The relationship between Eastern Cooperative Oncology Group performance status and healthcare resource utilization among patients with advanced or metastatic colorectal, lung or gastric cancer

Figures & data

Table 1. Demographic and clinical characteristics of eligible study population (N = 1311).

Demographic characteristics	Colorectal cancer patients		Lung cancer patients		Gastric cancer patients
	n = 783		n = 485		n = 43
	N/mean/median	%/SD/min, max	N/mean/median	%/SD/min, max	N/mean/median	%/SD/min, max
Age (mean, SD)	65.4	13.1	69.3	10.2	66.1	12.9
Median, min, max	65	29, 95	70	38, 90	68	34, 89
Gender (N, %)
Male	430	54.9%	238	49.1%	27	62.8%
Female	353	45.1%	247	50.9%	16	37.2%
Race/Ethnicity (N, %)
White	564	72.0%	359	74.0%	27	62.8%
Black	41	5.2%	30	6.2%	4	9.3%
Hispanic	7	0.9%	2	0.4%	5	11.6%
Other	95	12.1%	52	10.7%	2	4.7%
Unknown/missing	76	9.7%	42	8.7%	5	11.6%
Geographic region (N, %)
Northeast	195	24.9%	119	24.5%	8	18.6%
North Central	136	17.4%	126	26.0%	8	18.6%
South	326	41.6%	187	38.6%	23	53.5%
West	126	16.1%	53	10.9%	4	9.3%
Unknown	0	0.0%	0	0.0%	0	0.0%
Primary payer (N, %)
Commercial	399	51.0%	174	35.9%	18	41.9%
Medicare	384	49.0%	311	64.1%	25	58.1%
Clinical characteristics	N/Mean/median	%/SD/min, max		N/mean/median	%/SD/min, max		N/mean/median	%/SD/min, max
Disease stage (N, %)
Stage 0	1	0.1%		1	0.2%		0	0.0%
Stage I	47	6.0%		62	12.8%		5	11.6%
Stage II	149	19.0%		51	10.5%		5	11.6%
Stage III	189	24.1%		76	15.7%		5	11.6%
Stage IV	85	10.9%		72	14.8%		8	18.6%
Unknown / missing	312	39.8%		223	46.0%		20	46.5%
Charlson Comorbidity Index (CCI)^a
Mean CCI (mean, SD)	3.16	2.76		4.09	3.13		3.14	2.69
CCI = 0 (N, %)	115	14.7%		39	8.0%		6	14.0%
CCI = 1 (N, %)	28	3.6%		20	4.1%		0	0.0%
CCI = 2 (N, %)	331	42.3%		133	27.4%		21	48.8%
CCI = 3 (N, %)	110	14.0%		95	19.6%		5	11.6%
CCI = 4 (N, %)	34	4.3%		56	11.5%		2	4.7%
CCI = 5 (N, %)	18	2.3%		19	3.9%		1	2.3%
CCI = 6 (N, %)	5	0.6%		12	2.5%		1	2.3%
CCI = 7 (N, %)	4	0.5%		6	1.2%		0	0.0%
CCI = 8 (N, %)	92	11.7%		33	6.8%		6	14.0%
CCI = 9 (N, %)	32	4.1%		34	7.0%		0	0.0%
CCI = 10+ (N, %)	14	1.8%		38	7.8%		1	2.3%
Length of follow-up (days)
Mean, SD	493.5	511.3		377.2	403.7		429.7	370.5
Median, Min, Max	365	1, 3395		240	1, 2300		312	4, 1765

Abbreviations. SD, standard deviation.

^aDuring the 6-month pre-index period.

Table 2. Performance status (PS) periods observed in the data.

