Definition and research guide
This page combines a MeSH definition, publication statistics and selected research abstracts. It is a starting point for reading the literature, not a medical textbook or a systematic evidence review.
Content available: 4 complete abstracts (772 words), 10 references. Full article text is not stored or reproduced here; follow the PMID, DOI or PMC links to read the original sources and their access terms.
Definition
A performance measure for rating the ability of a person to perform usual activities, evaluating a patient's progress after a therapeutic procedure, and determining a patient's suitability for therapy. It is used most commonly in the prognosis of cancer therapy, usually after chemotherapy and customarily administered before and after therapy. It was named for Dr. David A. Karnofsky, an American specialist in cancer chemotherapy.
Definition: NLM Medical Subject Headings (MeSH) scope note (Public domain (U.S. National Library of Medicine); attribution requested). View the MeSH record.
Also known as: Performance Status, Karnofsky; Status, Karnofsky Performance; Karnofsky Index; Index, Karnofsky; Karnofsky Performance Status Scale; Karnofsky Scale; Scale, Karnofsky.
Where it fits in the MeSH classification
- Broader topics
- Severity of Illness Index
- See also
- Activities of Daily Living; Quality of Life
Research landscape
PubMed indexes 2,889 records tagged with the MeSH heading “Karnofsky Performance Status” (counts retrieved 2026-10-29). 344 of them (11.9%) were published from 2020 onward, and the busiest period so far is 2010-2019 with 1,420 records.
Reviews account for 169 records (5.8%) and meta-analyses for 27. Randomized controlled trials number 206 (7.1%) as a share of all records on the topic.
Show the data
| Period | Records |
|---|---|
| through 1999 | 247 |
| 2000-2009 | 878 |
| 2010-2019 | 1,420 |
| 2020 onward | 344 |
Publication-type chart data
| Type | Records | Share |
|---|---|---|
| Reviews | 169 | 5.8% |
| Meta-analyses | 27 | 0.9% |
| Randomized controlled trials | 206 | 7.1% |
Method: PubMed query "Karnofsky Performance Status"[MeSH Terms] with publication-type and date filters, retrieved 2026-10-29.
Reading the evidence in clinical research
Research methods determine how much a result can be trusted. Randomized trials guard against confounding, systematic reviews and meta-analyses combine many studies, and observational designs are valuable but can show only association. Reporting standards, trial registration and pre-specified outcomes reduce bias. When reading about a method, ask what problem it is designed to solve and which problems it does not solve.
Evidence from open-access studies
These open-access studies come from PubMed’s best-match results for this heading (papers whose main topic it is), ranked here by citation count, with one recent addition. Each abstract is reproduced in full under its recorded open licence so that you can read the authors’ own words. They illustrate the literature; they are not a systematic summary of it. Citation counts measure attention, not reliability or clinical benefit.
| Study / authors | Year | Source label / design | Europe PMC citations | Licence / source |
|---|---|---|---|---|
| Appraisal of the Karnofsky Performance Status and proposal of a simple algorithmic system for its evaluation | 2013 | Research article Design not recorded in structured metadata | 283 | cc by PMID 23870327 · DOI · PMC3722041 |
| Performance status score: do patients and their oncologists agree? | 2003 | Research article Design not recorded in structured metadata | 171 | cc by PMID 12966419 · DOI · PMC2376959 |
| Prognostic value of performance status assessed by patients themselves, nurses, and oncologists in advanced non-small cell lung cancer | 2001 | Research article Design not recorded in structured metadata | 167 | cc by PMID 11742480 · DOI · PMC2363970 |
| Karnofsky performance scale and modified Rankin scale as indicators of functional capacity in patients with mitochondrial disease | 2026 | Research article Design not recorded in structured metadata | 0 | cc by PMID 42455203 · DOI · PMC13372874 |
Appraisal of the Karnofsky Performance Status and proposal of a simple algorithmic system for its evaluation [1]
Abstract reading summary — source excerpts
- Opening excerpt
- BackgroundFor over 60 years, the Karnofsky Performance Status (KPS) has proven itself a valuable tool with which to perform measurement of and comparison between the functional statuses of individual patients.
