A Comprehensive Assessment of Cancer Patient Performance Status Documentation in a Large, Multicentre Hospital...

Area of Science:

• Oncology
• Health Informatics
• Clinical Research

Background:

• Performance status (PS) is vital for assessing cancer patient function and guiding treatment.
• Existing research indicates significant deficiencies in documenting PS scores within electronic health records (EHR).

Purpose of the Study:

• To analyze the documentation rates of performance status (PS) scores (Karnofsky, ECOG/Zubrod/WHO) in cancer patients' records.
• To identify patient and hospital characteristics associated with PS documentation completeness.

Main Methods:

• A regular expression (RegEx) was developed to automatically identify PS scores in hospital, consultation, and multidisciplinary team meeting (MDT) records.
• Analysis included 68,479 patients referred for cancer between January 2019 and June 2021.
• Multivariate analysis assessed factors influencing PS documentation, including cancer type, hospital, patient demographics, and metastatic status.

Main Results:

• The RegEx tool achieved high accuracy (>0.95 F1 score) for PS identification.
• Only 35% of patients had a documented PS near diagnosis; 18% of MDT reports included a PS score.
• PS documentation varied significantly by cancer type and hospital; male and older patients were more likely to have documented PS. Documented PS near diagnosis correlated with poorer 1-year survival.

Conclusions:

• Performance status (PS) documentation in EHRs is generally low and inconsistent.
• Enhanced PS documentation is essential for leveraging EHRs as reliable real-world data sources in oncology.
• Improving PS documentation practices can enhance clinical decision-making and research capabilities.