ECOG performance status as a representative of deficits in older Indian patients with cancer: A cross-sectional analysis from a large cohort study

Background: The Eastern Cooperative Oncology Group (ECOG) performance status (PS) is a standard assessment in older patients with cancer, but the correlation of the individual components of the geriatric assessment (GA) with the ECOG PS is less well studied, especially in Indian patients.Objective: To study the correlation of the ECOG PS with the individual components of the GA and with the burden of deficits as estimated in the GA.Materials and Methods: This cross-sectional observational study was conducted in the geriatric oncology clinic of the Tata Memorial Hospital, a tertiary cancer center in Mumbai, India, with approval from the Institutional Ethics Committee. Function and falls, comorbidities, nutrition, psychological status, and cognition were evaluated as a part of the GA. The primary outcome was defined as the presence of ≥2 abnormalities on the 5 tested domains in the GA, while the independent variable was ECOG PS (0–3) which was assessed as a discrete variable. The discriminatory power of the ECOG PS in identifying ≥2 geriatric abnormalities as well as deficits in the individual geriatric domains was calculated via logistic regression receiver operating characteristics (ROC) curves using area under the ROC curve (AUC). AUCs were divided into ≥0.8, <0.8–≥0.65, and <0.65 to represent excellent, moderate, and poor discriminant ability, respectively.Results: Between May 2018 and Jan 2021, we enrolled 594 patients in the study. Their median age was 69 years (range, 60–100), and 80% patients had an ECOG PS of 1 or 2. Abnormalities in at least 2 domains were detected in 77% patients. An ECOG PS ≥1 was predictive of abnormalities in at least 2 geriatric abnormalities with an AUC = 0.69 (95% confidence interval [CI], 0.64–0.74), sensitivity of 95.4%, and specificity of 18.4%. With each 1 unit increase in the ECOG PS, the odds of having ≥2 geriatric abnormalities increased by 4.69 (95% CI, 2.53–8.68). The ECOG PS correlated moderately well with deficits in cognition (AUC = 0.66 [95% CI, 0.61–0.72]), function and falls (AUC = 0.73 [95% CI, 0.69–0.77]), and psychological domains (AUC = 0.65 [95% CI, 0.60–0.70]) and poorly correlated with nutritional status (AUC = 0.63 [95% CI, 0.58–0.68]) and comorbidities (AUC = 0.55 [95% CI, 0.49–0.61]).Conclusions: Older patients with cancer with an ECOG PS ≥1 are very likely to harbor non-oncological vulnerabilities, and should therefore undergo a GA. The ECOG PS correlates moderately well with abnormalities in function and falls, psychological assessment, and cognition, while it poorly correlates with nutritional status and comorbidities. (Clinical Trials Registry – India number: CTRI/2020/04/024675).