Editing Performance status

{{Short description|Indicator of general well-being for cancer patients}}
{{Infobox diagnostic
| name            = Performance status
| image           = 
| alt             = 
| caption         = quantify cancer patients' general well-being
| pronounce       =  
| synonyms        = 
| reference_range =
| calculator      = 
| DiseasesDB      = <!--{{DiseasesDB2|numeric_id}}-->
| ICD10           = <!--{{ICD10|Group|Major|minor|LinkGroup|LinkMajor}} or {{ICD10PCS|code|char1/char2/char3/char4}}-->
| ICD9            = 
| ICDO            =
| MedlinePlus     = <!--article_number-->
| eMedicine       = <!--article_number-->
| MeshID          = 
| OPS301          = <!--{{OPS301|code}}-->
| LOINC           = <!--{{LOINC|code}}-->
}}
In [[medicine]] ([[oncology]] and other fields), '''performance status''' is an attempt to quantify [[cancer patient]]s' 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 [[oncology|oncological]] [[randomized controlled trial]]s as a measure of [[quality of life]].

==Scoring systems==
{{unreferenced section|date=December 2015}}
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 [[World Health Organization|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 of Mental Disorders|Diagnostic and Statistical Manual]]'' (DSM) of [[psychiatry]].

===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.<ref>Karnofsky DA, Abelmann WH, Craver LF, Burchenal JH. The Use of the Nitrogen Mustards in the Palliative Treatment of Carcinoma – with Particular Reference to Bronchogenic Carcinoma. Cancer. 1948;1(4):634-56.</ref> The primary purpose of its development was to allow physicians to evaluate a patient's ability to survive chemotherapy for cancer.

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

===ECOG/WHO/Zubrod score===
The [[Eastern Cooperative Oncology Group]] (ECOG) score (published by Oken ''et al.'' in 1982), also called the [[World Health Organization|WHO]] or Zubrod score (after [[C. Gordon Zubrod]]), runs from 0 to 5, with 0 denoting perfect health and 5 death:<ref>{{cite journal  |vauthors=Oken MM, Creech RH, Tormey DC, etal |title=Toxicity and response criteria of the Eastern Cooperative Oncology Group |journal=Am. J. Clin. Oncol. |volume=5 |issue=6 |pages=649–55 |year=1982 |pmid=7165009|doi=10.1097/00000421-198212000-00014|s2cid=2261448 }}</ref>  Its advantage over the Karnofsky scale lies in its simplicity.
* 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:<ref>{{cite journal |vauthors=Lansky SB, List MA, Lansky LL, Ritter-Sterr C, Miller DR |title=The measurement of performance in childhood cancer patients |journal=Cancer |volume=60 |issue=7 |pages=1651–6 |year=1987 |pmid=3621134|doi=10.1002/1097-0142(19871001)60:7<1651::AID-CNCR2820600738>3.0.CO;2-J|doi-access=free }}</ref>
* 100 – fully active, normal
* 90 – minor restrictions in strenuous physical activity
* 80 – active, but gets 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 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:<ref>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.</ref>

*Zubrod 0 equals Karnofsky 90–100
*Zubrod 1 equals Karnofsky 70–80
*Zubrod 2 equals Karnofsky 50–60
*Zubrod 3 equals Karnofsky 30–40
*Zubrod 4 equals Karnofsky 10–20
*Zubrod 5 equals Karnofsky 0

==References==

{{Reflist}}

==External links==
* {{usurped|1=[https://web.archive.org/web/20081202143931/http://www.hospicepatients.org/karnofsky.html A table]}} with the Karnofsky Performance Status.

[[Category:Medical scoring system]]
[[Category:Oncology]]
[[Category:Quality of life]]