Gaps In CRC Patient Performance Status Documentation Highlighted

Author: By Lynda Williams, Senior medwireNews Reporter 

medwireNews: A review of electronic health records has highlighted the need for careful recording of performance status (PS) in patients with a new diagnosis of colorectal cancer (CRC). 

“Assessing a patient’s functional status is critical for determining cancer prognosis, treatment, and clinical trial eligibility”, explain Lisa Iezzoni, from Massachusetts General Hospital in Boston, USA, and co-workers. 

But their natural language processing  analysis of records for 3180 patients aged 21–75 years entered into the Research Patient Data Registry for Massachusetts between 2010 and 2017 found just 50.9% had a mention of PS, such as an ECOG or Karnofsky PS score, within 3 months of diagnosis. 

The rates were similar 4–6, 7–9 and 10–12 months after diagnosis, at 56.5%, 47.5% and 44.4%, respectively. 

Manual analysis of 729 records that mentioned PS showed that the majority (92.9%) had numeric scores, while 6.0% recorded PS with a relevant description, such as “improved PS”. 

In addition, just 11.9% of the patients had separate documentation on their activities of daily living (ADL) within 3 months of diagnosis and this rate fell to 8.9% after 10–12 months. 

When the researchers reviewed 200 notes with the keyword ADL, they found almost half (46.0%) discussed ADL only as a binary function (eg, independent or not independent) and 44.5% mentioned ADL in other contexts (eg, ADL not discussed). Only 9.5% of notes detailed a patient’s performance on one or more specific ADL, such as toileting. 

Discussing their findings, Lisa Iezzoni et al say they were unable to determine whether PS was assessed and recorded at each clinical appointment or “cut and pasted” from a previous health record. 

Nor were the researchers able to assess what impact PS documentation had on clinical trial participation. 

“Future research should investigate approaches to improve documentation of functional status among patients with cancer”, they therefore recommend in JAMA Oncology. 

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2020 Springer Healthcare Ltd, part of the Springer Nature Group 

Reference 

Agaronnik N, Lindvall C, El-Jawahri A, He W, Iezzoni L. Use of natural language processing to assess frequency of functional status documentation for patients newly diagnosed with colorectal cancer. JAMA Oncol; Advance online publication 3 September 2020. doi:10.1001/jamaoncol.2020.2708