In Reply We thank Skelin and colleagues for their comments regarding our study¹ evaluating the association of early palliative care with survival among patients with advanced lung cancer. Performance status is an important parameter in cancer treatment decision-making, and the Eastern Cooperative Oncology Group scale is one set of criteria used to encourage standardized reporting of treatment toxic effects and response, especially in the conduct of randomized clinical trials. Unfortunately, interrater reliability is inconsistent,² inherent clinician bias may contribute to inconsistencies,³ and missing values are common in administrative data. Instead, we included the Charlson Comorbidity Index score, which measures comorbidities, and the Functional Comorbidity Index score, which measures physical function to predict survival in modeling, as surrogates of performance status because both are well validated in administrative data. Ultimately, treatment decision-making in oncology is complex, multifactorial, and influenced by clinician-related and patient-related factors; therefore, no single measure of patient suitability for treatment is likely to be sufficient.

在答复中，我们感谢Skelin及其同事对我们的研究¹的评论，该研究评估了晚期姑息治疗与晚期肺癌患者生存率之间的关系。表现状态是癌症治疗决策中的重要参数，并且东部合作肿瘤小组量表是用于鼓励标准化报告治疗毒性作用和反应的一组标准，尤其是在进行随机临床试验时。不幸的是，人际间的可靠性不一致，²内在的临床医生偏见可能导致不一致，³而缺失值在管理数据中很常见。取而代之的是，我们将测量合并症的查尔森合并症指数评分和测量物理功能以预测建模存活率的功能性合并症指数评分作为绩效状态的替代指标，因为两者在行政管理数据中均得到了很好的验证。最终，肿瘤学中的治疗决策是复杂，多因素的，并受临床医生和患者相关因素的影响。因此，对患者是否适合进行治疗的任何单一测量都可能不够。