative effect on performance status. For example, if people responded to a drug but started with a performance status of 0, which dropped to 2, healthcare providers would then need to consider whether or not the side effects of the treatment justified the positive results they found in treating the cancer.
Can lung cancer be treated with chemotherapy?
For example, people with lung cancer who have a poor performance status are more likely to experience adverse effects and have a poorer overall survival if they receive standard chemotherapy. 6 In contrast, targeted therapies, when appropriate, are much better tolerated by those who have a poor performance status.
Is performance status important for cancer patients?
Understanding performance status can help people with cancer and their oncologists weigh the potential benefits ...
What is the role of PS in cancer?
It plays a role both in shaping prognosis and in determining the best treatment for a patient with cancer. Performance status is a score that estimates the patient’s ability to perform certain activities of daily living (ADLs) without the help of others.
What is the scale for asymptomatic cancer?
The most commonly used is typically referred to as the Zubrod or ECOG (Eastern Cooperative Oncology Group) scale. This scale ranges from 0 to 4, with 0 being fully functional and asymptomatic, and 4 being bedridden. The other scale sometimes used is the Karnofsky scale.
Does PS change with cancer?
Patient PS can and usually does change over time. Patients can experience a gradual worsening of their PS as their cancer progresses, both from the cancer itself and from the cumulative adverse effects of treatments. On the other hand, effective treatment can lead to an improvement in PS if a patient is limited by cancer-related symptoms (as opposed to other chronic medical conditions unrelated to cancer) that improve as the cancer responds to treatment.
What does it mean when a patient has a worse PS?
Patients who have a worse PS and limited functional capacity tend to have more difficulty tolerating rigorous cancer treatments . These patients have less favorable outcomes than more fit patients with better PS, regardless of the treatments given.
What are the factors that affect prognosis?
There are many factors that can predict whether someone is likely to do well or poorly with their disease. Age, the stage of a cancer, and other illnesses all affect prognosis, but PS is one of the most important variables. It is more important than a patient’s actual age in predicting how a patient is likely to do.
Is JAMA Network Open accepting submissions?
New! JAMA Network Open is now accepting submissions. Learn more.
What is a WHO score?
WHO Score. 0 – No symptoms. Patient is able to carry on all normal activities. (These might be signs of disease in medical exam, but patient feels normal. 1 – Has symptoms but can walk and carry out pre-disease activities as long as they are not physically demanding.
Is chemo hard on the body?
Doctors don’t prescribe chemo lightly or any other systemic therapy for that matter. The stage of the tumor matters; chemotherapy guidelines almost always specify cancer stage with suggested regimens. The overall physical condition and health of the patient is another big factor as chemo is hard on the body.
Importance of Measuring Performance Status
Performance Scales
- Two primary performance scales are used to measure performance status for those living with cancer: The Eastern Co-operative Oncology Group (ECOG)/WHO system,4 and the Karnofsky performance score.5 The first of these ranks performance status on a scale of 0 to 5, and the second on a scale of 0 to 100. Note that these scales differ in whether a lower number or a high…
Performance Status in Selecting Treatments
- Many of the treatments for cancer, whether surgery, chemotherapy, radiation therapy, targeted therapies, clinical trials, or stem cell transplants, can be challenging enough for those who are very healthy at the time of diagnosis. Understanding performance status can help people with cancer and their oncologists and other healthcare providers weigh...
Performance Status and Quality of Life Issues
- When talking about cancer treatment, quality of life issues can sometimes be pushed to the back burner. By routinely measuring quality of life, and noting changes, oncologists can be more aware of problems that are reducing quality of life and recommend appropriate resources.7 This may include options such as physical therapy, occupational therapy, and cancer rehabilitation (such …
Performance Status and Prognosis
- Many people with cancer and their families ask about prognosis. While it may seem morbid to ask about expected life expectancy, having an idea of prognosis (while knowing that healthcare providers including oncologists do not have a crystal ball and that everyone is different) allows people to consider advance care planning and end of life issues, and can also help people have …
Performance Status in Clinical Trials
- Many people get frustrated with performance status requirements in clinical trials. Why are these so necessary? Doesn't it exclude people who could benefit? There are a few reasons researchers use the criteria of performance status to determine eligibility for entering a clinical trial.9 One is so that their results are "reproducible." In other words, if another researcher would do a similar trial, …
Bottom Line on Performance Status
- Many people become frustrated with performance status as a low performance status can limit who may be involved in a clinical trial. At the same time, this is a very helpful measure for people living with cancer. After all, what is often most important to people coping with any medical disease is how that condition is impacting their ability to live, work, and enjoy life.