What is Performance Status?
In medicine, particularly in cancer treatment, Performance Status (PS) is a measure of a cancer patient’s over-all well being and ability to do daily activities. PS gives the oncologist (cancer specialist) an idea if the cancer patient can handle the treatment plan. Cancer treatment may involve a combination of chemotherapy, radiation, or surgery. All of these have side effects, and complications can put added stress on the body.
How is Performance Status Measured?
There are two ways. One is the Karnofsky scoring. The higher the score, the better.
- 100 – Normal; no complaints; no evidence of disease.
- 90 – Able to carry on normal activity; minor signs or symptoms of the disease.
- 80 – Normal activity with effort; some signs or symptoms of the disease.
- 70 – Cares for self; unable to carry on normal activity or to do active work.
- 60 – Requires occasional assistance, but is able to care for most of their personal needs.
- 50 – Requires considerable assistance and frequent medical care.
- 40 – Disabled; requires special care and assistance.
- 30 – Severely disabled; hospital admission is indicated although death is not imminent.
- 20 – Very sick; hospital admission necessary; active supportive treatment necessary.
- 10 – Moribund; fatal processes progressing rapidly.
- 0 – Dead
The second one is the much shorter ECOG/WHO/Zubrod score. The lower the number, the better.
- 0 – Asymptomatic (Fully active, able to carry on all pre-disease activities without restriction)
- 1 – Symptomatic but completely ambulatory (Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature. For example, light housework, office work)
- 2 – Symptomatic, <50% in bed during the day (Ambulatory and capable of all self-care but unable to carry out any work activities. Up and about more than 50% of waking hours)
- 3 – Symptomatic, >50% in bed, but not bedbound (Capable of only limited self-care, confined to a bed or chair 50% or more of waking hours)
- 4 – Bedbound (Completely disabled. Cannot carry on any self-care. Totally confined to a bed or chair)
- 5 – Death
There is the Lansky score that is used for children.
- 100 – fully active, normal
- 90 – minor restrictions in strenuous physical activity
- 80 – active, but gets tired more quickly
- 70 – greater limit 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 dynamic 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
Drug Research and Performance Status
Drug development is expensive. Only 1 out of about seven drugs get final approval for use. It can cost up to $7 billion and years of work before a drug is put to market. That is why drug companies and researchers need good results for their medicines. They need to have their money back. Which is why drug research is usually conducted on subjects that have superb Performance Status.
If a new cancer drug is finally approved to be prescribed and the press release announces that it has a high success rate, those results may not apply to everybody. The new drug may have been tested on subjects with a Karnofsky score of 80 to 100. Therefore the same results may not apply not someone with a lower Karnofsky score of 70 or less. Some cancer patients may be too weak. Others that may have other diseases like uncontrolled diabetes, obesity, chronic kidney disease, liver cirrhosis, and heart failure may not get the same exceptional results.
It is also possible that the development of other medications other than for cancer is also conducted on subjects with excellent Performance Status. That way it will be easier to have it approved by the Food and Drug Administration.
So what? I don’t have cancer. Why should I care about PS?
Life has a way of throwing curveballs. Be it genetics or environment, cancer may still happen even with a health-conscious diet and exercise.
Staying healthy and active will provide a high-Performance Status that will give a better response to cancer treatment or any other disease.
It is not a surprise then that many studies have shown that people who are active do much better in surviving anything that nature throws at them. In fact, they have lower all-cause mortality. As in, they have a lower chance of dying from ANYTHING compared to their sedentary counterparts.
The article Physical Activity Correlates with Life Span talks about the different studies that show the dose-related response of physical activity and fitness to the length of life.
How Does Exercise Prolong Life? described how physical activity makes the body healthy. Gotta have that good Performance Status!
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Don’t Get Sick!
Related Readings:
- Physical Activity Correlates with Life Span
- How Does Exercise Prolong Life?
- The Benefits of Resistance Training
- The Surprising Benefits of Sweating
- The Good and Faithful Servant
- Effect of Short Term Exercise on Mortality
- What are Exerkines?
- Exercise Guidelines
- Why do You Need an Excellent Performance Status?
- Myokines: An Introduction
- What are Exerkines?
Image Credits:
- Bouldering Lady Photo by bady qb on Unsplash
- Runners and Bikers Photo by Chanan Greenblatt on Unsplash
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