- Closing excerpt
- The proposed algorithm suggests specific updates with the goal of ensuring continued adequacy and expediency in the determination of the KPS.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (156 words)
BackgroundFor over 60 years, the Karnofsky Performance Status (KPS) has proven itself a valuable tool with which to perform measurement of and comparison between the functional statuses of individual patients. In recent decades conditions for patients have changed, and so too has the KPS undergone several adjustments since its initial development.DiscussionThe most important works regarding the KPS tend to focus upon a variety of issues, including but not limited to reliability, validity and health-related quality of life. Also discussed is the question of what quantity the KPS may in fact be said to measure. The KPS is increasingly used as a prognostic factor in patient assessment. Thus, questions regarding if and how it affects survival are relevant.SummaryThis review honors the original intention of the discoverer and gives an overview of adaptations made in recent years. The proposed algorithm suggests specific updates with the goal of ensuring continued adequacy and expediency in the determination of the KPS.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 23870327 · DOI · PMC3722041
Performance status score: do patients and their oncologists agree? [2]
Abstract reading summary — source excerpts
- Opening excerpt
- Oncologists traditionally assess their patients' ECOG performance status (PS), and few studies have evaluated the accuracy of these assessments.
- Closing excerpt
- Although oncologists should continue to score PS objectively, it may benefit their clinical practice to involve their patients in these assessments.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (179 words)
Oncologists traditionally assess their patients' ECOG performance status (PS), and few studies have evaluated the accuracy of these assessments. In this study, 101 patients attending a rapid access clinic at Papworth Hospital with a diagnosis of lung cancer were asked to assess their own ECOG PS score on a scale between 0 and 4. Patients' scores were compared to the PS assessment of them made by their oncologists. Of 98 patients with primary non-small-cell lung cancer (NSCLC) and small-cell lung cancer (SCLC), weighted kappa statistics showed PS score agreement between patient and oncologist of 0.45. Both patient- and oncologist-assessed scores reflected survival duration (in NSCLC and SCLC) as well as disease stage (in NSCLC), with oncologist-assessed scores being only marginally more predictive of survival. There was no sex difference in patient assessment of PS scores, but oncologists scored female patients more pessimistically than males. This study showed that, with few exceptions, patients and oncologists assessed PS scores similarly. Although oncologists should continue to score PS objectively, it may benefit their clinical practice to involve their patients in these assessments.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 12966419 · DOI · PMC2376959
Prognostic value of performance status assessed by patients themselves, nurses, and oncologists in advanced non-small cell lung cancer [3]
Abstract reading summary — source excerpts
- Opening excerpt
- Accuracy in the assessment of performance status by oncologists has not been well evaluated.
- Closing excerpt
- These results showed that the assessment by the patients themselves is different from those by the nurses and the oncologists and provided additional support for the use of the assessment by oncologists in clinical oncology.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (192 words)
Accuracy in the assessment of performance status by oncologists has not been well evaluated. We investigated possible discrepancies in the assessment of performance status among patients, nurses, and oncologists, and evaluated the prognostic importance of each assessment. Two hundred and six inpatients with inoperable, advanced non-small cell lung cancer were investigated prospectively. Weighted Kappa statistics for inter-observer agreement were 0.53 between oncologists and patients and 0.63 between oncologists and nurses. There was a significant difference among the assessments by the three groups (P < 0.001). Oncologists gave the healthiest performance status assessment, nurses an intermediate assessment, and patients the poorest. When included separately in the Cox model, the assessment by each group was significantly correlated with survival. However, the assessment by the patients themselves failed to distinguish survival of patients with performance status 1 and 2. Among the three models including patient-, nurse-, and oncologist-assessed PS, that including oncologist-assessed PS best fitted to the observed survival data. These results showed that the assessment by the patients themselves is different from those by the nurses and the oncologists and provided additional support for the use of the assessment by oncologists in clinical oncology.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 11742480 · DOI · PMC2363970
Karnofsky performance scale and modified Rankin scale as indicators of functional capacity in patients with mitochondrial disease [4]
Abstract reading summary — source excerpts
- Opening excerpt
- BackgroundMitochondrial diseases are genetic multisystem disorders.
