Performance Status Reference
A Performance Status provides a standardized way to create a broad, general picture of a patient's health. They have many uses in prognostication as well as treatment decisions and research.
Palliative Perfomance Scale (PPS)1
Instructions: Starting at the 'Ambulation' column, find the decile/row that best fits the patient. Stronger performance factors are located on the left and if the patient doesn't fit all in one decile/row give preference to the ones that are leftmost. Self care is defined as things like being able to do mouth care, shave, bathe, etc...

PPS % Ambulation Activity and Evidence of Disease Self-Care Intake Conscious Level
100 Full Normal Activity, No Evidence of Disease Full Normal Full
90 Full Normal Activity, Some Evidence of Disease Full Normal Full
80 Full Normal Activity with Effort, Some Evidence of Disease Full Normal or Reduced Full
70 Reduced Unable Normal Job/Work, Some Evidence of Disease FullNormal or Reduced Full
60 Reduced Unable Hobby/House Work, Significant Disease Occasional Assistance Necessary Normal or Reduced Full or Confusion
50 Mainly Sit/Lie Unable to Do Any Work, Extensive Disease Considerable Assistance Necessary Normal or Reduced Full or Confusion
40 Mainly in Bed As Above Mainly Assistance Normal or Reduced Full, Drowsy or Confusion
30 Totally Bed Bound As Above Total Care Reduced Full, Drowsy or Confusion
20 As Above As Above As Above Minimal Sips Full, Drowsy or Confusion
10 As Above As Above As Above Mouth Care Only Drowsy or Coma
0 Death----

Karnofsky Performance Status2
KPS % Description
100 Normal, no complaints. No evidence of disease.
90 Able to carry on normal activity, minor signs or symptoms of disease.
80 Normal activity with effort, some signs or symptoms of 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 his/her 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 support treatment necessary.
10 Moribund, fatal processes progressing rapidly
0 Death

Score Description
0 Asymptomatic. Fully active, able to carry on all pre-disease activities without restriction.
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).
2 Ambulatory and capable of all selfcare but unable to carry out any work activities. Up and about more than 50% of waking hours.
3 Capable of only limited selfcare, confined to bed or chair more than 50% of waking hours.
4 Completely disabled. Cannot carry on any selfcare. Totally confined to bed or chair
5 Death

Dealing with Differences Between the ECOG, KPS and PPS.

In this tool, we check for agreement among the given performance status variables in two ways. First, we check that the PPS and KPS differ by no more than 20%. Secondly, to compare ECOG with PPS and KPS, we make sure that the estimates are no more than one 'level' apart based on the following paper.4

0 100
1 80-90
2 60-70
3 40-50
4 10-30

For example, an ECOG of 0 and a PPS/KPS of 80% are reasonable (one level apart), however an ECOG of 4 and a PPS/KPS 60% should raise questions about the accuracy of the scoring and will raise a flag.

  1. Anderson F, Downing GM, Hill J, Casorso L, Lerch N. Palliative Performance Scale (PPS): A New Tool. J Palliative Care. 1996;12(1):5-11.
  2. Karnofsky DA, Abelmann WH, Craver LF, Burchenal JH. The Use of the Nitrogen Mustards in the Palliative Treatment of Carcinoma, With Particular Reference to Bronchogenic Carcinoma. Cancer. 1948;1(4):634-656.
  3. Oken MM, Creech RH, Tormey DC, et al. Toxicity And Response Criteria Of The Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5:649-655.
  4. Ma C, Bandukwala S, Burman D, Bryson J, Seccareccia D, et al. Interconversion of Three Measures of Performance Status: An Empirical Analysis. Eur J Cancer. 2010;46(18):3175-83.