	Colorectal cancer patients			Lung cancer patients			Gastric cancer patients
	n = 783			n = 485			n = 43
	N/mean	%/SD/min, max		N/mean	%/SD/min, max		N/mean	%/SD/min, max
Total number of performance status (PS) periods during the follow-up period	1342			831			91
Number of PS periods during follow-up (N, % of patients)
1	593	75.7%		326	67.2%		30	69.8%
2	68	8.7%		84	17.3%		4	9.3%
3	52	6.6%		33	6.8%		3	7.0%
4	26	3.3%		19	3.9%		1	2.3%
5	8	1.0%		8	1.6%		1	2.3%
6	15	1.9%		6	1.2%		1	2.3%
7	5	0.6%		2	0.4%		1	2.3%
8	3	0.4%		2	0.4%		1	2.3%
9	2	0.3%		0	0.0%
10	2	0.3%		1	0.2%
11+	9	1.1%		4	0.8%		1	2.3%
Baseline PS period value (N, %)
0	503	64.2%		215	44.3%		23	53.5%
1	226	28.9%		182	37.5%		15	34.9%
2	46	5.9%		73	15.1%		3	7.0%
3	6	0.8%		15	3.1%		2	4.7%
4	2	0.3%		0	0.0%		0	0.0%
PS score in last observed PS period (N, %)
0	486	62.1%		182	37.5%		21	48.8%
1	207	26.4%		182	37.5%		15	34.9%
2	58	7.4%		83	17.1%		4	9.3%
3	26	3.3%		36	7.4%		2	4.7%
4	6	0.8%		2	0.4%		1	2.3%
PS periods by ECOG score
Number of PS periods with PS = 0 (N,% of PS periods)	679	50.6%		286	34.4%		36	39.6%
Duration of period in days (mean, SD)	375.5	455.2		300.4	361.3		283.4	320.0
Median, Min, Max	209	1, 3395		169	1, 2029		171	1, 1242
Number of PS periods with PS = 1 (N,% of PS periods)	467	34.8%		321	38.6%		37	40.7%
Duration of period in days (mean, SD)	210.8	274.2		207.1	242.7		166.4	200.4
Median, Min, Max	119	1, 2079		114	1, 1652		90	1, 731
Number of PS periods with PS = 2 (N,% of PS periods)	151	11.3%		168	20.2%		14	15.4%
Duration of period in days (mean, SD)	175.8	271.7		156.4	242.3		90.5	141.8
Median, Min, Max	85	1, 1772		71	1, 1341		19	3, 486
Number of PS periods with PS = 3 (N,% of PS periods)	39	2.9%		54	6.5%		3	3.3%
Duration of period in days (mean, SD)	133.6	254.3		78.6	124.0		260.0	258.3
Median, Min, Max	27	1, 1066		31	1, 618		121	101, 558
Number of PS periods with PS = 4 (N,% of PS periods)	6	0.4%		2	0.2%		1	1.1%
Duration of period in days (mean, SD)	204.5	248.4		17.5	4.9		71.0	–
Median, Min, Max	97	1, 551		18	14, 21		71	71, 71

Figure 1. Health care resource utilization by performance status (PS) periods for patients with colorectal, lung or gastric cancer.

Table 3. Descriptive health care resource utilization results by cancer site and Eastern Cooperative Oncology Group (ECOG) across performance status (PS) score periods.

