Performance status

Karnofsky Score, Zubrod Score

When doctors assess a person’s prognosis, performance status as well as mental attitude is taken into consideration.

Performance status is defined as such;

0 Fully active, able to carry on all pre-disease performance without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work
2 Ambulatory and capable of all selfcare but unable to carry out any work activities. Up and about more than 50% of waking hours
3 Capable of only limited selfcare, confined to bed or chair more than 50% of waking hours
4 Completely disabled. Cannot carry on any selfcare. Totally confined to bed or chair
5 Dead
Am. J. Clin. Oncol. (CCT) 5:649-655, 1982

Karnofsky Performance status score

The Karnofsky score is another method which measures patient performance of activities of daily living. The score has proven useful not only to follow the course of the illness (usually progressive deficit and ultimately death), but also a prognosticator: patients with the highest (best) Karnofsky scores at the time of tumor diagnosis have the best survival and quality of life over the course of their illness.


100 Normal, no evidence of disease
90 Able to perform normal activity with only minor symptoms
80 Normal activity with effort, some symptoms
70 Able to care for self but unable to do normal activities
60 Requires occasional assistance, cares for most needs
50 Requires considerable assistance
40 Disabled, requires special assistance
30 Severely disabled
20 Very sick, requires active supportive treatment
10 Moribund

ECOG/Zubrod Score Performance Status

The Zubrod Score is similar to the ‘performance status’ table:

0 Asymptomatic
1 Symptomatic, fully ambulatory
2 Symptomatic,in bed < 50% of the day
3 Symptomatic,in bed > 50% of the day but not bedridden
4 Bedridden
5 Dead

Strenuous excercise is not recommended while undergoing treatment. However, one of the most important things a person can do after their cancer diagnosis is get up and stay up.

It has been shown time and time again that when someone reacts to their diagnosis with a helpless/hopeless attitude, the prognosis is negatively effected. Some important ways to fight these overwhelming feelings would be to

* learn all you can about your options and choices
* take an active role in your treatment
* join a support group. It has been shown to positively increase survival.

A strong sense of hopelessness is now ranked as a serious contributing factor in both the emergence of new cases of cancer and heart disease and for death from these diseases. A study of 2428 Finnish men, aged 42-60, revealed that those with moderate to high hopelessness (based on answers to a questionnaire) died at a rate 2-3 times higher than those who did not feel hopeless; and for those with a high degree of hopelessness, the death rate from cancer, heart disease, violence, or injury was 5 times higher, regardless of the presence of other major risk factors. 1

Please see our section on ‘relaxation‘ for some survivor tips

back to invasive bladder cancer

1.B. Bower, Hopelessness Tied to Heart, Cancer Deaths,” Science News, Vol. 149, No. 15, April 13, 1996, p. 230.