Prognostic Factores in Cancer Patient

General

- Perfomance status

   ● Karnofsky ≤ 50, ECOG ≤ 3

   ● Most of the time in bed or lying down

 

Signs associated with prognosis ≤ 6 months

- Malignant pericardial or pleural effusions

- Malignant ascities

- Multiple Brain metastasis

- Carcinomatous meningitis

- Malignant bowel obstruction

- Serum albumin < 2.5mg/dL

- Hypercalcemia (except in newly diagnosed breast cancer or myeloma)

 

Cancer associated with prognosis ≤ 6 months

 - Metastatic lung cancer

 - Unresectable pancreatic cancer

 - Progressive metastatic breast or prostate cancer with poor or decreasing functional state

 - Metastatic solid tumor, acute leukemia , or high-grade lymphoma forgoing chemotherapy

 

 

 

The Karnofsky Performance Scale Index allows patients to be classified as to their functional impairment. This can be used to compare effectiveness of different therapies and to assess the prognosis in individual patients. The lower the Karnofsky score, the worse the survival for most serious illnesses.

 

KARNOFSKY PERFORMANCE STATUS SCALE DEFINITIONS RATING (%) CRITERIA

Able to carry on normal activity and to work; no special care needed.	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.
Unable to work; able to live at home and care for most personal needs; varying amount of assistance needed.	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 personal needs.
	50	Requires considerable assistance and frequent medical care.
Unable to care for self; requires equivalent of institutional or hospital care; disease may be progressing rapidly.	40	Disabled; requires special care and assistance.
	30	Severely disabled; hospital admission is indicated although death not imminent.
	20	Very sick; hospital admission necessary; active supportive treatment necessary.
	10	Moribund; fatal processes progressing rapidly.
	0	Dead

References:
Crooks, V, Waller S, et al. The use of the Karnofsky Performance Scale in determining outcomes and risk in geriatric outpatients. J Gerontol. 1991; 46: M139-M144.
de Haan R, Aaronson A, et al. Measuring quality of life in stroke. Stroke. 1993; 24:320- 327.
Hollen PJ, Gralla RJ, et al. Measurement of quality of life in patients with lung cancer in multicenter trials of new therapies. Cancer. 1994; 73: 2087-2098.
O'Toole DM, Golden AM. Evaluating cancer patients for rehabilitation potential. West J Med. 1991; 155:384-387.
Oxford Textbook of Palliative Medicine, Oxford University Press. 1993;109.
Schag CC, Heinrich RL, Ganz PA. Karnofsky performance status revisited: Reliability, validity, and guidelines. J Clin oncology. 1984; 2:187-193.

 

 

ECOG PERFORMANCE STATUS*

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

* As published in Am. J. Clin. oncol.: Oken, M.M., Creech, R.H., Tormey, D.C., Horton, J., Davis, T.E., McFadden, E.T., Carbone, P.P.: Toxicity And Response Criteria Of The Eastern Cooperative oncology Group. Am J Clin oncol 5:649-655, 1982.