Makindo Medical Notes

Related Subjects: |Neutropenic Sepsis |Oncological emergencies |Spinal Cord Compression |Brain Tumours |Cancer of Unknown Primary |Head and Neck Cancers

Introduction

The Karnofsky Performance Status (KPS) scale is a standardized tool used by healthcare professionals to assess a cancer patient's ability to perform ordinary tasks and carry out daily activities. It serves as an important measure of functional status, helping clinicians determine prognosis, evaluate the impact of the disease, and make informed decisions regarding appropriate treatment options.

Scale Description

The KPS scale ranges from 0 to 100, with intervals of 10, where higher scores indicate better functional ability. The scale assesses patients based on their ability to work, carry out daily activities, and the need for assistance or medical care.

• 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.
• 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 personal needs.
• 50% - Requires considerable assistance and frequent medical care.
• 40% - Disabled; requires special care and assistance.
• 30% - Severely disabled; hospitalization is indicated, though death not imminent.
• 20% - Very sick; hospitalization necessary; active supportive treatment needed.
• 10% - Moribund; fatal processes progressing rapidly.
• 0% - Dead.

Interpretation

• 80-100%: Patients are able to carry on normal activities and work; no special care is needed.
• 50-70%: Patients are unable to work but can live at home and care for most personal needs with varying degrees of assistance.
• 0-40%: Patients are unable to care for themselves; they require institutional or hospital care and constant medical support.

Clinical Use

• Prognosis: Higher KPS scores are generally associated with better prognosis and longer survival rates. They help clinicians estimate life expectancy and disease progression.
• Treatment Decisions: The KPS scale aids in determining a patient's ability to tolerate specific treatments such as chemotherapy, radiation therapy, or surgical interventions. It helps in tailoring treatment plans to individual patient capacities.
• Monitoring: Regular assessment using the KPS scale allows healthcare providers to monitor changes in a patient's functional status over time, adjust treatments accordingly, and identify the need for supportive or palliative care.
• Research and Clinical Trials: KPS scores are often used as eligibility criteria for enrollment in clinical trials and for stratifying patients in research studies.

Advantages

• Simple and quick to administer.
• Provides a standardized measure for comparing patient status across different settings.
• Facilitates communication among multidisciplinary teams.

Limitations

• Subjectivity in scoring can lead to variability between assessors.
• May not capture psychosocial aspects affecting patient quality of life.
• Less sensitive to small but clinically significant changes in functional status.

Comparison with ECOG Performance Status

Another commonly used performance status scale is the Eastern Cooperative Oncology Group (ECOG) scale, which ranges from 0 to 5. Both KPS and ECOG scales assess functional status but use different scoring systems. KPS provides a more granular assessment with 11 levels, while ECOG has 6 levels.

Summary

The Karnofsky Performance Status scale is a valuable tool in oncology for assessing cancer patients' functional ability, determining prognosis, and guiding treatment decisions. By quantifying a patient's capacity to perform daily activities, the KPS scale assists healthcare providers in delivering personalized care and optimizing clinical outcomes. Regular use of the KPS scale facilitates monitoring of disease progression and supports communication within the healthcare team and with patients and their families.

References

• Karnofsky DA, Abelmann WH, Craver LF, Burchenal JH. The use of the nitrogen mustards in the palliative treatment of carcinoma. Cancer. 1948;1(4):634-656.
• National Cancer Institute. Karnofsky Performance Status definition.
• Mitchell AJ. A meta-analysis of the accuracy of the mini-mental state examination in the detection of dementia and mild cognitive impairment. J Psychiatr Res. 2009;43(4):411-431.