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PubMed2002

alpha-Tocopheryl-L-ascorbate-2-O-phosphate diester, a hydroxyl radical scavenger, prevents the occurrence of epileptic foci in a rat model of post-traumatic epilepsy.

Intracortical injection of iron ions has been used to model post-traumatic epilepsy. The results obtained using these models suggest that oxidation of neural membranes by active oxygen free radicals may be involved in the etiology of post-traumatic epilepsy. This is a study of the effects of alpha-tocopheryl-L-ascorbate-2-O-phosphate diester potassium salt (EPC-K1), known as a hydroxyl radical scavenger, on the peroxidation of neural membranes by FeCl(3) in vitro and on the occurrence of epileptic discharges in the FeCl(3) injected post-traumatic epilepsy model rats. EPC-K1 dose-dependently inhibited the production of thiobarbituric acid reactive substances (TBARS) and protein carbonyl (P-Carb), both indices of biogenic macromolecular peroxidation. In vivo studies, sporadic spike discharges and/or epileptiform activities were observed in electrocorticograms (ECoG) of male Sprague-Dawley rat 15-90 min after 500 nmol of FeCl(3) was injected into the motor cortex. On the other hand, when 200 mg/kg of EPC-K1 was injected intraperitoneally 60 min prior to the injection of FeCl(3), the occurrence of epileptic discharges was prevented or delayed. When EPC-K1 (2.5-5 nmol) was injected along with the ferric ions, the occurrence of epileptiform activities was also prevented or delayed. EPC-K1 prevented the induction of early convulsion, the major risk factor of post-traumatic epilepsy. Rats in the Fe+EPC group were injected with 500 nmol of FeCl(3) into the left motor cortex and were given an EPC-K1-diet (CE-2 chow contained 0.2% of EPC-K1, and daily EPC-K1 intake was about 80 mg/kg/day). In the Fe+EPC group rats, the percent induction of epileptic discharges in ECoGs was significantly lower than that in the Fe+CE group rats, which were fed CE-2 after FeCl(3) injection. In the homotropic contra lateral cortex, TBARS and P-Carb content did not show any changes. However, the relative TBARS content in the focal area significantly increased in the Fe+CE and Fe+EPC group rats 3 h after the injection. It became normal 3 days after in the Fe+EPC group. The relative P-Carb content in the focal area significantly increased in the Fe+CE and Fe+EPC group rats 3 h after the injection. However, it became normal after 3 days. In the present study, EPC-K1, which consists of vitamins E and C connected by a phosphate, protected the oxidation of neural membranes and prevented the occurrence of ferric ion-induced epileptic discharges by its radical scavenger activity. These data suggest that EPC-K1 may be clinically useful in not only preventing the focus formation of post-traumatic epilepsy, but also in treating and attenuating the progression of free radical-induced degenerative disorders.

Journal Article↗

PubMed1998

Multielectrode array for simultaneous recording of glucose, oxygen and electrocorticography from cerebral cortex in experimental focal epilepsy.

Delineating epileptic tissue before and during surgery is still a major problem. Electroencephalography (EEG), electrocorticography (ECoG), and magnetoencephalography (MEG) evaluations may not always correlate with outcome. Metabolic mapping, i.e. positron emission tomography (PET) or single photon emission tomography (SPECT), is not practical or not sensitive--both spatial and temporal--enough for use in neurosurgery. Amperometric electrochemical electrodes for recording oxygen and glucose from nervous tissue are developed and tested in rat experimental focal penicillin epilepsy model. With a three-by-three array of glucose electrodes, epileptic focus is mapped. Simultaneous recordings of ECoG, oxygen and glucose levels performed. During seizure, extracellular glucose level showed a biphasic response pattern while oxygen level decreased slightly. It has been concluded that such a combined subdural grid recording might help before and during surgery. This method can be used in ischemia and such experimental metabolic studies.

Animals↗

PubMed2000

Paclitaxel and carboplatin in bladder cancer: recent developments.

