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    Patent Pending

    Karnofsky Performance Status Scale

    Determines ability of patient to tolerate chemotherapy.
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    INSTRUCTIONS

    For patients ≥ 16 years old. Useful to use over time to track disease progression.
    When to Use
    Pearls/Pitfalls
    Why Use

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

    • 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.

    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.

    Result:

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    Next Steps
    Evidence
    Creator Insights

    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.

    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.

    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.

    Facts & Figures

    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

    Literature

    Dr. David Karnofsky

    About the Creator

    David A. Karnofsky, MD, (d. 1969) was an oncologist at Sloan-Kettering Institute for Cancer Research. He specialized in cancer chemotherapy and affiliated with the division of experimental chemotherapy.

    To view Dr. David Karnofsky's publications, visit PubMed