# Performance status (ECOG, Karnofsky)

Source: https://onco.cc/terms/performance-status/  
OnCo record `performance-status` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A simple score of how well a patient can get about and look after themselves: ECOG 0 is fully active, 1 restricted from strenuous work, 2 up more than half the day, 3 in bed more than half the day, 4 bedbound. It predicts how treatment will be tolerated and gates almost every trial.

## Summary

The ECOG/WHO scale (0-5) and the Karnofsky scale (100-0) are the standard fitness measures in oncology. Most phase 3 trials enrol only ECOG 0-1, so evidence for the many patients with PS 2-3 is thin; 'fit' versus 'unfit' (for intensive chemotherapy, cisplatin, transplant) is often decided by performance status plus organ function and comorbidity, and phrases like 'cisplatin-ineligible' or 'transplant-ineligible' define whole treatment pathways. Geriatric assessment captures frailty more precisely than PS and changes treatment in older adults. Poor PS caused by the cancer itself can improve dramatically when an effective targeted drug works.

## Fields

- Kind: Term
- Last checked: 2026-09-09
- Also known as: ECOG; ECOG 0-1; ECOG 0; ECOG 1; ECOG 2; ECOG PS; ECOG performance status; Karnofsky; Karnofsky score; KPS; PS 0-1; poor performance status; fit patients; unfit patients; frail; frailty; IMWG frailty index; IMWG frailty score; comorbidity; comorbidities; HCT-CI; HCT comorbidity index; cisplatin-ineligible; platinum-ineligible; transplant-eligible; transplant-ineligible

## Notes

- Lung cancer: NICE NG122 uses performance status as a threshold in several places, so it is worth knowing what yours is recorded as. It asks for twice-daily radiotherapy with chemotherapy in limited-stage small-cell disease for people with a performance status of 0 or 1 (1.10.2), preventive brain radiotherapy for 0 to 2 (1.10.5), postoperative chemotherapy for WHO 0 or 1 (1.6.11 and 1.6.12), and says a clinical oncologist specialising in thoracic oncology should determine suitability for radical radiotherapy taking performance status and other illnesses into account (1.4.15).

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Performance_status
- Wikipedia: https://en.wikipedia.org/wiki/Performance_status
- NICE NG122: lung cancer, management: https://www.nice.org.uk/guidance/ng122/chapter/Management

## Connected records

- terms: [Accrual and enrolment](https://onco.cc/terms/accrual/), [Cancer cachexia](https://onco.cc/terms/cachexia/), [DIPSS, DIPSS-plus and MIPSS70 (myelofibrosis risk scores)](https://onco.cc/terms/dipss-mipss70/), [Disease-specific staging and risk systems (FIGO, Ann Arbor, IPI, R-ISS, ELN, IMDC)](https://onco.cc/terms/staging-systems/), [Dose reduction, interruption and discontinuation](https://onco.cc/terms/dose-modification/), [Graded Prognostic Assessment (GPA) for brain metastases](https://onco.cc/terms/graded-prognostic-assessment/), [Hypomethylating agents (azacitidine, decitabine)](https://onco.cc/terms/hma/), [Malignant pleural effusion](https://onco.cc/terms/malignant-pleural-effusion/), [Resectability in lung cancer](https://onco.cc/terms/resectability-lung-cancer/), [Sarcopenia](https://onco.cc/terms/sarcopenia/), [Superior vena cava obstruction](https://onco.cc/terms/superior-vena-cava-obstruction/)
- cancers: [Advanced-stage classical Hodgkin lymphoma (stage III to IV)](https://onco.cc/cancers/advanced-stage-classical-hodgkin-lymphoma/), [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Diffuse large B-cell lymphoma](https://onco.cc/cancers/dlbcl/), [Early-stage classical Hodgkin lymphoma (stage I to II)](https://onco.cc/cancers/early-stage-classical-hodgkin-lymphoma/), [Follicular lymphoma](https://onco.cc/cancers/follicular-lymphoma/), [Gallbladder cancer](https://onco.cc/cancers/gallbladder/), [Hodgkin lymphoma](https://onco.cc/cancers/hodgkin-lymphoma/), [Large cell neuroendocrine carcinoma of the lung](https://onco.cc/cancers/lung-lcnec/), [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Mantle cell lymphoma](https://onco.cc/cancers/mantle-cell-lymphoma/), [Marginal zone lymphoma](https://onco.cc/cancers/marginal-zone-lymphoma/), [Non-Hodgkin lymphoma (all types)](https://onco.cc/cancers/non-hodgkin-lymphoma/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma)](https://onco.cc/cancers/peripheral-t-cell-lymphoma/), [Prostate cancer](https://onco.cc/cancers/prostate/), [Relapsed and refractory classical Hodgkin lymphoma](https://onco.cc/cancers/relapsed-refractory-hodgkin-lymphoma/), [Small-cell lung cancer](https://onco.cc/cancers/sclc/), [Waldenström macroglobulinaemia](https://onco.cc/cancers/waldenstrom/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [G8 geriatric screening tool](https://onco.cc/technologies/g8-geriatric-screening/), [Geriatric assessment](https://onco.cc/technologies/geriatric-assessment/)
- roadmaps: [Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question](https://onco.cc/roadmaps/pancreatic-roadmap/)
- ideas: [A fast-track pathway from suspicion to treatment for pancreatic cancer in the NHS, measured from first scan to first treatment](https://onco.cc/ideas/idea-pdac-uk-fast-track-diagnosis-to-treatment-pathway/), [Embed cachexia treatment in chemotherapy trials: weight, muscle and treatment delivery as co-primary endpoints](https://onco.cc/ideas/idea-pdac-cachexia-trials-embedded-in-chemotherapy-trials/)
- trials: [LACE (Lung Adjuvant Cisplatin Evaluation) pooled analysis](https://onco.cc/trials/lace-pooled-analysis/), [PRODIGE 4 / ACCORD 11](https://onco.cc/trials/prodige-4-accord-11/)
- key papers: [Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer](https://onco.cc/key-papers/paper-schiller-ecog-1594-four-chemotherapy-regimens-nejm-2002/), [Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group](https://onco.cc/key-papers/paper-lace-adjuvant-cisplatin-pooled-analysis-jco-2008/), [Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer](https://onco.cc/key-papers/paper-sandler-ecog-4599-bevacizumab-nsclc-nejm-2006/), [Randomized trial of TAS-102 for refractory metastatic colorectal cancer (RECOURSE)](https://onco.cc/key-papers/paper-mayer-recourse-tas-102-nejm-2015/), [Socioeconomic inequalities in lung cancer treatment: systematic review and meta-analysis](https://onco.cc/key-papers/paper-forrest-socioeconomic-inequalities-lung-cancer-treatment-plos-med-2013/), [Trifluridine-tipiracil and bevacizumab in refractory metastatic colorectal cancer (SUNLIGHT)](https://onco.cc/key-papers/paper-prager-sunlight-trifluridine-tipiracil-bevacizumab-nejm-2023/)

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