Karnofsky performance status revisited: reliability, validity, and guidelines.

Abstract

Little research has been conducted documenting the reliability and validity of the Karnofsky Performance Status (KPS) scale, and guidelines based on empirical data do not exist to govern its use. Two hundred ninety-three cancer patients completed a questionnaire that assesses their physical and psychosocial difficulties. Physicians rated patients on the KPS and a subsample of 75 patients was used to evaluate interrater reliability. Analyses were conducted to evaluate the interrater reliability and construct validity of the KPS. The KPS was shown to have good reliability and validity. Detailed examination of the reliability data suggested areas in which physicians err in their judgments. Multiple regression techniques were used to empirically identify seven behaviorally based questions that would be helpful in predicting KPS scores. The seven variables included weight loss, weight gain, reduced energy, difficulty walking, driving, grooming, and working part time. An interview approach with behaviorally based guidelines is presented using these variables to obtain relevant data and make more accurate KPS ratings. With the approach suggested and the guidelines presented, oncologists may train themselves to use the KPS in a standard way, which should increase reliability and validity of the KPS and has implications for patients and research studies that use KPS as a stratifying variable.

The applicability of a weight loss grading system in cancer cachexia: a longitudinal analysis

“…From grades 0 to 4, dietary intake changed from a mean value of 0.4, representing a near normal intake of nutrients (normal intake is score 0), to 1.4, which represents a reduced intake of normal food (or feeding by nasogastric tube or vein) (score 1) or intake of little solid food (score 2) 14. KPS changed from a mean value close to 70 to close to 60, the difference being the ability to fully care for oneself vs. requiring occasional assistance 17. Appetite loss and fatigue changed by a score of 20, which is considered to be a definite clinical significant change.…”

“…Regarding the EORTC‐QLQ, a difference in score of ≥20 was considered a definite clinical significant difference, a difference in score of 10–20 was considered a moderate difference, and a difference in score of 5–10 was considered a small difference 16. In addition, health care personnel‐reported performance status (Karnofsky scale) was assessed due to its long standing importance in cancer prognostication 17. The Karnofsky scale ranges from 0 (Dead) to 100 (normal, no complaints, and no evidence of disease).…”

Risk factors for survival of 106 surgically treated patients with symptomatic spinal epidural metastases

“…All available patient records were retrospectively studied for gender, age, site of the primary tumor, location of the symptomatic spinal metastasis, preoperative functioning according to the Karnofsky performance status (KPS) [9,10], the presence of visceral metastases, the presence of other spinal and extraspinal bone metastases and neurologic functioning according to the Frankel classification [11]. Based on the survival data from this study, the primary tumor scores of the Tomita and van der Linden models were adapted to better reflect the study population: in the van der Linden model, kidney cancer was added to the 'prostate group' and thyroid cancer was added to the 'breast group'.…”

What is the best staging system for hepatocellular carcinoma in the setting of liver transplantation?

“…Few of these systems include an assessment of the presence of cancerrelated symptoms. 4,8,9,17,18 The assessment of the Eastern Cooperative Oncology Group performance status 19 or the Karnofsky index 20 is a well-established item in oncology practices; patients with a performance status > 2 are usually considered to have a grim prognosis, and the survival impact of any therapy is highly doubtful. Among the recently assessed systems that are used today, only the BCLC and GRETCH systems assess the performance status, and the CUPI system assesses the presence or absence of symptomatic disease.…”