ECOG 0
Fully active, able to carry on all pre-disease performance without restriction
ECOG 1
Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature
ECOG 2
Ambulatory and capable of all self-care but unable to carry out any work activities
ECOG 3
Capable of only limited self-care, confined to bed or chair more than 50% of waking hours
ECOG 4
Completely disabled, cannot carry on any self-care, totally confined to bed or chair
ECOG 5
Dead
Clinical Implications
- ECOG 0-1: Suitable for standard treatment regimens
- ECOG 2: May require dose modifications or reduced intensity
- ECOG 3-4: Consider palliative or supportive care focus
- ECOG 5: Deceased
Important Notes
- ECOG status should be assessed at each visit
- Changes in status may indicate disease progression
- Use in conjunction with other clinical assessments
- Consider patient's baseline functional status
Eastern Cooperative Oncology Group (ECOG) Performance Status
The Eastern Cooperative Oncology Group (ECOG) Performance Status is a standardized tool used to assess a patient's level of functioning and daily living abilities. It is widely used in oncology to evaluate a patient's general well-being and ability to carry out activities of daily living, which helps guide treatment decisions and predict outcomes.
ECOG Performance Status Scale
ECOG 0 - Fully Active
- Description: Fully active, able to carry on all pre-disease performance without restriction
- Clinical implications: Suitable for full treatment regimens, including intensive chemotherapy
- Treatment considerations: Can tolerate standard doses and schedules
- Prognostic significance: Associated with better outcomes and survival
ECOG 1 - Symptomatic but Ambulatory
- Description: Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature
- Clinical implications: May require dose modifications or schedule adjustments
- Treatment considerations: Can usually tolerate most treatments with monitoring
- Prognostic significance: Generally good prognosis with appropriate treatment
ECOG 2 - Ambulatory but Unable to Work
- Description: Ambulatory and capable of all self-care but unable to carry out any work activities
- Clinical implications: Consider reduced intensity treatment regimens
- Treatment considerations: May need dose reductions or alternative schedules
- Prognostic significance: Intermediate prognosis, requires careful monitoring
ECOG 3 - Limited Self-Care
- Description: Capable of only limited self-care, confined to bed or chair more than 50% of waking hours
- Clinical implications: Palliative care focus recommended
- Treatment considerations: Limited tolerance for aggressive treatment
- Prognostic significance: Poor prognosis, focus on quality of life
ECOG 4 - Completely Disabled
- Description: Completely disabled, cannot carry on any self-care, totally confined to bed or chair
- Clinical implications: Supportive care only
- Treatment considerations: Minimal treatment, focus on comfort
- Prognostic significance: Very poor prognosis
ECOG 5 - Deceased
- Description: Dead
- Clinical implications: Not applicable
- Treatment considerations: Not applicable
- Prognostic significance: Not applicable
Clinical Applications
Treatment Decision Making
- ECOG 0-1: Suitable for standard treatment regimens, including clinical trials
- ECOG 2: May require dose modifications or reduced intensity protocols
- ECOG 3-4: Consider palliative or supportive care focus
- Clinical trials: Most trials require ECOG 0-2 for enrollment
Prognostic Assessment
- Survival prediction: Lower ECOG scores associated with better survival
- Treatment response: Better performance status correlates with improved response
- Complication risk: Higher ECOG scores associated with increased toxicity risk
- Quality of life: Performance status directly impacts quality of life
Important Considerations
Assessment Timing
- ECOG status should be assessed at each visit
- Changes in status may indicate disease progression
- Improvement may suggest treatment response
- Deterioration may require treatment modification
Limitations
- Subjective assessment - may vary between observers
- May not capture subtle functional changes
- Cultural and social factors may influence assessment
- Should be used in conjunction with other clinical assessments
Comparison with Other Scales
- Karnofsky Performance Status: More detailed but more complex
- ECOG: Simpler, more widely used in clinical trials
- Clinical correlation: Both scales correlate well with outcomes
Clinical Pearls
- Always assess performance status before treatment decisions
- Consider patient's baseline functional status
- Monitor for changes during treatment
- Use in conjunction with other clinical parameters
- Consider social support and access to care
- Document performance status in medical records
- Reassess if patient condition changes significantly
This calculator provides a standardized method for assessing patient performance status, which is crucial for treatment planning, prognostic assessment, and clinical trial eligibility. The ECOG Performance Status is widely used in oncology practice and clinical research.
References
- Oken, M. M., Creech, R. H., Tormey, D. C., Horton, J., Davis, T. E., McFadden, E. T., & Carbone, P. P. (1982). Toxicity and response criteria of the Eastern Cooperative Oncology Group. American Journal of Clinical Oncology, 5(6), 649-655.
- Buccheri, G., Ferrigno, D., & Tamburini, M. (1996). Karnofsky and ECOG performance status scoring in lung cancer: a prospective, longitudinal study of 536 patients from a single institution. European Journal of Cancer, 32(7), 1135-1141.
- Maione, P., Perrone, F., Gallo, C., Manzione, L., Piantedosi, F., Barbera, S., ... & Gridelli, C. (2005). Pretreatment quality of life and functional status assessment significantly predict survival of elderly patients with advanced non-small-cell lung cancer receiving chemotherapy: a prognostic analysis of the multicenter Italian lung cancer in the elderly study. Journal of Clinical Oncology, 23(28), 6865-6872.
- National Cancer Institute. (2017). Common Terminology Criteria for Adverse Events (CTCAE) v5.0. U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute.
- Zubrod, C. G., Schneiderman, M., Frei, E., Brindley, C., Gold, G. L., Shnider, B., ... & Gendel, B. R. (1960). Appraisal of methods for the study of chemotherapy of cancer in man: comparative therapeutic trial of nitrogen mustard and triethylene thiophosphoramide. Journal of Chronic Diseases, 11(1), 7-33.
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