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The Karnofsky Performance Scale Index allows patients to be classified as to their functional impairment.

This can be used to compare effectiveness of different therapies and to assess the prognosis in individual patients. The lower the Karnofsky score, the worse the survival for most serious illnesses.


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

20 10 0

References: Crooks, V, Waller S, et al. The use of the Karnofsky Performance Scale in determining outcomes and risk in geriatric outpatients. J Gerontol. 1991; 46: M139-M144. de Haan R, Aaronson A, et al. Measuring quality of life in stroke. Stroke. 1993; 24:320- 327. Hollen PJ, Gralla RJ, et al. Measurement of quality of life in patients with lung cancer in multicenter trials of new therapies. Cancer. 1994; 73: 2087-2098. O'Toole DM, Golden AM. Evaluating cancer patients for rehabilitation potential. West J Med. 1991; 155:384-387. Oxford Textbook of Palliative Medicine, Oxford University Press. 1993;109.

Schag CC, Heinrich RL, Ganz PA. Karnofsky performance status revisited: Reliability, validity, and guidelines. J Clin Oncology. 1984; 2:187-193.

Performance status
What is the WHO performance scale and how does this help doctors decide who can go on a clinical trial or not? Doctors use the WHO performance scale to describe how well you are. They also call it your performance status. There are different ways of assessing general health. The World Health Organisation designed the scale that doctors use most often. It has categories from 0 to 4. Here is what they mean
0 you are fully active and more or less as you were before your illness 1 you cannot carry out heavy physical work, but can do anything else 2 you are up and about more than half the day and can look after yourself, but are not well

enough to work 3 you are in bed or sitting in a chair for more than half the day and you need some help in looking after yourself
4 you are in bed or a chair all the time and need a lot of looking after

Another commonly used scale is the Karnofsky performance status. It is similar to the WHO scale, but goes to up 100.
100 you dont have any evidence of disease and feel well 90 you only have minor signs or symptoms but are able to carry on as normal 80 you have some signs or symptoms and it takes a bit of effort to carry on as normal 70 you are able to care for yourself but not able to carry on with all your normal activities or

do active work
60 you need help from time to time but can mostly care for yourself 50 you need quite a lot of help to care for yourself 40 you always need help to care for yourself 30 you are disabled and may need to stay in hospital 20 you are ill, in hospital and need a lot of treatment 10 you are very ill and unlikely to recover

Clinical trials often include performance status as one of the criteria you must meet to join the trial. Researchers have to make sure that people are well enough to take part in a trial. You must be able

to withstand the treatment they are testing. And, it sounds harsh, but for some trials they have to make sure that the people taking part live long enough for the trial to get results. There is no point testing a treatment to see if it improves 5 year survival if the people being tested don't live for at least 5 years. Researchers use a set scale because it makes sure that all the patients who join are assessed in the same way.

FAST FACTS AND CONCEPTS #125 Author(s): L Scott Wilner MD and Robert Arnold MD Background A ccurate prognostic information is important for patients, families and physicians. This Fast Fact reviews the Palliative Performance Scale; see Fast Fact #124 The Palliative Prognostic Score for another prognostic tool used in palliative care patients. The Palliative Performance Scale (PPS) uses five observer-rated domains correlated to the Karnofsky Performance Scale (100-0). The PPS is a reliable and valid tool and correlates well with actual survival and median survival time for cancer patients. It has been found useful for purposes of identifying and tracking potential care needs of palliative care patients, particularly as these needs change with disease progression. Large validation studies are still needed, as is analysis of how the PPS does, or does not, correlate with other available prognostic tools and commonly used symptom scales.


Activity Level % Ambulation Evidence of Disease Self-Care Intake Level of Consciousness

Estimated Median Survival in Days (a) (b) (c)

Normal 100 Full No Disease Normal 90 Full Some Disease 80 Full Normal with Effort Full Normal or Reduced Full Full Normal Full N/A N/A 108 Full Normal Full

Some Disease Can't do normal job 70 Reduced or work Some Disease Can't do hobbies or housework Significant Disease Can't do any work Extensive Disease As above in Bed 30 Bed Bound 20 Bed Bound 10 Bed Bound 0 Death As above As above As above Occasional Assistance Needed Full As above Full 145



As above Full or Confusion 29


Mainly sit/lie

Considerable Assistance Needed

As above Full or Confusion 30

11 41

Mainly 40

Mainly Assistance Total Care As above As above -

As above Reduced Minimal

Full or Drowsy or 18 Confusion As above As above 8 4 1

8 5 2 6 1

Mouth Drowsy or Coma Care Only --

a. b. c.

Survival post-admission to an inpatient palliative unit, all diagnoses (Virik 2002). Days until inpatient death following admission to an acute hospice unit, diagnoses not specified (Anderson 1996). Survival post admission to an inpatient palliative unit, cancer patients only (Morita 1999).

References 1. 2. 3. Anderson F, Downing GM, Hill J. Palliative Performance Scale (PPS): a new tool. J Palliat Care. 1996; 12(1): 5-11. Morita T, Tsunoda J, Inoue S, et al. Validity of the Palliative Performance Scale from a survival perspective. J Pain Symp Manage. 1999; 18(1):2-3. Virik K, Glare P. Validation of the Palliative Performance Scale for inpatients admitted to a palliative care unit in Sydney, Australia. J Pain Symp Manage. 2002; 23(6):455-7.

Fast Facts and Concepts are edited by Drew A Rosielle MD, Palliative Care Center, Medical College of Wisconsin. For more information write to: drosiell@mcw.edu. More information, as well as the complete set of Fast Facts, are available at EPERC: www.eperc.mcw.edu. Version History: This Fast Fact was originally edited by David E Weissman MD and published in November 2004. Current version re-copy-edited in April 2009. Copyright/Referencing Information: Users are free to download and distribute Fast Facts for educational purposes only. Wilner LS, Arnold R. The Palliative Performance Scale. Fast Facts and Concepts. November 2004; 125. Available at: http://www.eperc.mcw.edu/fastfact/ff_125.htm. Disclaimer: Fast Facts and Concepts provide educational information. This information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Facts cite the use of a product in a dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used. ACGME Competencies: Medical Knowledge, Patient Care Keywords: Prognosis

ECOG Performance Status

These scales and criteria are used by doctors and researchers to assess how a patient's disease is progressing, assess how the disease affects the daily living abilities of the patient, and determine appropriate treatment and prognosis. They are included here for health care professionals to access.

ECOG PERFORMANCE STATUS* Grade ECOG 0 1 Fully active, able to carry on all pre-disease performance without restriction Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work Ambulatory and capable of all selfcare but unable to carry out any work activities. Up and about more than 50% of waking hours

3 4 5

Capable of only limited selfcare, confined to bed or chair more than 50% of waking hours Completely disabled. Cannot carry on any selfcare. Totally confined to bed or chair Dead

* As published in Am. J. Clin. Oncol.: Oken, M.M., Creech, R.H., Tormey, D.C., Horton, J., Davis, T.E., McFadden, E.T., Carbone, P.P.: Toxicity And Response Criteria Of The Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649-655, 1982. The ECOG Performance Status is in the public domain therefore available for public use. To duplicate the scale, please cite the reference above and credit the Eastern Cooperative Oncology Group, Robert Comis M.D., Group Chair. Next topic

How to contact ECOG All contents copyright 1998-2000 Eastern Cooperative Oncology Group. All rights reserved. Revised: July 27, 2006