Paclitaxel demonstrates significant single-agent activity in advanced urothelial carcinoma. Paclitaxel/carboplatin is an active and tolerable outpatient chemotherapy treatment regimen for these patients. This regimen has been studied in several phase II trials with response rates ranging from 14 to 65%. Paclitaxel/carboplatin may be considered in patients with advanced urothelial cancer and renal insufficiency, and a recent Eastern Cooperative Oncology Group (ECOG) phase II trial investigates this regimen specifically in this patient population. Ongoing ECOG trials are comparing paclitaxel/carboplatin with M-VAC (methotrexate, vinblastine, doxorubicin, cisplatin) in both the advanced disease and adjuvant settings.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2003

Does use of alternative medicine predict survival from cancer?

This study examines the association between alternative medicines (AM) and cancer survival. A national multicentre study was carried out in Norway in December 1992 to assess the prevalence of AM use among cancer patients. One of the aims of this study was to assess the association between AM and long-time survival. In January 2001, survival data were obtained with a follow-up of 8 years for 515 cancer patients. A total of 112 (22%) assessable patients used AM. During the follow-up period, 350 patients died. Death rates were higher in AM users (79%) than in those who did not use AM (65%). In a Cox regression model adjusted for demographic, disease and treatment factors, the hazard ratio of death for any use of AM compared with no use was 1.30, (95% Confidence Interval (CI) 0.99, 1.70; P=0.056), suggesting that AM use may predict a shorter survival. Sensitivity analyses strengthened the negative association between AM use and survival. AM use had the most detrimental effect in patients with an ECOG (Eastern Cooperative Oncology Group) performance status (PS) of 0 (hazard ratio for use=2.32, 95% CI, 1.44, 3.74, P=0.001), when compared with an ECOG PS of 1 or higher. The use of AM seems to predict a shorter survival from cancer. The effect appears predominantly in patients with a good PS.

Adolescent↗

PubMed1998

Systemic adjuvant treatment of high-risk melanoma: the role of interferon alfa-2b and other immunotherapies.

Until recently, the prognosis of patients with deep primary melanomas or regionally metastatic nodal disease has been poor, with 5-year survival rates of 25-50%. The results of the Eastern Cooperative Oncology Group (ECOG) trial 1684 represent the first evidence of effective adjuvant therapy for these patients. Interferon alfa-2b (IFN-alpha 2b) administered at maximally tolerated doses for 1 year significantly improved both relapse-free and overall survival. The impact of interferon therapy was observed early during treatment and the effect was durable. The results of this trial represent a breakthrough in the treatment of high-risk resected cutaneous melanoma and identify the new reference standard for new cytokines, vaccines and combinations. The favourable results provide a strong impetus for redoubled research into immunotherapy for treatment of melanoma. Specifically, ganglioside vaccines have been identified that induce antibody responses and may affect patient outcome and peptide/protein vaccines that are recognised by the T-cell have been identified in large numbers. ECOG and the U.S. Intergroup are conducting a phase III trial (E1694) that compares GM2 vaccine to IFN-alpha 2b and a phase II trial evaluating concurrent or sequential use of interferon and vaccines for patients with resectable melanoma. They are also planning phase II trials of peptides for patients with metastatic unresectable melanoma. Laboratory analyses of the immune responses induced by IFN and the several vaccines are anticipated to reveal the fundamental immune mechanisms that are important for relapse-free survival and immunological control of melanoma.

Antineoplastic Agents↗

PubMed1997

Vinorelbine is well tolerated and active in the treatment of elderly patients with advanced non-small cell lung cancer. A two-stage phase II study.

