Performance status

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


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

  • 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:

  • 0 - Asymptomatic
  • 1 - Symptomatic but completely ambulant
  • 2 - Symptomatic, <50% in bed during the day
  • 3 - Symptomatic, >50% in bed, but not bedbound
  • 4 - Bedbound
  • 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


  • Karnofsky DA, Burchenal JH. The Clinical Evaluation of Chemotherapeutic Agents in Cancer. In: MacLeod CM (Ed), "Evaluation of Chemotherapeutic Agents." Columbia Univ Press, 1949:196.
  • Lansky SB, List MA, Lansky LL, Ritter-Sterr C, Miller DR. The measurement of performance in childhood cancer patients. Cancer 1987;60:1651-6. PMID 3621134.
  • Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982;5:649-655. PMID 7165009.

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