	Colorectal cancer				Lung cancer				Gastric cancer
	PS 0/1	PS 2	PS 3	PS 4	PS 0/1	PS 2	PS 3	PS 4	PS 0/1	PS 2	PS 3	PS 4
Number of patients	742	108	35	6	421	136	47	2	40	8	3	1
Number of PS periods	1146	151	39	6	607	136	54	2	73	8	3	1
Duration of time period, mean days (SD)	308.4 (399.8)	175.8 (271.7)	133.6 (254.3)	204 (248.4)	251.1 (307.7)	156.4 (242.3)	78.6 (124.0)	17.5 (4.9)	224.1 (270.8)	90.5 (141.8)	260.0 (258.3)	71.0 (–)
Periods with ≥ 1 hospitalization, N (%)	217 (18.9%)	36 (23.8%)	5 (12.8%)	4 (66.7%)	131 (21.6%)	56 (33.3%)	13 (24.1%)	0 (0.0%)	17 (23.3%)	5 (35.7%)	1 (33.3%)	0 (0.0%)
Periods with ≥ 1 emergency room (ER) visit, n (%)	233 (20.3%)	38 (25.2%)	8 (20.5%)	2 (33.3%)	170 (28.0%)	51 (30.4%)	14 (25.9%)	0 (0.0%)	15 (20.5%)	3 (21.4%)	0 (0.0%)	1 (100.0%)
ER visits per month^a, mean (SD)	0.3 (0.4)	0.4 (0.4)	0.6 (0.4)	0.1 (0.0)	0.3 (0.3)	0.6 (0.6)	0.8 (0.7)	0.0 (0.0)	0.5 (0.4)	0.1 (0.0)	0.0 (0.0)	0.8 (–)
Periods with systemic anti-cancer therapy administration, n (%)	402 (35.1%)	65 (43.%)	11 (28.2%)	1 (16.7%)	225 (37.1%)	74 (44.0%)	10 (18.5%)	0 (0.0%)	38 (52.1%)	9 (64.3%)	0 (0.0%)	0 (0.0%)
Percentage of period receiving systemic anti-cancer therapy, mean (SD)	55.6% (35.3%)	66.0% (33.2)	76.6% (19.8)	9.5% (–)	57.8% (30.9)	55.8% (32.9)	63.8% (31.5)	0.0% (0.0)	64.3% (35.1)	71.6% (32.2)	0.0% (0.0)	0.0% (0.0)
Periods with radiation therapy, n (%)	39 (3.4%)	6 (4.0%)	2 (5.1%)	0 (0.0%)	95 (15.7%)	33 (19.6%)	10 (18.5%)	1 (50.0%)	5 (6.8%)	3 (21.4%)	1 (33.3%)	0 (0.0%)
Periods with home health care, n (%)	59 (5.1%)	13 (8.6%)	2 (5.1%)	3 (50.0%)	12 (2.0%)	2 (1.2%)	1 (1.9%)	0 (0.0%)	2 (2.7%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
Periods with claims for durable medical equipment (DME), n (%)	456 (39.8%)	61 (40.4%)	16 (41.0%)	3 (50.0%)	213 (35.1%)	70 (41.7%)	22 (40.7%)	0 (0.0%)	23 (31.5%)	5 (35.7%)	1 (33.3%)	1 (100.0%)
Number of DME claims per month^a, mean (SD)	13.8 (46.7)	14.3 (35.1)	10.5 (14.0)	41 (63.3)	9.3 (11.7)	9.8 (15.7)	5.7 (6.6)	0.0 (0.0)	7.6 (10.1)	9.8 (5.2)	10 (–)	2 (–)
Periods with anti-emetic use, n (%)	458 (40.0%)	64 (42.4%)	15 (38.5%)	3 (50.0%)	275 (45.3%)	84 (50.0%)	16 (29.6%)	0 (0.0%)	32 (43.8%)	9 (64.3%)	2 (66.7%)	1 (100.0%)
Periods with hematopoietic agent use, n (%)	155 (13.5%)	44 (29.1%)	9 (23.1%)	1 (16.7%)	98 (16.1%)	32 (19.0%)	3 (5.6%)	0 (0.0%)	17 (23.3%)	4 (28.6%)	0 (0.0%)	0 (0.0%)
Periods with transfusions, n (%)	16 (1.4%)	4 (2.6%)	3 (7.7%)	0 (0.0%)	26 (4.3%)	13 (7.7%)	5 (9.3%)	0 (0.0%)	1 (1.4%)	1 (7.1%)	0 (0.0%)	0 (0.0%)

Abbreviations. SD, standard deviation.

^aAmong those utilizing the resource.

Table 4. Partial Spearman correlations of performance status (PS) period with health care resource utilization^a.

Covariate – combined population	Correlation coefficient
Inpatient days	0.0628
Percentage of PS period as an inpatient	0.0798
Monthly count of claims for emergency room visits	0.0431
Monthly count of claims for physician office visits	0.0846
Days receiving systemic anti-cancer therapy	0.0630
Proportion of PS period receiving systemic anti-cancer therapy	0.0991
Days of with radiation therapy	0.0615
Proportion of PS period receiving radiation therapy	0.0658
Days of inpatient surgical care	0.0114
Percentage of PS period as inpatient surgical care	0.0180
Days of non-surgical inpatient care	0.0635
Percentage of PS period as non-surgical inpatient care	0.0697

^aAdjusted for age, sex, payer, and Charlson Comorbidity Index score using all available PS periods.

Data availability statement

The data that support the findings of this study were obtained from Truven Health Analytics (now part of IBM Watson Health). Restrictions apply to the availability of these data, which were used under license for this study.