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Performance Status in Patients With Cancer

Patient performance status (PS) is an important part of cancer care and treatment.

What Is Patient PS? Performance Status Scales

Patient PS is one of the most central factors in cancer care. It plays
a role both in shaping prognosis and in determining the best treat- Zubrod Scale Karnofsky Scale

ment for a patient with cancer. Performance status is a score that 100 Normal; no evidence of disease
estimates the patient’s ability to perform certain activities of daily 0 Normal activity
Able to perform normal activities
living (ADLs) without the help of others. These ADLs include basic 90
with only minor symptoms
activities such as getting dressed, eating, and bathing, as well as more
complex activities such as cleaning the house and working a regu- 80 Normal activity with effort;
some symptoms
lar job. Symptomatic and ambulatory;
1
cares for self
There are 2 widely used scales for PS. The most commonly used 70
Able to care for self but unable to
do normal activities
is typically referred to as the Zubrod or ECOG (Eastern Cooperative
Oncology Group) scale. This scale ranges from 0 to 4, with 0 being 2
Ambulatory >50% of time;
60
Requires occasional assistance;
occasional assistance cares for most needs
fully functional and asymptomatic, and 4 being bedridden. The other
scale sometimes used is the Karnofsky scale. This scale ranges from 50 Requires considerable assistance
10 (moribund) to 100 (no limitations). Ambulatory ≤50% of time;
3 40 Disabled; requires special assistance
These scales of PS are often included in physician assessments nursing care needed
of patients, eligibility criteria for clinical trials, and guidelines for stan- 30 Severely disabled
dard treatment recommendations.
Very sick; requires active
20
supportive treatment
4 Bedridden
Why Does PS Matter?
There are many factors that can predict whether someone is likely 10 Moribund

to do well or poorly with their disease. Age, the stage of a cancer,

and other illnesses all affect prognosis, but PS is one of the most im-
portant variables. It is more important than a patient’s actual age in
predicting how a patient is likely to do.
Patients who have a worse PS and limited functional capacity
tend to have more difficulty tolerating rigorous cancer treatments.
These patients have less favorable outcomes than more fit pa-
tients with better PS, regardless of the treatments given.
Many clinical trials, and the treatment recommendations that
are developed from them, are restricted to more fit patients, such
as those with a PS of 0 to 1 on the Zubrod scale or higher than 70 on
the Karnofsky scale. As a result, there is less clinical evidence avail-
able for treatments for more frail patients with lower PS. Because
FOR MORE INFORMATION
• Performance status
https://en.wikipedia.org/wiki/Performance_status
• FAQ: What is “performance status” and why does it matter
so much?
http://cancergrace.org/cancer-101/2015/07/29/faq-perfstatus/
To find this and other JAMA Oncology Patient Pages, go to the
Patient Page link on the JAMA Oncology website at
http://www.jamaoncology.com.

nearly all anticancer treatments have potentially serious adverse ef-

fects, the risks of using certain treatments in low-PS patients may
far exceed the benefits. However, other trials testing less intensive
treatment approaches may allow or even focus specifically on more
frail patients who need more support.
Patient PS can and usually does change over time. Patients can
experience a gradual worsening of their PS as their cancer pro-
gresses, both from the cancer itself and from the cumulative ad-
verse effects of treatments. On the other hand, effective treat-
ment can lead to an improvement in PS if a patient is limited by
cancer-related symptoms (as opposed to other chronic medical con-
ditions unrelated to cancer) that improve as the cancer responds
to treatment.

Authors: Howard (Jack) West, MD; Jill O. Jin, MD, MPH
Published Online: September 3, 2015. doi:10.1001/jamaoncol.2015.3113.
Conflict of Interest Disclosures: None reported.
Section Editor: Howard (Jack) West, MD.
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