Photo Credit: Thitima Uthaiburom

Baseline functional scores strongly improve overall survival and functional resilience prognostication in NSCLC compared with ECOG performance status.

Baseline functional scores, assessed using the mEQ-5D-5L survey, are a stronger predictor of overall survival and functional resilience among patients with non-small cell lung cancer than the traditionally used Eastern Cooperative Oncology Group (ECOG) Performance Status (PS), according to results published in Lung Cancer.

“As more treatments emerge for advanced, stage IV non-small cell lung cancer (NSCLC), oncologists have difficulty predicting functional resiliency vs functional decline throughout cancer treatment,” Carolyn J. Presley, MD, MHS, and colleagues wrote. “Our study evaluates functional resilience among patients with advanced NSCLC.”

Understanding functional disability and resilience during lung cancer treatment is crucial, especially for NSCLC, the leading cause of cancer-related mortality globally. Despite advances in treatment, there is limited data on tracking functional status as a repeated, longitudinal outcome.

Many older adults prioritize maintaining their functional status and may even forgo treatments if they lead to functional decline, underscoring the importance of monitoring during cancer care, Dr. Presley and colleagues noted. Decline in functional status can lead to increased risk for hospitalization, loss of independence, and reduced survival rates.

Currently, the ECOG PS is the primary tool used in clinical trials to measure functional status, but it has limitations, especially among older patients. Previous research shows that baseline physical function, symptom burden, and mental health influence functional outcomes. 

Study Parameters

To characterize functional resilience, identify baseline predictors of resilience versus decline, and examine how early functional decline during treatment may impact overall survival, Dr. Presley and colleagues enrolled 207 patients with NSCLC from The Ohio State University Comprehensive Cancer Center’s Thoracic Oncology Clinic as part of the ongoing Beating Lung Cancer in Ohio (BLCIO) cohort study.

Participants were newly diagnosed, aged 18 years and older, and within 40 days of starting first-line treatment. Exclusion criteria included receipt of prior treatment for more than 40 days, undergoing concurrent chemotherapy and radiotherapy with curative intent, and impairments that prevented consent or completion of surveys.

Data collection was conducted within the first 2 weeks of enrollment. Participants provided written informed consent and completed surveys on various patient-reported outcomes (PROs), including demographics, anxiety (GAD-7), depression (PHQ-9), lung cancer-specific symptoms (EORTC-QLQ-LC13), functional status (EQ-5D-5L), and cancer-related stress (IES-R). Additional clinical data such as medical comorbidities, brain and bone metastases, and disease response were gathered from medical records. The study also captured adverse events.

Patient-reported functional status over time was assessed with the EQ-5D-5L survey, focusing on three key dimensions–mobility, self-care, and usual activities–and excluding pain and anxiety/depression. Participants were categorized into groups based on changes in functional scores over 12 months.

Results & Clinical Implications

The mean age of the 207 patients included in the study was 63.5; approximately half of the cohort was older than 65. More than half of the patients (58.9%) were men and married (58.9 %). Most patients (82.6%) were White and had a history of active tobacco exposure (72.9%).

“We defined [four] patient categories based on functional status over time: maintenance, functional decline, resilient, and variable,” Dr. Presley and colleagues wrote.

The researchers observed varied changes in functional status:

• 42.0% maintained functional status;
• 37.7% had functional decline;
• 10.6% were resilient; and
• 9.7 % experienced variable functional status.

According to the study results, functional decline was marked by a significant increase in disability scores without recovery, while resilience was characterized by initial decline followed by improvement.

“Data show that ECOG PS, which has traditionally been relied upon to predict which patients will better tolerate cancer treatments, was not a predictor of functional resilience or [overall survival]. Over one-third of participants with the best ECOG PS experienced functional decline. Baseline functional score, measured with [three] questions from the mEQ-5D-5L, was a much stronger predictor.”

Specifically, Dr. Presley and colleagues found that participants with the best baseline function experienced the longest overall survival, while those with the worst baseline function had the shortest overall survival. “Among the healthiest patients, early score increases indicated shorter overall survival. Baseline ECOG PS was not associated with overall survival.”

The study emphasizes the need for multidisciplinary cancer care teams to monitor patients’ functional status closely early on. The investigators noted that any decline within the first three months can indicate a higher risk of mortality. Further, the findings suggest that a more proactive approach to assessing and addressing functional decline can improve patient outcomes, particularly in older adults receiving chemotherapy.

 Key Takeaways

• Traditionally, ECOG Performance Status is used to assess functional status in patients with cancer, but it has limitations, particularly in older patients
• An assessment of baseline functional scores shows these measures are a stronger predictor of overall survival and functional resilience in NSCLC
• Specifically, those with the best baseline function had the longest overall survival
• The results show that a more proactive approach to assessing and addressing functional decline can improve patient outcomes