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Karnofsky Performance Scale

KPS 0–100 — functional status for oncology & transplant
The Karnofsky Performance Scale quantifies a patient's functional status and ability to manage daily activities. Widely used in oncology trial eligibility, bone marrow transplant assessment, and palliative care prognosis.
Oncology Transplant Performance Status Palliative Care
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Karnofsky Performance Score
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Full KPS Scale

ScoreDescriptionCategory
100Normal; no complaints; no evidence of diseaseIndependent
90Able to carry on normal activity; minor signs or symptomsIndependent
80Normal activity with effort; some signs or symptomsIndependent
70Cares for self; unable to carry on normal activity or active workReduced activity
60Requires occasional assistance; cares for most personal needsSelf-caring
50Requires considerable assistance and frequent medical careDependent
40Disabled; requires special care and assistanceDependent
30Severely disabled; hospitalisation indicated; death not imminentSeverely impaired
20Very ill; hospitalisation necessary; active supportive treatment neededSeverely impaired
10Moribund; fatal processes progressing rapidlyMoribund
0DeadDead

KPS–ECOG Conversion

ECOGKPSDescription
0100–90Fully active; no restriction
180–70Normal activity with effort; self-caring
260–50Ambulatory but unable to work; requires some assistance
340–30Limited self-care; in bed >50% of waking hours
420–10Totally disabled; no self-care
50Dead

Conversion between KPS and ECOG is approximate. Inter-rater reliability of both scales is moderate; use descriptors — not numerics alone — when communicating performance status between clinicians.

Clinical Thresholds

  • KPS ≥80 — Generally suitable for intensive chemotherapy and enrolment in most phase I/II trials
  • KPS ≥70 — Threshold for most standard chemotherapy and phase III trial entry; below this, benefit-risk balance shifts
  • KPS 60–50 — Dependent patients; palliative-intent regimens preferred; toxicity risk elevated
  • KPS <60 — Palliative intent; best supportive care discussions; standard chemotherapy likely to cause net harm
  • KPS <40 — Actively dying; goals-of-care and end-of-life planning; chemotherapy contraindicated

Clinical Application

Oncology: KPS was the original performance scale in oncology, introduced by Karnofsky and Burchenal in 1949. It remains the most commonly used scale in North American and European oncology centres for assessing fitness before starting systemic therapy.

Bone marrow & solid organ transplant: Many transplant programs require a minimum KPS of 70–80 for eligibility. KPS <60 is a relative or absolute contraindication in most programs due to the high peri-transplant morbidity and mortality.

Palliative care prognosis: A KPS <50 in patients with advanced solid tumours is associated with median survival of weeks to a few months. KPS decline of ≥20 points over 1–2 months signals rapid functional deterioration and should trigger a goals-of-care conversation.

Trial eligibility: Always cross-reference with the specific protocol — some trials use ECOG criteria exclusively; others explicitly require KPS. When in doubt, calculate both.

References

  1. Karnofsky DA, Burchenal JH. The clinical evaluation of chemotherapeutic agents in cancer. In: MacLeod CM, ed. Evaluation of Chemotherapeutic Agents. Columbia University Press; 1949:191–205.
  2. Schag CC, Heinrich RL, Ganz PA. Karnofsky performance status revisited: reliability, validity, and guidelines. J Clin Oncol. 1984;2(3):187–193.
  3. Oken MM, Creech RH, Tormey DC, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5(6):649–655.
  4. Mor V, Laliberte L, Morris JN, Wiemann M. The Karnofsky Performance Status Scale: an examination of its reliability and validity in a research setting. Cancer. 1984;53(9):2002–2007.

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