Performance status

Table 5. Performance Status of Continuous MCFC Technologies. ...

There are no well-defined clinical characteristics or established tests to identify patients likely to benefit from chemotherapy. Factors associated with an increased probability of response that have been identified include a good performance status, a limited number (one to two) of disease sites, and patients who respond to chemotherapy or hormonal therapy with a long disease-free interval. Patients who have progressive disease during chemotherapy have a lower probability of response to a different type of chemotherapy. However, this is not necessarily true for patients who are given chemotherapy after some interval during which they have received no chemotherapy. Patients who do not respond to endocrine therapy are as likely to respond to chemotherapy as patients who are treated with chemotherapy as their initial treatment modality. Age, menopausal status, and receptor status have not been associated with favorable or unfavorable response to chemotherapy. 

The performance status of the patient represents an important aspect of chemotherapy treatment decisions. Patients with a performance status of 0 to 1 maybe treated with chemotherapy. Patients with a performance status of 2 maybe treated with less aggressive regimens that have a decreased risk of major toxici-ties, whereas performance status 3 and 4 patients should be treated with supportive care only. 

The treatment of recurrent disease depends on the time to recurrence. If the time to recurrence is less than 6 months, second-line therapy should be considered if the patient has an acceptable performance status (see Patient Care and Monitoring ). The most widely accepted second-line therapies in SCLC are topotecan alone or CAV [cyclophosphamide, doxorubicin (Adriamycin), vincristine]. Relapses occurring more than 6 months after treatment warrant a repeat of the initial regimen. Poor performance status patients (3—4) typically are treated with palliative care therapies. 

Verify the histology and clinical stage of disease. Evaluate the patient s performance status. Is the patient a surgical candidate How does this influence treatment recommendations ... 

Recent advances in the treatment of cancer of the colon and rectum now offer the potential to improve patient survival, but for many patients, improved disease- and progression-free survival represent equally important therapeutic outcomes. In the absence of the ability of a specific treatment to demonstrate improved survival, important outcome measures should include the effects of the treatment on patient symptoms, daily activities, performance status, and other quality-of-life indicators. Individualized patient care to balance the risks associated with treatment with the benefits of a specific treatment regimen is necessary to optimize patient outcomes. 

Age greater than 60 years Stage lll/IV disease Extranodal disease greater than 1 site ECOG performance status 2 or greater Serum LDH greater than 1 x normal limit... 

Generally, younger patients with a better performance status tolerate chemotherapy better than elderly patients. Caucasian women tend to have a worse prognosis and response to therapy compared with other ethnic backgrounds.2,4,5... 

The type of HCT performed depends on a number of factors, including type and status of disease, availability of a compatible donor, patient age, performance status, and organ function. In addition to bone marrow, hematopoietic cells may be obtained from the peripheral blood progenitor cells (PBPCs) and umbilical cord blood. The essential properties of the hematopoietic cells are their ability to engraft, the speed of engraftment, and the durability of engraftment.1... 

Poor performance status Planned full dose intensity of chemotherapy... 

Performance status A clinical staging of the patient s ability to perform activities of daily life. Oncologists use it in evaluation of a patient s ability to tolerate a contemplated chemotherapy regimen. 

Selection of an adjuvant regimen (Table 62-1) is based on patient specific factors including performance status, comorbid conditions, and patient preference based on lifestyle factors. 

Most patients with good performance status will receive oxaliplatin in combination with 5-FU and leucovorin. 

Docetaxel, pemetrexed, and an oral epidermal growth factor receptor inhibitor, erlotinib, are options for unresectable stage III or IV NSCLC patients with good performance status who progress during or after first-line therapy. 

Prognosis depends on histologic subtype and clinical risk factors (e.g., age more than 60 years, performance status of 2 or more, elevated lactic dehydrogenase, extranodal involvement, and stage III or IV disease). These risk factors are used to calculate the International Prognostic Index. 

A newer prognostic index uses similar risk factors except that poor performance status is replaced with low hemoglobin (less than 12 g/dL). Current research is focused on the prognostic importance of phenotypic and molecular characteristics of NHL. 

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