Patient Performance Status

A performance status is a rating doctors use to design cancer treatments or discuss cancer outcomes. These statuses are a way to measure your ability to function in daily life. The functions they look at include being able to care for yourself, being able to be physically active, and whether you need any assistance or medical care.^1,2

What are performance statuses?

Doctors use performance statuses to create an overall picture of someone's health and functioning. The measures often used include the Karnofsky Performance Status and the Eastern Cooperative Oncology Group (ECOG) Performance Status.^1,2

Performance statuses are also important because they impact clinical trials. Many clinical trials decide on who can participate based on the person’s performance status.^1-3

Karnofsky Performance Status

The Karnofsky Performance Status is the oldest cancer performance scale. It was first designed for people receiving chemotherapy for lung cancer. The status assigns each patient a number from 0 to 100.^1,2

A score of 100 means fully active with no signs of cancer. A score of 0 means dead. The numbers in between correspond with different ability levels. The scores include:^1,2

• 90 – Minor disease signs or symptoms
• 80 – Activity is normal, but more signs of disease
• 70 – Can take care of themselves but struggles with some activities and/or active work
• 60 – May need some help but mostly independent
• 50 – Requires significant help and care
• 40 – Disabled and requires care and assistance
• 30 – Severely disabled and likely hospitalized
• 20 – Very sick and needs to be in the hospital
• 10 – Near death

ECOG Performance Status

The ECOG was invented to simplify the Karnofsky Performance Status. ECOG gives the scores 0 through 5:^1-3

• 0 – Fully active and living with no restrictions.
• 1 – Some physical problems but able to complete most tasks.
• 2 – Can still complete all self-care but struggles with work. Still moving during more than half of the day.
• 3 – Unable to complete most self-care. Problems leaving bed or chair. Unable to move for more than half of the day.
• 4 – Fully disabled and confined to a bed or chair.
• 5 – Dead.

How does performance status relate to outcomes or treatment?

Performance status scores may be used to help determine likely outcome (prognosis) or treatment options for lung cancer. One study on people with lung cancer focused on ECOG scores. It found that people with a score of 0 were twice as likely to live another year as people with a score of 2. The higher a person's ECOG score, the better the chances that their score will predict their prognosis.^1-3

Doctors may use prognosis status when deciding on treatment. For example, people with better scores may be able to handle more aggressive treatment. Doctors may also use prognosis status to measure how well a treatment worked.^3-5

What are the limitations of performance statuses?

Some doctors and researchers believe there are limitations with the Karnofsky and ECOG scales. For example, a person’s score can be inaccurate or impacted by doctor bias. Studies show that different doctors may give different scores for the same patient. Other doctors prefer different – less common – ways to measure performance status. These different ways may include:^3-5

• Short Physical Performance Battery – This score uses simple physical tests to measure physical health. It has been studied for being able to predict cancer outcomes.
• Measures of exercise – Examples include the 6-minute walk test, Timed Up and Go Test, and exercise behavior survey. These measures have been shown to predict function and prognosis for people with cancer.
• Scales that are specifically for older people – Examples include the Comprehensive Geriatric Assessment, Cancer and Aging Research Group score, and chemotherapy risk assessment scale for high age patients.

More research is needed to see if scales other than Karnofsky and ECOG can be helpful for everyone with cancer.^3-5