Percentage-based assessment of functional status and ability to work
Primary source: Karnofsky DA, Burchenal JH. Evaluation of chemotherapeutic agents 1949
The Karnofsky Performance Status (Karnofsky DA, Burchenal JH, 1949) is a historical functional status scale for oncology patients. It uses a 0-100% range in increments of 10. It is more granular than ECOG, which makes it popular in transplantation (assessment of bone marrow transplant candidates), palliative care, and research.
Categories: 100 — normal, no complaints; 90 — normal activity with minor symptoms; 80 — normal activity with effort; 70 — cares for self, unable to carry on normal activity or work; 60 — requires occasional assistance; 50 — requires considerable assistance and medical care; 40 — disabled, requires special care; 30 — severely disabled, hospitalization indicated; 20 — very sick, active supportive care needed; 10 — moribund; 0 — death.
In bone marrow transplantation, KPS ≥ 80 is generally required for a myeloablative conditioning regimen; 60-70 for a reduced-intensity regimen; < 60 usually precludes transplantation. In palliative care, KPS is used to predict survival (PaP Score).
A 58-year-old woman with myelodysplastic syndrome is being evaluated for allogeneic bone marrow transplantation. She is active and manages household tasks but tires with strenuous activity; she rarely needs to rest during the day.
Normal activity with effort, symptoms present → KPS 80.
KPS 80 is an acceptable functional status for transplantation. Parallel assessment: HCT-CI (comorbidity index), MDS molecular profile, and availability of a matched donor. If all criteria are met, a myeloablative regimen is feasible; if overall risk is moderate, a reduced-intensity regimen is preferred.
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