- Closing excerpt
- Further studies are needed to confirm whether patients with nuclear gene defects are at particular risk of progression.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (245 words)
BackgroundMitochondrial diseases are genetic multisystem disorders. Only symptomatic treatment is available, and clinical progression is common. We investigated whether two commonly used quantitative measures of functional capacity, modified Rankin scale (mRS) and Karnofsky Performance scale (KPS) scores, could be determined retrospectively based on electronic patient records (EPRs) and whether they provided insights into disability and disease progression.MethodsPreviously identified 52 patients (28 women) with clinically and genetically confirmed mitochondrial disease at Turku University Hospital (TUH, Turku, Finland) were investigated. Genetic diagnoses were the m.3243 A > G mitochondrial DNA (mtDNA) variant (N = 21), other pathogenic mtDNA variants (N = 22), and nuclear gene variants causing mitochondrial disease (N = 9). Mean age was 50 years (range 10-85 years); average follow-up was nine years. Available neurology and emergency medicine EPRs were reviewed, and mRS and KPS scores determined.ResultsPatients harbouring the m.3243 A > G, other mtDNA variants, or nuclear gene variants were compared. In all groups, functional capacity declined over time. Those with m.3243 A > G had lower first and latest KPS and mRS values than those with nuclear gene variants (p G and other pathogenic mtDNA variants were not significant.ConclusionFunctional decline seems a common feature in mitochondrial disease. The KPS and mRS scales may offer a simple tool for long-term evaluation of the functional capacity of patients with mitochondrial disease, especially in non-specialist and primary healthcare. Further studies are needed to confirm whether patients with nuclear gene defects are at particular risk of progression.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 42455203 · DOI · PMC13372874
Key reviews and meta-analyses
The most cited review-type papers among PubMed’s best-match results for this heading, listed with bibliographic details only. Follow the links for the full text and access terms.
- Research article Treatment of advanced non-small-cell lung cancer patients with ECOG performance status 2: results of an European Experts Panel [5]
- Research article Meta-analysis of survival prediction with Palliative Performance Scale [6]
- Research article Inter-rater reliability in performance status assessment among healthcare professionals: an updated systematic review and meta-analysis [7]
- Research article Importance of performance status for treatment outcome in advanced pancreatic cancer [8]
- Research article Patient performance status and cancer immunotherapy efficacy: a meta-analysis [9]
- Research article Karnofsky Performance Scale (KPS) or Physical Performance Test (PPT)? That is the question [10]
References
- Péus D, Newcomb N, Hofer S. Appraisal of the Karnofsky Performance Status and proposal of a simple algorithmic system for its evaluation. . 2013. PMID 23870327 · DOI · PMC3722041
- Blagden SP, Charman SC, Sharples LD, Magee LR, Gilligan D. Performance status score: do patients and their oncologists agree?. . 2003. PMID 12966419 · DOI · PMC2376959
- Ando M, Ando Y, Hasegawa Y, Shimokata K, Minami H, Wakai K, et al.. Prognostic value of performance status assessed by patients themselves, nurses, and oncologists in advanced non-small cell lung cancer. . 2001. PMID 11742480 · DOI · PMC2363970
- Koskiniatis JA, Martikainen MH. Karnofsky performance scale and modified Rankin scale as indicators of functional capacity in patients with mitochondrial disease. . 2026. PMID 42455203 · DOI · PMC13372874
- Gridelli C, Ardizzoni A, Le Chevalier T, Manegold C, Perrone F, Thatcher N, et al.. Treatment of advanced non-small-cell lung cancer patients with ECOG performance status 2: results of an European Experts Panel. Ann Oncol. 2004. PMID 14998843 · DOI
- Downing M, Lau F, Lesperance M, Karlson N, Shaw J, Kuziemsky C, et al.. Meta-analysis of survival prediction with Palliative Performance Scale. J Palliat Care. 2007. PMID 18251442 · DOI
- Chow R, Bruera E, Temel JS, Krishnan M, Im J, Lock M. Inter-rater reliability in performance status assessment among healthcare professionals: an updated systematic review and meta-analysis. Support Care Cancer. 2020. PMID 31900613 · DOI
- Boeck S, Hinke A, Wilkowski R, Heinemann V. Importance of performance status for treatment outcome in advanced pancreatic cancer. World J Gastroenterol. 2007. PMID 17226900 · DOI · PMC4065949
- Bersanelli M, Brighenti M, Buti S, Barni S, Petrelli F. Patient performance status and cancer immunotherapy efficacy: a meta-analysis. Med Oncol. 2018. PMID 30128793 · DOI
- Terret C, Albrand G, Moncenix G, Droz JP. Karnofsky Performance Scale (KPS) or Physical Performance Test (PPT)? That is the question. Crit Rev Oncol Hematol. 2011. PMID 20185330 · DOI
About this article
- Sources
- NLM Medical Subject Headings (definition, synonyms); NCBI PubMed (counts, identifiers); Europe PMC (open-access abstracts and citation counts).
- Verification
- Every reference was resolved against PubMed on 2026-10-31; title, year and DOI matched.
- Review state
- automated source verified; no human expert review has been recorded yet.
- