What is Performance Status?

It is a score of a person’s Functional State. There are two commonly used scales.

The Karnofsky scale which goes from 0 to 100, where the person who is completely asymptomatic and fully functional scores a 100, and loses points for the onset of pain, mobility, weakness, or other difficulties, which lead to an impairment of function.

The ECOG scale goes from a best of 0 to worst of 4.

As the person’s Performance score drops, their ability to tolerate treatment and do well worsens. It is a valuable guide, often better than their age, or other “co-morbidities” e.g. diabetes, hypertension, heart disease etc.

If we embark on a treatment on someone who is doing very poorly, the chances of reaching the goal are slim, and we should tread cautiously.

The exceptions to this rule are some rapidly progressive diseases, e.g. high-grade lymphomas, leukemias,  and a subset of lung cancer called small cell lung cancer. These diseases cause the rapid onset of symptoms, which can be reversed by the quick initiation of chemotherapy, which then results in a quick improvement of Performance Status.

This is why seeing the patient is so important. Did they walk into the office on their own two feet? Do they look malnourished? Tired? Or are they on their way to work? Babysitting grandchildren? Do they live alone? Do they have a lot of family support?

Test results are only part of the story. All these answers go into making a good treatment decision.