Scale for assessing the functional status of oncology patients
Primary source: Oken MM et al. Am J Clin Oncol 1982; 5(6): 649-655
ECOG (Eastern Cooperative Oncology Group) Performance Status is the standard tool for assessing functional status in oncology patients. Introduced by M. Zubrod et al. (1960) and adapted by ECOG in 1982. Also known as the WHO Performance Status.
Scale: 0 — fully active, no restrictions; 1 — restricted in strenuous physical activity, ambulatory and able to do light work; 2 — ambulatory, capable of self-care but unable to work; up and about more than 50% of waking hours; 3 — capable of only limited self-care; confined to bed or chair more than 50% of waking hours; 4 — completely disabled; cannot carry out any self-care; totally confined to bed or chair; 5 — dead.
Main use: decisions on chemotherapy and treatment intensity. ECOG ≤ 2 identifies candidates for standard antineoplastic therapy; ECOG 3 warrants an individualized approach with reduced-intensity regimens; ECOG 4 usually points toward palliative care. ECOG is also used to stratify clinical trials — most protocols require ECOG ≤ 1 or ≤ 2 for enrollment. Both ESMO and other major oncology guidelines are standardized around ECOG.
Performance status — assessed by the treating physician based on the patient's functional status over the past week.
A 67-year-old man with metastatic lung cancer. He can walk and care for himself but tires after light housework, spends about 20% of the day in bed or sitting, can go out to buy groceries but cannot manage an 8-hour workday.
Ambulatory, capable of self-care, restricted in physical work, <50% of time in bed → ECOG 1.
ECOG 1 — good functional status, candidate for standard systemic therapy. Approach: chemotherapy / immunotherapy / targeted therapy per the tumor-specific protocol (guided by molecular profile — EGFR, ALK, PD-L1, etc.). In parallel, provide symptomatic support and discuss clinical trial enrollment if eligibility criteria are met.
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