More than 30% of lung cancers arise in patients aged 70 years or more; however, because elderly patients are not considered to tolerate chemotherapy, they are generally excluded from clinical trials and are not considered eligible for aggressive cisplatin-based chemotherapy in clinical practice. The aims of the present study were to test tolerability and activity of weekly vinorelbine in advanced non-small cell lung cancer (NSCLC) patients aged 70 years or more, and to define whether minimum conditions existed for a randomised comparison with best supportive care. The study was designed as a multicentre two-stage phase II trial according to Simon's optimal design: 8 or more responses out of 43 treated patients were expected at the end of the trial. Patients aged 70 years or more were eligible if they had a cytological or histological diagnosis of NSCLC at stage IIIb-IV and a performance status less than or equal to two according to the ECOG scale. Vinorelbine was given intravenously (i.v.) at a dose of 30 mg/m2 every week for 12 doses. As planned, 43 patients entered the study; median age was 73 years (range 70-80); 11 patients were older than 75 years. Median dose-intensity (mg/m2/week) of vinorelbine was 21.2 (range 7.5-30) and was not affected by age of patients. Toxicity was generally mild, mainly haematological and never life-threatening. ECOG performance status improved in 26% of patients; cough and pain improved in more than 40% of patients symptomatic at entry, while dyspnoea improved in 28%; approximately half the patients had a stabilisation of their symptoms. 10 patients (23-95% exact confidence interval (CI): 12-39%) obtained a partial response. Median time to progression was 11 weeks (95% CI 8-30) and median survival 36 weeks (95% CI 28-53). One-year estimated progression-free and overall survival rates are 16% and 36%, respectively. In conclusion, vinorelbine was well tolerated and active in the treatment of elderly NSCLC patients. A phase III trial (ELVIS-Elderly Lung Cancer Vinorelbine Italian Study) comparing best supportive care versus best supportive care plus vinorelbine is now ongoing.

Age Factors↗

PubMed1994

Surface cortical cerebral blood flow monitoring and single photon emission computed tomography: prognostic factors for selecting temporal lobectomy candidates.

A series of 23 patients with medically intractable temporal lobe epilepsy was studied with surface cortical cerebral blood flow monitoring, single photon emission computed tomography (SPECT) and subdural strip electrocorticographic (ECoG) monitoring for localization of the seizure focus. All patients underwent anterior temporal lobectomy and seizure outcome was determined after a mean of 9 months (range: 3-17 months). Invasive and non-invasive cerebral blood flow (CBF) parameters with prognostic value for seizure-free outcome were: (a) inter-ictal seizure focus with CBF < 65 ml/100 gm-min; (b) inter-ictal seizure focus CBF < or = normal temporal lobe CBF; and (c) concordance of inter-ictal and/or early post-ictal SPECT and ictal ECoG for seizure focus localization. These results should improve prognostic value of invasive and non-invasive cerebral blood flow data for selection of temporal lobectomy candidates.

Adolescent↗

PubMed2002

Surgical treatment of temporal lobe epilepsy. Personal experience.

The authors present their results with epilepsy surgery of the temporal lobe performed during a 5 years period at the Hospital of the University of Jordan, in 12 patients. All patients underwent comprehensive presurgical evaluation, including neurological history, examination, video-Electroencefalogram, Electroencephalogram for intercritical and habitual seizures and optimum magnetic resonance. After appropriate selection, we performed epilepsy surgery in 12 patients (9 males and 3 females). The mean age at operation was 21.4 years (range 4-44 years). All patients were receiving high therapeutic doses of antiepileptic therapy. Abnormal findings in Magnetic Resonance were observed in all cases. Pre and post resection electrocorticogram were recorded and graded according to Jay Scale. Pathological findings showed, neoplasic lesion in 2 cases (16%); one ganglioglioma and a low grade astrocytoma) and 10 patients (84%) showed non-neoplasic lesions. Three patients (25%) had cortical dysplasia, another 3 (25%) had mesotemporal sclerosis, three more (25%) gliosis and one (8%) an arachnoid cyst. Post resection ECoG showed (84%) type A, (8%) type B, and (8%) type C. The present study has shown that intraoperative ECoG has an important role in the prediction of medically intractable epilepsy. Outcome of temporal lobe epilepsy surgery in our series was comparable to results reported by other authors despite of the absence of sophisticated functional tests.

