Patient-related factors in advanced lung cancer: A review of ECOG-PS, malnutrition, and sarcopenia

Patient-related factors-including performance status, nutritional state, and physical function-are increasingly acknowledged as essential in guiding treatment choices and predicting prognosis for advanced lung cancer. Although the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) is still the most widely used clinical measure, it is subjective by nature and often shows variation between assessors. Malnutrition and sarcopenia, which are frequently overlooked in everyday practice, have been identified as important prognostic indicators that can be measured objectively. This review examines how ECOG-PS, malnutrition, and sarcopenia interact, pointing out the shortcomings of relying solely on ECOG-PS and suggesting supplementary or alternative evaluation methods. Malnutrition, determined through a combination of serum albumin levels, inflammatory markers, and body mass index, was strongly linked to lower ECOG-PS scores and poorer survival. Sarcopenia-particularly when evaluated through muscle quality or functional measures such as grip strength and walking speed-is related to deteriorated ECOG-PS and worse treatment results. Although there is inconsistency in diagnostic standards and inherent limitations in retrospective research, the evidence indicates that integrating objective assessments of nutritional and functional status may improve personalized treatment strategies and prognostic precision. Using straightforward and easily available clinical measures could help identify physical inactivity earlier, enabling more suitable therapeutic actions. Assessing patient-related factors such as malnutrition and sarcopenia in addition to ECOG-PS before treatment may further enhance outcomes and quality of life for patients with advanced lung cancer.