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Inter-rater reliability in performance status assessment between clinicians and patients: a systematic review and meta-analysis
  1. Ronald Chow1,2,3,
  2. Camilla Zimmermann2,
  3. Eduardo Bruera4,
  4. Jennifer Temel5,
  5. James Im1 and
  6. Michael Lock3
  1. 1Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
  2. 2Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
  3. 3Division of Radiation Oncology, Department of Oncology, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada
  4. 4Palliative Care and Rehabilitation Medicine, UT M. D. Anderson Cancer Center, Houston, Texas, USA
  5. 5Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, United States
  1. Correspondence to Mr Ronald Chow, Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 3K7, Canada; rchow48{at}


Introduction Performance status is an essential consideration for clinical practice and for patient eligibility for clinical trials in oncology. Assessment of performance status is traditionally done by clinicians, but there is an increasing interest in patient-completed assessment. The aim of this systematic review and meta-analysis was to summarise inter-rater concordance between patient and clinician ratings of performance status.

Methods A search strategy was developed and executed in the databases of Ovid MEDLINE, Embase and Cochrane Central Register of Controlled Trials, from inception until 15 August 2019. Articles were eligible for inclusion if there was mention of both (1) use of performance status tool Karnofsky Performance Status (KPS) or Eastern Cooperative Oncology Group Performance Status (ECOG), and (2) assessment of performance status by both clinicians and patients. Pearson correlation coefficients were calculated for each study and were meta-analysed according to a random-effect analysis model. Analyses were conducted using Comprehensive Meta-Analysis (V.3) by Biostat.

Results Sixteen articles were included in our review, reporting on a cumulative sample size of 6619 patients. The quality of evidence was moderate, as determined by the GRADE tool.

Concordance ranged from fair to moderate for both the KPS and ECOG tools. The Pearson correlation coefficient was 0.449 for KPS and 0.584 for ECOG.

Conclusions There is fair to moderate concordance of patient and clinician performance status ratings. Future studies should examine the reasoning behind clinician and patient ratings to better understand discrepancies between ratings.

  • prognosis
  • performance status
  • concordance
  • clinicians
  • patients

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  • Contributors RC was responsible for study conception and design. RC and JI were responsible for collection and assembly of data. RC was responsible for data analysis. All authors were responsible for data interpretation, manuscript writing and final approval of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.