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In medicine (oncology and other fields), performance status is an attempt to quantify cancer patients' general well-being. 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.

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.

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.

Karnofsky scoring

The Karnofsky score runs from 100 to 0, where 100 is "perfect" health and 0 is death. Although the score has been described with intervals of 10, a practitioner may choose decimals if he or she feels a patient's situation holds somewhere between two marks. It is named after Dr David A. Karnofsky, who described the scale with Dr Joseph H. Burchenal in 1949.^[1]

• 100% - normal, no complaints, no signs of disease
• 90% - capable of normal activity, few symptoms or signs of disease
• 80% - normal activity with some difficulty, some symptoms or signs
• 70% - caring for self, not capable of normal activity or work
• 60% - requiring some help, can take care of most personal requirements
• 50% - requires help often, requires frequent medical care
• 40% - disabled, requires special care and help
• 30% - severely disabled, hospital admission indicated but no risk of death
• 20% - very ill, urgently requiring admission, requires supportive measures or treatment
• 10% - moribund, rapidly progressive fatal disease processes
• 0% - death.

ECOG/WHO/Zubrod score

The 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:^[2]

• 0 - Asymptomatic (Fully active, able to carry on all predisease activities without restriction)
• 1 - Symptomatic but completely ambulatory (Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature. For example, light housework, office work)
• 2 - Symptomatic, <50% in bed during the day (Ambulatory and capable of all self care but unable to carry out any work activities. Up and about more than 50% of waking hours)
• 3 - 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)
• 5 - Death

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:^[3]

• 100 - fully active, normal
• 90 - minor restrictions in strenuous physical activity
• 80 - active, but tired more quickly
• 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
• 50 - lying around much of the day, but gets dressed; no active playing participates in all quiet play and activities
• 40 - mainly in bed; participates in quiet activities
• 30 - bedbound; needing assistance even for quiet play
• 20 - sleeping often; play entirely limited to very passive activities
• 10 - doesn't play; does not get out of bed
• 0 - unresponsive

Comparison

A comparison between the Zubrod and Karnofsky scales has been validated in a large sample of patients:^[4]

• Zubrod 0 equals Karnofsky 100; 90-100
• Zubrod 1 equals Karnofsky 80-90; 70-80
• Zubrod 2 equals Karnofsky 60-70; 50-60
• Zubrod 3 equals Karnofsky 40-50; 30-40
• Zubrod 4 equals Karnofsky 20-30;10-20

References

1. ^ Karnofsky DA, Burchenal JH. (1949). "The Clinical Evaluation of Chemotherapeutic Agents in Cancer." In: MacLeod CM (Ed), Evaluation of Chemotherapeutic Agents. Columbia Univ Press. Page 196.
2. ^ Oken MM, Creech RH, Tormey DC, et al. (1982). "Toxicity and response criteria of the Eastern Cooperative Oncology Group". Am. J. Clin. Oncol. 5 (6): 649–55. doi:10.1097/00000421-198212000-00014. PMID 7165009.  
3. ^ Lansky SB, List MA, Lansky LL, Ritter-Sterr C, Miller DR (1987). "The measurement of performance in childhood cancer patients". Cancer 60 (7): 1651–6. doi:10.1002/1097-0142(19871001)60:7<1651::AID-CNCR2820600738>3.0.CO;2-J. PMID 3621134.  
4. ^ Buccheri G, Ferrigno D, Tamburini M. Karnofsky and ECOG performance status scoring in lung cancer: a prospective, longitudinal study of 536 patients from a single institution. Eur J Cancer. 1996 Jun;32A(7):1135-41.

External links

• Performance status calculator (Food and Drug Administration (FDA))
• A table with the Karnofsky Performance Status.