Performance Status and Fitness for Chemotherapy

Who Should Get Chemotherapy?

Doctors don’t prescribe chemo lightly or any other systemic therapy for that matter.

The stage of the tumor matters; chemotherapy guidelines almost always specify cancer stage with suggested regimens.  The overall physical condition and health of the patient is another big factor as chemo is hard on the body.  Which diseases are present is a factor, and the patient has some say, too.

The medical community has developed scoring systems to try to quantify or more precisely evaluate whether a patient is healthy enough for chemo.  These include the Karnofsky score and the WHO/ECOG score.    Fitness scores are not a measure of how the cancer has advanced or how much of a threat it poses.

WHO Score

  • 0 – No symptoms.  Patient is able to carry on all normal activities.  (These might be signs of disease in medical exam, but patient feels normal.
  • 1 – Has symptoms but can walk and carry out pre-disease activities as long as they are not physically demanding.   Patients with this score can usually carry out housework and office work.
  • 2 – Has symptoms and spends less than half of daytime in bed.  Can get around but not work,
  • 3 – Patient has severe symptoms and spends majority of daytime in bed.
  • 4 – Patient is completely disabled. Cannot carry on any self-care. Totally confined to bed or chair
  • 5 – Death

Other names for the WHO score are the Zubrod score and the Eastern Cooperative Oncology Group (ECOG) status.

Karnofsky Score

  • 100 – Normal and healthy.
  • 90 – Minor signs or symptoms of disease with little impact on patient functioning.
  • 80 – Patient can carry on normal activities with effort.
  • 70 – Patient can care for self but unable to carry on normal activity or to do active work.
  • 60 – Patient requires some help, but is able to use the bathroom.
  • 50 – Requires assistance in daily living tasks and needs frequent medical care.
  • 40 – Disabled; requires help assistance.
  • 30 – Patient is severely disabled and should go to hospital but not at apparent risk of dying.
  • 20 – Patient is very sick; active supportive treatment in a hospital necessary.
  • 10 – Moribund; fatal processes progressing rapidly.
  • 0 – Dead

These scores are subjective and rely on what the patient tells the medical practitioner to some extent.  Because children are not as articulate as adults, another system called the Lansky score has been developed:

Lansky Score

  • 100 – Normal, no symptoms
  • 90 – Strenuous physical activity difficult
  • 80 – Active, but gets tired quickly
  • 70 – More restriction of play and less time spent in play activity
  • 60 – Child is ambulatory, but active play minimal; is involved in quieter activities
  • 50 – Child lies around much of the day, but gets dressed
  • 40 – Mainly in bed; participates in quiet activities
  • 30 – Bedbound; needing assistance even for quiet play
  • 20 – Sleeps a lot; play entirely limited to very passive activities
  • 10 – Patient neither plays nor gets out of bed
  • 0 – Unresponsive

The Cancer and Aging Research Group medical practice published a Chemotherapy Toxicity Tool for predicting how well elderly patients will be able to handle chemotherapy regimens.  It’s on line at

Hospices also employ these scores in determining which patients need hospice care.

Related: decisions about how to proceed with chemotherapy