Utilising the General Practitioner in assessing fitness for chemotherapy: a pilot study. 


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Sophie Otter1, Duncan Gilbert1
1Royal Sussex County Hospital, Brighton, United Kingdom

Background

The recent NCEPOD report [1] highlighted the importance of patient-related factors, specifically performance status, when considering systemic treatment for cancer patients. Oncologists must often make a decision regarding a patient’s fitness for chemotherapy based on a single consultation, which may not be representative of their general condition. General Practitioners (GPs) may be better placed to accurately assess their functional status, particularly in patients who are of borderline fitness and are less likely to tolerate chemotherapy well.

Method

100 consecutive patients commencing a new course of chemotherapy were identified prior to administration of the first cycle. A letter was sent to the GP of each patient that included a copy of the WHO performance status criteria. GPs were asked to identify the performance status category that applied to their patient. This was compared to the performance status as recorded by the Oncologist on the electronic chemotherapy prescription and/or clinic letter.

Results

In 77 patients the GPs responded prior to the administration of chemotherapy. For 35  (45%) cases, there was concordance between GP and Oncologist scores. For 18 patients (23%) the GP scored their patients at a poorer performance status than that of the Oncologist. In 11 (14%) the GPs scored their patients higher than Oncologists. In 13 (17%) a comparison was not possible either because the GP felt unable to comment or because the Oncologist had not recorded the performance status.

Conclusion

GPs are willing to provide information about performance status that can be collected in a timely manner and contribute to assessment of fitness for chemotherapy. This identifies a minority of patients in whom Oncologists may overestimate functional status with potentially deleterious outcomes as highlighted by the NCEPOD report. Additionally this leads to greater communication with GPs around patients on chemotherapy with potentially broader clinical benefit.