Adult↗

PubMed2001

Analysis and localization of epileptic events using wavelet packets.

This article compares results obtained in previous studies using time-frequency representations (Wigner-Ville, Choi-Williams and Parametric) and the wavelet transform with those obtained with wavelet packet functions to show new findings about their quality in the analysis of ECoG recordings in human intractable epilepsy: data from 21 patients have been analyzed and processed with four types of wavelet functions, including Orthogonal, Biorthogonal and Non-Orthogonal basis. These functions were compared in order to test their quality to represent spikes in the ECoG. The energy based on the wavelet coefficients to different scales was also calculated. The best results were found with the biorthogonal-6.8 wavelet on 5-7 scales, which gave 0.92 sensitivity, but with a high percentage of false positives; this representation was highly correlated with spike events on time and duration. To improve these results we have studied the wavelet packet coefficients energy. We found that reconstruction wavelet packet coefficients at 4 and 9 nodes contain significant information to characterize the spike event. These nodes' reconstruction coefficients were multiplied and this product was highly correlated with spikes events on time and duration. With this procedure we improved the sensitivity up to 0.96 with the same biorthogonal-6.8 wavelet at four levels. With this technique we do not sacrifice computation time: 896 samples are processed at only 0.16 s, so that it is possible to show the spike scattering path on line, because 896 samples (7 s)/16 channels are processed at 3.13 s.

Adult↗

PubMed2000

Phase relationships between cortical and muscle oscillations in cortical myoclonus: electrocorticographic assessment in a single case.

AIM: To compare voluntary- and sensory-induced myoclonic jerks using spectral analysis in a subject with cortical myoclonus. METHODS: The coherence, phase and cumulant density estimates were calculated between right electrocorticographic (ECoG) signals and distal left leg muscles in a patient with subdural electrodes inserted over the right sensorimotor cortex. RESULTS: Significant coherence between sensorimotor cortex and muscle was found up to 60 Hz during voluntary induced myoclonic jerks. Additional higher frequency coherence ( approximately 140 and 190 Hz) was found during sensory-induced myoclonic jerks. The cortical signals phase led muscle signals at frequencies >15 Hz by delays consistent with transmission along corticospinal pathways. Below 15 Hz the cortex phase lagged the muscle signals. Polarity reversal of the cumulant density estimate and the ECoG site demonstrating the highest coherence helped to localize the site of the abnormal oscillatory activity to the leg area of the motor cortex. CONCLUSIONS: Oscillations of different frequencies can co-exist at a given location and can both phase lead and lag contralateral muscle. This has implications for cortex-muscle latency measures calculated by back-averaging techniques.

Aged↗

PubMed2002

Structural mechanisms underlying autonomic reactions in pediatric arousal.

Arousal provides an essential means to restore homeostasis following a system perturbation during a quiescent state. The classic definition of 'arousal' includes a constellation of cardiovascular, respiratory and somatic muscle characteristics, together with activation of the electrocorticogram (ECoG). At least two ascending activating systems, a ventral cholinergic and a serotonergic ascending system, both interacting with other regional neurotransmitter processes, contribute to electrocortical activation, with separate behaviors mediated by each system. A number of 'arousal' processes essential for survival operate at local levels, and interact with the systems that mediate cortical activation. These processes include cerebellar compensatory mechanisms which respond to extreme cardiovascular challenges, and limbic structures which respond to hypoxia or hypercarbia and the resultant dyspnea. The local processes show exceptional cortical arousing properties upon recruitment of some structures, such as the amygdala, which has major projections to ascending arousal systems. Components of arousal can emerge without ECoG activation and can be mediated at local levels which interact with ascending systems.

Journal Article↗

PubMed2004

[Community-acquired pneumonia among the elderly: differences between patients living at home and in nursing homes].

