Performance status (ECOG, Karnofsky)
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.
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.
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