What is PS scoring?
You may hear your doctor refer to the PS score.
You may hear your doctor refer to the term “PS score,” which is a system your doctor uses to evaluate your cancer patient’s overall behavior and ability to perform activities of daily living, called Performance Status, or PS for short.
In clinical practice, physicians use two main PS scoring systems: the ECOG score and the Carlsbad score. They have different score ranges, but both can be used to assess a patient’s physical condition before they undergo cancer treatment such as surgery or radiotherapy, so that doctors can select the most appropriate treatment plan. We describe each separately.
ECOG score and Carlsbad score
The ECOG score is commonly used by general physicians, with a score that rises from 0 to 5, representing good to poor tolerance of treatment.
The ECOG score was published in 1982 and is also known as the WHO score or Zubrod score (ZPS score). The specific criteria are as follows:
Zubrod-ECOG-WHO (5-point scale)
| Strength status | Grading |
| Normal activity | 0 |
| Mild symptoms, comfortable living, able to perform light physical activities | 1 |
|
Tolerant of tumor symptoms, self-care, requiring bed rest during the day but not more than 50% of the time |
2 |
| Severe tumor symptoms with more than 50% daytime bedrest, but still able to get up and stand, partially self-care | 3 |
| Seriously ill and bedridden | 4 |
| Death | 5 |
Another scoring system is called the Karnofsky (also known as the Kahl’s scale, KPS, and percent method) scoring system, which is scored on a scale of 0 to 100, with steps of 10. The higher the score, the better the physical condition. The specific criteria are as follows:
| Strength status | Rating |
| Normal, no signs and symptoms | 100 |
| Ability to perform normal activities with mild signs and symptoms | 90 |
|
Very barely able to perform normal activities with some signs or symptoms |
80 |
| Living on your own, but unable to maintain normal life and work | 70 |
| Mostly self-care, but need occasional help | 60 |
| Often needs care | 50 |
|
Unable to care for themselves and need special care and assistance |
40 |
| 30 | |
| Seriously ill, requiring hospitalization and aggressive supportive care | 20 |
| Seriously ill, near death | 10 |
| dead | 0 |
ECOG scores are simpler compared to PS scores, and they basically correspond to each other, e.g.
- ECOG score of 0 corresponds to KPS 100, 90-100;
- ECOG 1 is equivalent to KPS 80-90, 70-80;
- ECOG 1 is equivalent to KPS 80-90, 70-80;
- ECOG 2, equivalent to KPS 60~70, 50~60;
- ECOG 2, equivalent to KPS 60~70, 50~60;
- ECOG 3 points, equivalent to KPS 40~50, 30~40 points;
- ECOG 3 points, equivalent to KPS 40~50, 30~40 points;
- ECOG 4 points, equivalent to KPS 20~30, 10~20 points.
What does the PS score mean for lung cancer treatment?
It is well known that most chemotherapy drugs have significant toxic side effects, that radiation therapy can cause some side effects, and that surgery can have many complications that can cause some degree of damage to the body, and that patients who are not well may not be able to “cope” with these side effects of treatment. The PS score can help doctors “quantify” the overall condition of the patient, and the different scores mean that the treatment is tolerated differently, which helps doctors choose the appropriate treatment strategy.
With chemotherapy, for example, the PS score helps doctors determine whether a patient can tolerate chemotherapy, whether the dose of the drug needs to be adjusted, how intense palliative care needs to be, and so on. The lower the score on the ECOG score, for example, the better the health status, the more likely it is that the patient will “tolerate” the side effects, and therefore the more likely it is that the patient will receive stronger, more thorough treatment. Conversely, a higher score indicates poorer health and less tolerance of treatment. A score above 2 generally precludes chemotherapy; a score of 4 precludes many effective antitumor treatments and focuses on supportive care to relieve symptoms and improve quality of life.
Co-reviewed by: Guangdong Provincial People’s Hospital Guangdong Lung Cancer Institute Xie Liang, Associate Chief Physician Dr. Dong Song Tang Wenfang, MD