Longitudinal neurological assessments in brain tumor patients: correlation between nano domains and performance status

Abstract The Karnofsky Performance Status (KPS) and Eastern Cooperative Oncology Group (ECOG) performance status are clinician-reported outcomes critical in guiding management and prognostication in patients with primary brain tumors as they can reflect longitudinal functional changes. However, they are subjective. The Neurologic Assessment in Neuro-Oncology (NANO) scale is a metric with specific neurological domains that was subsequently developed to provide an objective standardized measure of the neurologic functional status of patients, but how longitudinal changes in NANO scale relate to KPS or ECOG scores is unknown. METHODS: A linear mixed model analysis involving 111 patients with primary brain tumors was performed. RESULTS: Statistically significant associations were identified between changes in specific NANO domains and KPS or ECOG scores. After controlling for time course both in univariable and multivariable analyses, worsening scores in gait, language and behavior domains showed significant association with decreased KPS. Gait and behavior were demonstrated to be significantly associated with ECOG both in univariable and multivariable analyses. CONCLUSIONS: The neurologic status of patients with a primary brain tumor is closely related to their performance status. In particular, the patient’s cognitive status and mobility have the greatest impact on their functional status and therefore their prognosis. Interventions and supportive care targeting these domains of function may help improve the outcomes of patients with brain tumors.