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Performance Status Questionnaire

Hello,

Please fill out the details on this form

Date (שדה חובה)

Patient’s details:

Name and Surname (שדה חובה)

ID No. (שדה חובה)

Type of cancer (שדה חובה)

Name and Surname (שדה חובה)

Relation to patient (שדה חובה)

E-mail (שדה חובה)

Mark the sentence that best describes the patient's current performance abilities as it is TODAY[1]:

Mark:: Grade 0 - Fully active, able to carry on all pre-disease performance without restriction (שדה חובה)

Mark:: Grade 1 - Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light housework, office work (שדה חובה)

Mark:: Grade 2 - Ambulatory and capable of all self-care but unable to carry out any work activities. Up and about more than 50% of waking hours (שדה חובה)

Mark:: Grade 3 - Capable of only limited selfcare, confined to bed or chair more than 50% of waking hours (שדה חובה)

Mark:: Grade 4 - Completely disabled. Cannot carry on any self-care. Totally confined to bed or chair (שדה חובה)

[1] Adapted from: WHO Performance status

What is the importance of a performance status assessment questionnaire in cancer patients[2]?

Assessing the patient's performance status helps in analyzing the medical condition and determining the best treatments for the patient.

This assessment is sometimes used by physicians and clinicians when choosing a drug or medical treatment, for participating in clinical trials, or for any other treatment.

Why is it important to perform a performance status assessment in cancer patients?

There are many factors that can be used to assess the patient's chances of coping well with the disease or the treatment, for example age, stage of the disease, existing underlying diseases, and more.

The performance status assessment provides a better answer regarding the patient's ability to successfully cope with the disease and with the proposed treatments.

What is the difference between high performance and poor performance in the choice of treatment?

Over the years, many clinical trials and treatment recommendations for advanced and innovative drugs are often offered to patients with high performance. Such patients have the ability to cope physically with the proposed treatment in a better way, both in the effectiveness of the treatment and in coping with the side effects.

In general, patients with poor assessment and limited performance capacity tend to have more difficulty complying with a regimen of rigorous cancer treatments. Therefore, these patients have poorer outcomes than patients with better performance.

In addition, almost all anticancer treatments have the potential for side effects and the risks of certain treatments in patients with poor function may far outweigh the benefits.

In which cases is it possible to join the service of Trial-IN Pharma?

In high-medium performance stages.

When the patient is fully disabled, i.e., unable to take care of self, and is completely bedridden or confined to a chair all day (performance assessment 4 in the table above), the chance that we will be able to bring value to him is very low, so we prefer that you wait until there is an improvement in his condition and that you focus on the quality of life and providing supportive care.

I have read and understood the topic of the performance status questionnaire (שדה חובה)

Notes:

[2] JAMA Oncol. 2015;1(7):998. doi:10.1001/jamaoncol.2015.3113