In medicine

Medicine

Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....

 (oncology

Oncology

Oncology is a branch of medicine that deals with cancer...

 and other fields), performance status is an attempt to quantify cancer

Cancer

Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...

 patients' general well-being and activities of daily life. This measure is used to determine whether they can receive chemotherapy

Chemotherapy

Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....

, whether dose adjustment is necessary, and as a measure for the required intensity of palliative care

Palliative care

Palliative care is a specialized area of healthcare that focuses on relieving and preventing the suffering of patients...

. It is also used in oncological

Oncology

Oncology is a branch of medicine that deals with cancer...

 randomized controlled trial

Randomized controlled trial

A randomized controlled trial is a type of scientific experiment - a form of clinical trial - most commonly used in testing the safety and efficacy or effectiveness of healthcare services or health technologies A randomized controlled trial (RCT) is a type of scientific experiment - a form of...

s as a measure of quality of life

Quality of life

The term quality of life is used to evaluate the general well-being of individuals and societies. The term is used in a wide range of contexts, including the fields of international development, healthcare, and politics. Quality of life should not be confused with the concept of standard of...

.

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

World Health Organization

The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

. For children, the Lansky score is used.

Parallel scoring systems include the Global Assessment of Functioning

Global Assessment of Functioning

The Global Assessment of Functioning is a numeric scale used by mental health clinicians and physicians to subjectively rate the social, occupational, and psychological functioning of adults, e.g., how well or adaptively one is meeting various problems-in-living. The scale is presented and...

(GAF) score, which has been incorporated as the fifth axis of the Diagnostic and Statistical Manual

Diagnostic and Statistical Manual of Mental Disorders

The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...

 (DSM) of psychiatry

Psychiatry

Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...

.

Karnofsky scoring

The Karnofsky score runs from 100 to 0, where 100 is "perfect" health and 0 is death. Although practitioners occasionally assign performance scores in between standard intervals of 10, there is no substantiated rationale for this and prognostication is not improved. This scoring system is named after Dr David A. Karnofsky, who described the scale with Dr Joseph H. Burchenal in 1949.

• 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

World Health Organization

The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

 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.

• 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:

• 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:

• 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

External links

• A table with the Karnofsky Performance Status.