Performance Status ECOG Score

Evaluates the functional status of patients with cancer to determine their prognosis.

In the text below the tool there is more information about the score and a comparison with Karnofsky, another malignancy functional status score.

The ECOG score is a functional status evaluation that assesses how a patient’s cancer is progressing and how their daily activities are affected by it.

ECOG is also used to determine appropriate therapeutic routes, e.g. whether the patient can undergo chemotherapy.

The ECOG status is used as a prognostic tool in several types of cancers. It was initially devised by the Eastern Cooperative Oncology Group (ECOG) in 1960, now part of the ECOG-ACRIN Cancer Research Group.

The second version, the one with six items on a scale from 0 to 5, was published in 1982 following a study by Oken et al. In subsequent validation studies, ECOG was found to have good inter-rater reliability.

Please select the answer choice that best applies to the current situation of the patient to see the position number on the scale:

Asymptomatic (Fully active, able to carry on all pre-disease activities without restriction)

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)

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)

Symptomatic, >50% in bed, but not bedbound (Capable of only limited self-care, confined to bed or chair 50% or more of waking hours)

Bedbound (Completely disabled. Cannot carry on any self-care. Totally confined to bed or chair)

Death

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Steps on how to print your input & results:

1. Fill in the calculator/tool with your values and/or your answer choices and press Calculate.

2. Then you can click on the Print button to open a PDF in a separate window with the inputs and results. You can further save the PDF or print it.

Please note that once you have closed the PDF you need to click on the Calculate button before you try opening it again, otherwise the input and/or results may not appear in the pdf.

About the tool

The ECOG score is used in the holistic evaluation of cancer patients and can help with prognosis and management of the malignant condition because performance status is highly correlated with survival and has predictive capacity in regard to the patient’s ability to tolerate chemotherapy.

The original study was devised in 1960 as a five item scale by the Eastern Cooperative Oncology Group (ECOG), now part of the ECOG-ACRIN Cancer Research Group.

The second version of the score, the one used by this tool, was created in 1982, following a study by Oken et al. and consists of a scale with 6 items, from 0 to 5.

The evaluation consists of the clinician analysing the patient status and assigning them to one of the six stages of function, ranging from 0 (asymptomatic) to 4 (bedbound) and 5 (dead).

There are other models that evaluate the performance of patients with cancer and that can help with therapeutic decision making, like the Karnofsky score or the Lansky score, the former being used in pediatric patients.

Score capability

The ECOG score is being used as a prognostic tool in several types of cancers and can determine whether there is need for in-hospital care or the patient can be treated ambulatory.

Subsequent studies have tested its inter-observer variability, one study testing a population of 100 patients with 3 oncologists, with the following results:

■ Total unanimity observed in 40 cases;

■ Unanimity between 2 observers in 53 cases;

■ Total disagreement in 7 cases.

Clinical trial studies uses scores like ECOG or Karnofsky to evaluate the general health of prospective subjects in order to assign them to a stage.

ECOG vs. Karnofsky

The two functional status scores are similar. Although there is no formal mapping of the association between the two, there is however, an association that is being used by most sources:

ECOG performance status	Karnofsky performance status
0 - Fully active, able to carry on all pre - disease performance without restriction	100 - Normal, no complaints; no evidence of disease 90 - Able to carry on normal activity; minor signs or symptoms of disease
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	80 - Normal activity with effort, some signs or symptoms of disease 70 - Cares for self but unable to carry on normal activity or to do active 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	60 - Requires occasional assistance but is able to care for most of personal needs 50 - Requires considerable assistance and frequent medical care
3 - Capable of only limited selfcare; confined to bed or chair more than 50% of waking hours	40 - Disabled; requires special care and assistance 30 - Severely disabled; hospitalization is indicated although death not imminent
4 - Completely disabled; cannot carry on any selfcare; totally confined to bed or chair	20 - Very ill; hospitalization and active supportive care necessary 10 - Moribund
5 - Dead	0 - Dead

Between the two, ECOG was found to have a slightly better discrimination power and is more preferred for clinical usage as it is shorter and simpler to use.

Original source

Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5(6):649-55.