To increase the awareness of consistent ECOG Performance Status (ECOG PS) evaluation, Eli Lilly & Company in UK has together with Dr Tim Benepal (Consultant Medical Oncologist, St. George’s Hospital, London), Naomi Horne Macmillan (Lead Lung Cancer Nurse, Llangdough Hospital, Cardiff) and Dr Robert Rintoul (Consultant Chest Physician in Thoracic Oncology, Papworth Hospital, Cambridge) developed an interactive ECOG PS tool called The Interactive Performance Status Program.
The Performance Status Program is designed to increase the focus, dialogue and ultimately the consistency around ECOG PS assessments. The tool focus on lung cancer patients, however it might be useful for all who work with cancer, independent of tumor specificity. It can be used both as an interactive self-learning program as well as in team meetings, the latter usually executed with administrative help from Lilly. The program has been available in Denmark since the beginning of 2015, and a short summary based on experiences and feedback from Danish oncology departments is given below.
Self-learning: Most appropriate as a part of the induction program for new colleagues, junior physicians or nurses etc. with limited or no previous experience working with ECOG PS. Using this approach the participant is initially introduced to ECOG PS criteria’s, followed by the opportunity to assess ECOG PS in 4 real-life patient video cases. After each case there is a filmed panel -discussion by three experienced specialists (chest physician, oncologist and nurse). The panel discusses the individual patient case and their rational for what ECOG PS they see to be the most appropriate for the respective patient.
Team Meeting: Most appropriate as a topic on staff meetings or for multi-disciplinary team meetings. The typical agenda is an initial brief background ECOG PS, it’s use and results from studies looking at consistency in ECOG PS evaluation. Up to four patient case films are shown, and the participants are providing their initial ECOG PS score anonymously voting pads after each film. The voting results are discussed in plenum, allowing a dialogue and discussion around the rationales for deviating ECOG PS scores.
General feedback on ECOG Performance Status meetings in Denmark: The meetings have created a very engaging environment for discussions on all aspects concerning ECOG PS rating. Voting pads expose very well how different the individual persons assess the same patient, and these discrepancies have subsequently catalyzed a strong interdisciplinary dialogue, both on the patient case(s) specifically, but also on more general terms; how should the individual items in ECOG PS-scale be interpreted and what can be done to ensure a more uniform application.
The Performance Status Program will be available for Norwegian health care providers with interest in cancer treatment in early 2016 (www. performancestatustool.com). The first meeting for multi-disciplinary specialties will be held in Kristiansand on 26th January 2016. For more information on The Performance Status Program, feel free to contact Eli Lilly.