OBJECTIVE: The etiology, presentation, and prognosis of community-acquired pneumonia (CAP) among nursing home residents are believed to differ from those of other groups. However, few Spanish studies have confirmed those assumptions or studied regional differences in CAP etiology. PATIENTS AND METHODS: A prospective study which included all patients over 65 years of age admitted to our hospital with CAP was carried out over a period of 18 months (2002-2003). We examined clinical, analytical, and radiographic characteristics paying particular attention to functional status--using the Eastern Cooperative Oncology Group (ECOG) scale and Barthel and Karnofsky indices--and comorbidity. Two blood cultures, a Legionella antigen test in urine, and serology for atypical bacteria were used for the etiologic diagnosis; bacterial cultures of respiratory samples were also used in certain cases. RESULTS: Ninety-one patients, 25 of whom were nursing home residents, were enrolled. The nursing home residents were older than the other patients (mean [SD] age of 82 [4] compared with 73 [5]; P=.0001) and had greater comorbidity (P=.0001)--with a significantly greater presence of diabetes mellitus, cerebrovascular disease, congestive heart failure, and dementia. They also had a poorer functional status (ECOG, 2.09 [0.9] compared with 0.93 [1.1], P=.001; Barthel Index, 19 [33] compared with 77 [35], P=.001; Karnofsky In-dex, 51 [17] compared with 78 [23], P=.001). Regarding clinical characteristics, significant differences were found for respiratory rate (39 [11] compared with 27 [7] breaths/min; P=.001), blood pressure (69.5 [20] compared with 79.2 [18] mm Hg; P=.029), and temperature (36.6 [1.2] compared with 37.7 [1.1] degrees C; P=.001). CAP patients from nursing homes presented a greater number of affected lobules in chest x-rays (P=.004), more hypoxemia, acidosis, anemia, hypoalbuminemia, and greater scores of urea and creatinine. Fine Scale scores were also greater (134 [26] compared with 95 [28]; P=.001) as was mortality (7/25 compared with 3/66; P=.005). Few patients had an etiologic diagnosis and no significant differences were observed between the groups. The variable that predicted mortality in elderly patients in this series, according to stepwise logistic regression, was urea (adjusted R2=0.452). CONCLUSIONS: In our sample population, nursing home residents were older, had greater comorbidity, and severe functional impairment. Under these circumstances the severity of CAP increases and becomes an important cause of mortality despite the fact that the etiologic agents do not appear to differ from those of the other patients.

Aged↗

PubMed2000

Dysembryoplastic neuroepithelial tumor: radiological findings (including PET, SPECT, and MRS) and surgical strategy.

In order to elucidate the radiological features of dysembryoplastic neuroepithelial tumor (DNT), and to clarify the optimal surgical strategy for this tumor, the authors retrospectively analyzed 20 cases of DNT treated at our institution. Magnetic resonance (MR) imaging (all cases), 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) (eight cases), ictal/interictal Tc99m-HMPAO single photon emission computed tomography (SPECT) (seven and five cases respectively) and proton magnetic resonance spectroscopy (1H MRS) (one case) were performed preoperatively. Invasive monitoring/intraoperative electrocorticography (ECoG) was performed in four cases in order to determine the epileptogenic zone. A well-demarcated lobulating tumor located in the cortical with/without subcortical area was the typical MR finding. 18F-FDG PET showed glucose hypometabolism in all cases. Ictal Tc99m-HMPAO SPECT showed hyperperfusion of the lesion in three cases and interictal Tc99m-HMPAO SPECT showed hypoperfusion of the lesion in one case. 1H MRS showed nonspecific findings. Gross total resection was performed in all cases. Histologically, associated cortical dysplasia was found in 11 cases. The mean duration of follow-up after surgery was 37.9 months, and the overall seizure free rate was 90%. Follow-up MR imaging was performed in 14 cases (mean duration of follow-up: 21.6 months) and showed no recurrence of tumor in any of these cases. Invasive monitoring/intraoperative ECoG and the presence of cortical dysplasia showed no significant relationship with seizure control rate (p = 1.25 and p = 1.62 respectively).

