Don’t ask, don’t tell: Missing ECOGS and anticancer treatment, neutrophil-to-lymphocyte ratios, and outcomes in hospitalized patients with solid tumors.

Abstract

e24071 Background: ASCO’s Choosing Wisely campaign has recommended avoiding cancer-directed therapy for patients with ECOG performance status (PS) 3–4. Hospitalized patients with solid tumor patients frequently have poor PS, yet ECOG documentation is often missing, potentially contributing to non-beneficial treatment. Caregiver-reported ECOG may offer a pragmatic alternative source of functional status information. Methods: We are enrolling hospitalized patients with solid tumors and their personal caregivers from a NYPresbyterian-affiliated (Weill, Queens, Brooklyn Methodist) Hospital (preliminary analyses on the first 21). Caregivers (e.g., spouses/partners) completed ECOG PS and sarcopenia assessments at baseline. Medical charts were reviewed for ECOG documentation, anticancer treatments, and neutrophil-to-lymphocyte ratio (NLR) values closest to baseline and 3-month follow-up. Caregiver expectations were assessed at baseline and patient survival and quality-of-life at 3 months. Results: ECOG PS was undocumented in 88% of charts within 48 hours of baseline. Caregivers rated 70% of patients as ECOG > 2. Over 80% had NLR > 4 (indicating significant inflammation). Patient sarcopenia assessments were completed by 88% of caregivers (vs. 22% of patients). Caregiver-rated patient functional impairment was substantial: 56% could not lift 10 lbs., 61% could not walk, and 41% could not transfer independently. Despite poor PS and high NLR, more than half were receiving anticancer therapy; most were offered at least one modality (chemotherapy 75%, immunotherapy 25%, targeted therapy 17%, radiation 32%, surgery 17%). Caregivers strongly endorsed treatment, with 65% wanting inpatient chemotherapy and most believing it would improve quality of life (71%) and 3-month survival (69%). At follow-up, 58% of patients had died; among survivors, 66% continued to have NLR > 4. Conclusions: Hospitalized patients with solid tumors in this cohort were acutely ill, yet ECOG PS was rarely documented. Caregivers provided feasible and clinically plausible assessments of ECOG and sarcopenia. Despite caregiver-identified poor PS and high NLR, most patients were offered and received anticancer therapy; the majority died within 3 months. Caregiver-reported ECOG may represent a scalable, underutilized clinical signal to guide more treatment decisions for hospitalized patients with solid tumor cancers.