ⓘ Performance status. In medicine, performance status is an attempt to quantify cancer patients general well-being and activities of daily life. This measure is u ..


ⓘ Performance status

In medicine, performance status is an attempt to quantify cancer patients general well-being and activities of daily life. This measure is used to determine whether they can receive chemotherapy, whether dose adjustment is necessary, and as a measure for the required intensity of palliative care. It is also used in oncological randomized controlled trials as a measure of quality of life.


1. Scoring systems

There are various scoring systems. The most generally used are the Karnofsky score and the Zubrod score, the latter being used in publications by the WHO. For children, the Lansky score is used. Another common system is the Eastern Cooperative Oncology Group ECOG system. Parallel scoring systems include the Global Assessment of Functioning GAF score, which has been incorporated as the fifth axis of the Diagnostic and Statistical Manual DSM of psychiatry.


1.1. Scoring systems Karnofsky scoring

The Karnofsky Performance Score KPS ranking runs from 100 to 0, where 100 is "perfect" health and 0 is death. Practitioners occasionally assign performance scores in between standard intervals of 10. This scoring system is named after Dr. David A. Karnofsky, who described the scale with Dr. Walter H. Abelmann, Dr. Lloyd F. Craver, and Dr. Joseph H. Burchenal in 1948. The primary purpose of its development was to allow physicians to evaluate a patients ability to survive chemotherapy for cancer.

  • 60 – Requires occasional assistance, but is able to care for most of their personal needs.
  • 80 – Normal activity with effort; some signs or symptoms of disease.
  • 100 – Normal; no complaints; no evidence of disease.
  • 40 – Disabled; requires special care and assistance.
  • 70 – Cares for self; unable to carry on normal activity or to do active work.
  • 0 – Dead
  • 10 – Moribund; fatal processes progressing rapidly.
  • 50 – Requires considerable assistance and frequent medical care.
  • 20 – Very sick; hospital admission necessary; active supportive treatment necessary.
  • 90 – Able to carry on normal activity; minor signs or symptoms of disease.
  • 30 – Severely disabled; hospital admission is indicated although death not imminent.

1.2. Scoring systems ECOG/WHO/Zubrod score

The Eastern Cooperative Oncology Group ECOG score published by Oken et al. in 1982, also called the WHO or Zubrod score after C. Gordon Zubrod, runs from 0 to 5, with 0 denoting perfect health and 5 death: Its advantage over the Karnofsky scale lies in its simplicity.

  • 2 – Symptomatic, 50% in bed, but not bedbound Capable of only limited self-care, confined to bed or chair 50% or more of waking hours
  • 4 – Bedbound Completely disabled. Cannot carry on any self-care. Totally confined to bed or chair
  • 1 – Symptomatic but completely ambulatory
  • 5 – Death
  • 0 – Asymptomatic Fully active, able to carry on all predisease activities without restriction

1.3. Scoring systems Lansky score

Children, who might have more trouble expressing their experienced quality of life, require a somewhat more observational scoring system suggested and validated by Lansky et al. in 1987:

  • 100 – fully active, normal
  • 20 – sleeping often; play entirely limited to very passive activities
  • 40 – mainly in bed; participates in quiet activities
  • 30 – bedbound; needing assistance even for quiet play
  • 0 – unresponsive
  • 50 – lying around much of the day, but gets dressed; no active playing participates in all quiet play and activities
  • 10 – doesnt play; does not get out of bed
  • 90 – minor restrictions in strenuous physical activity
  • 70 – greater restriction of play and less time spent in play activity
  • 60 – up and around, but active play minimal; keeps busy by being involved in quieter activities
  • 80 – active, but gets tired more quickly


2. Comparison

A translation between the Zubrod and Karnofsky scales that works especially well for healthy patients has been validated in a large sample of lung cancer patients:

  • Zubrod 2 equals Karnofsky 60–70
  • Zubrod 0–1 equals Karnofsky 80–100
  • Zubrod 3–4 equals Karnofsky 10–50
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