Adolescent↗

PubMed1998

Pitfalls in grading severity of chemotherapy-induced peripheral neuropathy.

BACKGROUND: Reliable reporting of chemotherapy-induced neurotoxicity is important. The objectives of the current study were to evaluate the differences in the peripheral neurotoxicity sections of several widely used chemotherapy-related toxicity grading systems, and the differences in the way in which observers interpret these scales. PATIENTS AND METHODS: Two neurologists independently rated the severity of chemotherapy-induced peripheral neuropathy, according to WHO, ECOG, Ajani, and NCIC-CTC criteria in 37 patients. RESULTS: The highest percentage grade 1, grade 2 and grade 3 peripheral neurotoxicity was noted when employing the WHO, Ajani and NCIC-CTC scales, respectively. Percentage inter-observer agreement across all grades of severity ranged from 45.9 (NCIC-CTC) to 83.8 (WHO). The degree of agreement varied from 'poor to fair' to 'substantial'. Percentage inter-observer agreement for the dichotomy grade < or = 2 and grade 3 ranged from 81.1 (NCIC-CTC) to 94.6 (Ajani and WHO), however, exact agreement on grade 3 peripheral neurotoxicity ranged from 0 (Ajani and WHO) to 42% (NCIC-CTC). Percentage interscale agreement for the dichotomy grade < or = 2 and grade 3 varied from 67.6 (WHO and NCIC-CTC) to 100 (WHO and ECOG). Interobserver disagreement of severity grading was partly due to different interpretation of scale parameters. CONCLUSIONS: Our results suggest that caution should be used in interpreting results across studies using different scales for neurotoxicity grading in chemotherapy-related peripheral neuropathy. When (multicentre) trials are to be undertaken with potential neurotoxic or neuroprotective agents, consensus should be sought regarding the toxicity rating scale used, and its interpretation by participating physicians.

Adult↗

PubMed2001

N-Methylformamide in advanced squamous cancer of the uterine cervix: an Eastern Cooperative Oncology Group phase II trial.

PURPOSE: Preclinical and clinical data support the study of polar-planar compounds such as N-Methylformamide (NMF) in advanced squamous cell carcinoma of the uterine cervix (SCC). This phase II trial sought to determine the efficacy and toxicities of NMF in patients with advanced SCC. PATIENTS AND METHODS: Eligibility for this trial required bidimensionally measurable squamous or adenosquamous cell cancer of the uterine cervix incurable by surgery or radiation therapy, ECOG performance status of < or = 2, no prior NMF and no more than one prior chemotherapy regimen. Patients received NMF at 2000 mg/m2 intravenously over 15-30 minutes days 1, 8 and 15. The cycle was repeated every 42 days. A single dose escalation of 25%, 500 mg/m2 was made after the first cycle if the toxicities did not exceed grade I for hepatic toxicity and grade II for nausea and vomiting. RESULTS: From July 1987 through September 1998, 21 patients with advanced squamous cell carcinoma of the uterine cervix were entered on study. Two patients were ineligible because there was no pretreatment SGOT on one and the other deteriorated prior to drug approval. Therefore, 19 patients were include in the analysis of response and survival. Four were inevaluable, three due to inappropriate tumor evaluation and one secondary to grade III vomiting, who went off study. These patients were included in the denominator while computing the results. There were 2 deaths, one due to pulmonary hemorrhage from perforation during central venous insertion and one due to disease. 30% (6/19) patients had toxicities, Eastern Cooperative Oncology Group (ECOG) grade III or higher and 2 of these patients suffered multiple grade III toxicities. There were no complete or partial responses. CONCLUSION: In this population, NMF in the dose and schedule employed exhibited no clinical activity.

Aged↗

PubMed1997

Dipole source analysis may differentiate benign focal epilepsy of childhood with occipital paroxysms from symptomatic occipital lobe epilepsy.

