The Accuracy of Physician Assignment vs Patient Assignment in the Karnofsky Performance Score as it Relates to Lifespan in Advanced Lung Cancer Patients

In 2018 there is expected to be about 234,030 new cases of lung cancer in the United States, with approximately 154,050 of those diagnosed either this year or previously passing away as a result of this debilitating disease.1 A persistent problem in the treatment of patients is their ability to gauge their own abilities versus their physicians making the same assessment. A survey of 167 patients and their physicians with advanced lung cancer from the North Central Cancer Treatment Group in Rochester, Minnesota was taken. The information gathered pertained to which institution the patient was receiving treatment from, how many days the patient survived, whether or not their data had been censored or if the patient had passed away, how many years old the patient was, their sex, their ECOG performance score, their Karnofsky Performance Score as assessed by their physician, their Karnofsky Performance Score as assessed by themselves, how many calories they consumed at their meals, and how much weight the patients lost in the last six months. Physicians were likely to answer the survey with the expectation that their patients were doing better than the patients themselves felt they were.

Patient vs Physician Viewpoint

Overall, patients tended to agree with their physicians when it came to their Karnofsky Performance Score. The Karnofsky Performance Score is a tool for assessing functional impairment - how much and how well a person can perform any number of mundane daily tasks.2

Patients did tend to score down their own ability to handle things with no major variation between males and females.

Doctors tended to feel their patients were, on the whole, were doing better and able to handle more than the patients themselves felt they were.

Females tended towards agreeing with their physicians on their Karnofsky Performance Score, showing only a slight leaning towards the extremes in their own perceptions of how much they were or were not capable of managing.

On the other hand, males showed doubt about their health and capabilities, compared to their doctors who were more optimistic about the males’ outlooks.

Survival Rates

Based off of the surveyed information, it can be seen that the amount of time a male has left to live after his joining the group is likely to be significantly shorter than that of a female counterpart who joined at the same time.

Older patients had the shorter life spans, and younger patients easily made the first 150 days. Despite this, 70.66% patients were deceased before the end of their first year. Whether due to rapid deterioration or miscommunication, 65.62% of the female patients and 73.79% of the male patients were dead within the year of their joining the group.

The odds are not in favor of the patients when it comes to survival. Female lung cancer patients were likely to die within the year after joining the cancer group, even if they claimed in the survey to feel in tip-top shape.

Males were less likely to embellish their performance scores, and also more likely to die before their first year with the group was up as compared to their fellow patients of the opposite sex.

Analysis

Patients with advanced stage lung cancer joining the North Central Cancer Treatment Group have a high likelihood of dying within the first year as a member of the group. Male patients were more likely to die sooner than their female counterparts, and more likely to have a doctor report they believe the male patients in question were functioning well in accordance to the Karnofsky Performance Score. Age did not play a large factor in survivability after joining the group. Physicians typically felt their patients were doing better than their patients felt they were, and this correlates at least in part with the brevity of days survived.

Lung cancer remains a near-certain death sentence, especially in advanced stage patients such as were used for this survey and study. Physicians in general, but especially the ones used in this study, need to work on being more in-tune with their patients’ needs so they can better recognize and acknowledge when their patients are suffering or having issues.

If a weekly survey had been kept with similar parameters, it might provide more insight into advanced stage lung cancer patients on all fronts, but especially to pinpoint where and how doctors need to anticipate their patients’ needs and deteriorating states.

References

  1. Key Statistics for Lung Cancer. (n.d.). Retrieved January 18, 2018, from https://www.cancer.org/cancer/non-small-cell-lung-cancer/about/key-statistics.html
  2. Karnofsky Performance Status Scale. (2017, January 06). Retrieved January 18, 2018, from https://emedicine.medscape.com/article/2172510-overview