Lung Cancer.pdf

222 J.B. Putnam, Jr.
therapy. Patients with poor performance status may be more likely to be
offered palliative therapy. Changes in performance status may suggest a
transition from therapy-oriented care to comfort-oriented care. Several
performance scales are available for grading the overall physical status
of patients with lung cancer. Performance scales are useful because they
define in a broad but reproducible manner the patient’s activities and
functional limitations and provide an indirect measure of general health
status at a specific point in time. Commonly used performance scales include
the modified Zubrod performance scale (Zubrod et al, 1960),
which is used by the Eastern Cooperative Oncology Group to measure
the performance of patients enrolled in its clinical trials (Oken et al,
1982), the Karnofsky performance scale (Karnofsky, 1961), the European
Organization for Research and Treatment of Cancer Quality of Life
Questionnaire (EORTC QLQ-C30) (Hollen and Gralla, 1996) and its lung
cancer module (EORTC QLQ-LC13) (Langendijk et al, 2000), the Functional
Assessment of Cancer Therapy—Lung quality of life instrument,
and the Lung Cancer Symptom Scale (Cella et al, 1995; Hollen and
Gralla, 1996). The Zubrod and Karnofsky scales are shown in Table 12–1.
Other performance scales, such as the Medical Outcomes Study Short
Form Survey (SF-36), may be used as measures of general health. In the
M.D. Anderson Thoracic Center, physicians most often use the Zubrod and
Karnofsky performance scales.
Patients treated in the context of clinical trials may have specific performance
measures assessed at every outpatient visit. At M.D. Anderson, the
Zubrod or Karnofsky performance status and pain status are measured at
each visit.
After primary (or additional) therapy has been completed, patients are
screened for symptoms. In the M.D. Anderson Thoracic Center, we screen
all patients for symptoms before treatment and at each postoperative visit.
The symptoms screened for are listed in Tables 12–2 and 12–3. Special attention
is paid to weight loss, pain, and dyspnea.
Table 12–1.
ECOG or
Performance Status Scales/Scores
Zubrod Karnofsky
Scale Score
0 Asymptomatic and fully active 100%
1 Symptomatic; fully ambulatory; restricted
in physically strenuous activity
80%–90%
2 Symptomatic; ambulatory; capable of self-care;
more than 50% of waking hours are spent out of bed
60%–70%
3 Symptomatic; limited self-care; spends more than 50%
of time in bed, but not bedridden
40%–50%
4 Completely disabled; no self-care; bedridden 20%–30%
ECOG indicates Eastern Cooperative Oncology Group.