The aim of the study was to distinguish Benign Focal Epilepsy of Childhood with Occipital Paroxysms (BEOP) from its symptomatic counterpart on the basis of the location of the sources of the interictal EEG spikes. Patients were classified into two groups: idiopathic BEOP and symptomatic occipital lobe epilepsy. Source analysis of the averaged occipital spikes was performed using a homogeneously conducting sphere as the volume conductor model. Results showed a statistically significant difference in the eccentricity, i.e., the distance of the occipital spike focus from the centre of the head. The dipole sources of the occipital spikes in the BEOP group were found to be located more superficially than in the symptomatic group, corresponding in six of the nine cases with a source position estimated to be within the cortical layer just below the skull. The eccentricity of the symptomatic occipital spikes suggests a location deeper than the cortical layer. The results were validated in two patients from the symptomatic group. In one patient the estimated deeper dipole source location corresponded with a deeper location of spike activity observed during ECoG; in the other patient's ECoG, spike activity was observed superficially but over an extended area. The discrepancy between estimated and real location may be explained by the method of dipole source analysis used. It is concluded that the finding of a superficial dipole source location of the occipital spikes provides an indication for the diagnosis BEOP (sensitivity: 67%; specificity: 74%).

Adolescent↗

PubMed1993

Performance status assessment in cancer patients. An inter-observer variability study.

The ECOG Scale of Performance Status (PS) is widely used to quantify the functional status of cancer patients, and is an important factor determining prognosis in a number of malignant conditions. The PS describes the status of symptoms and functions with respect to ambulatory status and need for care. PS 0 means normal activity, PS 1 means some symptoms, but still near fully ambulatory, PS 2 means less than 50%, and PS 3 means more than 50% of daytime in bed, while PS 4 means completely bedridden. An inter-observer variability study of PS assessment has been carried out to evaluate the non-chance agreement among three oncologists rating 100 consecutive cancer patients. Total unanimity was observed in 40 cases, unanimity between two observers in 53 cases, and total disagreement in seven cases. Kappa statistics reveal the ability of the observers compared to change alone and were used to evaluate non-chance agreement. Overall Kappa was 0.44, (95% confidence limits 0.38-0.51). The Kappa for PS 0 was 0.55 (0.44-0.67), while those for PS 1, 2, 3 and four were 0.48 (0.37-0.60), 0.31 (0.19-0.42), 0.43 (0.32-0.55), and 0.33 (0.33-0.45), respectively. If one observer allocated patients to PS 0-2, then another randomly selected observed placed the patients in the same category with a probability of 0.92. For patients with PS 3-4 the probability that the same category would be chosen was 0.82. Overall, the non-chance agreement between observers was only moderate, when all ECOG Performance Status groups were considered. However, agreement with regard to allocation of patients to PS 0-2 versus 3-4 was high. This is of interest because this cut-off is often used in clinical studies.

Activities of Daily Living↗

PubMed2003

Performance status score: do patients and their oncologists agree?

Oncologists traditionally assess their patients' ECOG performance status (PS), and few studies have evaluated the accuracy of these assessments. In this study, 101 patients attending a rapid access clinic at Papworth Hospital with a diagnosis of lung cancer were asked to assess their own ECOG PS score on a scale between 0 and 4. Patients' scores were compared to the PS assessment of them made by their oncologists. Of 98 patients with primary non-small-cell lung cancer (NSCLC) and small-cell lung cancer (SCLC), weighted kappa statistics showed PS score agreement between patient and oncologist of 0.45. Both patient- and oncologist-assessed scores reflected survival duration (in NSCLC and SCLC) as well as disease stage (in NSCLC), with oncologist-assessed scores being only marginally more predictive of survival. There was no sex difference in patient assessment of PS scores, but oncologists scored female patients more pessimistically than males. This study showed that, with few exceptions, patients and oncologists assessed PS scores similarly. Although oncologists should continue to score PS objectively, it may benefit their clinical practice to involve their patients in these assessments.

Adult↗