Karnofsky Performance Status Scale

Karnofsky Performance Status

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Determines ability of patient to tolerate chemotherapy.

Why Use

Performance status is highly correlated with survival time and need for services in the home. It may also help predict ability to thrive with invasive and intensive treatment.

When to Use

Patients with advancing cancer or other chronic diseases — or even frailty progression in the elderly.

Formula

Description Points assigned* Description Normal no complaints; no evidence of disease. 100 Able to carry on normal activity and to work; no special care needed. Able to carry on normal activity; minor signs or symptoms of disease. 90 Normal activity with effort; some signs or symptoms of disease. 80 Cares for self; unable to carry on normal activity or to do active work. 70 Unable to work; able to live at home and care for most personal needs; varying amount of assistance needed. Requires occasional assistance, but is able to care for most of his personal needs. 60 Requires considerable assistance and frequent medical care. 50 Disabled; requires special care and assistance. 40 Unable to care for self; requires equivalent of institutional or hospital care; disease may be progressing rapidly. Severely disabled; hospital admission is indicated although death not imminent. 30 Very sick; hospital admission necessary; active supportive treatment necessary. 20 Moribund; fatal processes progressing rapidly. 10 Dead. 0 *% Survival correlates with points assigned.

Pearls / Pitfalls

The Karnofsky Performance Status Scale (KPS) is used extensively and for many purposes, including response to chemotherapy in cancer and chronic disease assessment. It quantifies a patient's functional abilities and impact of treatments like chemotherapy on their basic functional capacities. It is sometimes also used prognostically and to help determine treatment.

Management

We are unaware of validated management algorithms using the Karnofsky Scale.

Critical Actions

The Karnofsky Scale and other performance scales should be used in the holistic assessment of cancer patients, though its accuracy as a prognostic tool in individual cases is not yet well proved.

Advice

The Karnofsky Performance Status Scale is clearly useful to clinicians, and either this or another functional status scale should be used to improve understanding of patient needs and abilities, as well as potentially to prognose.

More Information

The lower the Karnofsky Scale, the worse the prognosis: Unable to tolerate therapies Survival rates decrease Karnofsky vs. ECOG/Zubrod Scores ECOG PERFORMANCE STATUS KARNOFSKY PERFORMANCE STATUS 0—Fully active, able to carry on all pre-disease performance without restriction 100—Normal, no complaints; no evidence of disease 90—Able to carry on normal activity; minor signs or symptoms of disease 1—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 80—Normal activity with effort, some signs or symptoms of disease 70—Cares for self but unable to carry on normal activity or to do active work 2—Ambulatory and capable of all selfcare but unable to carry out any work activities; up and about more than 50% of waking hours 60—Requires occasional assistance but is able to care for most of personal needs 50—Requires considerable assistance and frequent medical care 3—Capable of only limited selfcare; confined to bed or chair more than 50% of waking hours 40—Disabled; requires special care and assistance 30—Severely disabled; hospitalization is indicated although death not imminent 4—Completely disabled; cannot carry on any selfcare; totally confined to bed or chair 20—Very ill; hospitalization and active supportive care necessary 10—Moribund 5—Dead 0—Dead