Research Article|Articles in Press, 100482

Impact of Performance Status on Survival Outcomes and Health Care Utilization in Patients with Advanced Non-Small Cell Lung Cancer Treated with Immune Checkpoint Inhibitors

Open AccessPublished:February 23, 2023DOI:
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      Landmark trials testing immune checkpoint inhibitors (ICIs) in advanced non-small cell lung cancer (NSCLC) are difficult to extrapolate to real-world practice given the exclusion of patients with poor (i.e. ≥2) Eastern Cooperative Oncology Group performance status (ECOG PS). We sought to evaluate the impact of ECOG PS on clinical outcomes and health care utilization in NSCLC patients treated with ICI in real-world practice.


      Patients with advanced NSCLC who received at least one dose of Pembrolizumab or Nivolumab were retrospectively identified from the Alberta Immunotherapy Database. The primary outcome was median overall survival (mOS), as stratified by ECOG PS. Secondary outcomes included median time-to-treatment failure (mTTF) and metrics of health care utilization, including emergency department (ED) visits, hospitalizations and death in hospital.


      790 patients were included, with 29.2% having poor ECOG PS at initiation of ICI. These patients had significantly lower mOS (3.3 vs. 13.4 months) and mTTF (1.4 vs. 4.9 months) compared to those with favorable ECOG PS (p<0.0001 for both outcomes). Patients with poor ECOG PS were also more likely to present to the ED, be admitted to the hospital, and die in hospital during their first admission (RR 1.6, 2.3, 2.7 – p < 0.001).


      NSCLC patients with poor ECOG PS treated with ICI had significantly worse survival outcomes and were significantly more likely to utilize health care services than those with favorable ECOG PS. The large proportion of patients with poor ECOG PS further justifies the urgent need for randomized trials evaluating the efficacy of ICI in this high-risk population.


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