Moving beyond Karnofsky and ECOG Performance Status Assessments with New Technologies

Table 1

Alternative measurement instruments of functional performance.

Assessment tool	Description	Nature of assessment	Feasibility	Limitations	Correlation with outcomes
KPS [3]	Linear scale from 0 (dead) to 100 (normally active, without evidence of disease) summarizing ability to perform daily activities, and level of assistance required	Subjective	Time to completion: minutes; Easy to perform; No equipment required	Poor reliability, variable levels of interobserver agreement; Subjective, poor concordance between patient recorded and physician recorded KPS; Poor predictor of prognosis when PS is good; Poor sensitivity at the lower end of the scale; Validated in a younger patient cohort and less applicable to an older heterogeneous patient group; Unable to verify accuracy of assessment	Survival; Prognosis; Response to chemotherapy; Chemotherapy toxicity; Quality of life
ECOG PS [5]	6-point scale ranging from 0 (fully active) to 5 (dead), assessing level of function, ambulation, and capability of self-care	Subjective	Time to completion: minutes; Easy to perform; No equipment required	Poor reliability, variable levels of interobserver agreement; Subjective, poor concordance between patient recorded and physician recorded KPS; Poor sensitivity at the lower end of the scale; Poor predictor of prognosis when PS is good; Unable to verify accuracy of assessment	Survival; Prognosis; Response to chemotherapy; Chemotherapy toxicity; Quality of life
TUG [21]	Assessment of mobility and functional balance; functional mobility is quantified by the time it takes a patient to get up from a seated position, walk 3 meters, turn around, and return to a seated position	Objective	Time to completion: seconds; Easy to perform; Minimal equipment; Required	Focused on one domain, mobility	Risk of falling; Gait speed; Residential status; Ability to go outside alone safely; Berg Balance Scale; Barthel Index of Activity of Daily Living
Frailty Index (FI) [22]	FI is the ratio of the deficits present in a person to the total number of potential deficits evaluated	Subjective and objective components		Expensive	Mortality; Predicts risk of adverse health outcomes
SPPB [23, 24]	SPPB measures physical and functional health and consists of three subtests: 4-meter walk, repeated chair stands, and standing balance	Objective	Time to completion: 5–10 minutes; More complex assessment, 3 tests; Minimal equipment required	Cost; Inconvenient	Mortality (data available for older cancer patients and survivors)
EAM [25–27]	Wearable devices that objectively measure physical activity and can provide feedback	Objective	Time to completion: continuous assessment, duration dictated by patient; Requires expensive equipment; Feasibility and patient acceptability have been demonstrated	Cost; Reduced accessibility; Increased demand on healthcare computer information systems	Physical intervention, weight reduction; Correlation with ECOG PS

KPS: Karnofsky Performance Status, ECOG PS: Eastern Cooperative Oncology Group, TUG: Timed Get Up and Go, SPPB: Short Physical Performance Battery, EAM: electronic activity monitoring, and PS: performance status.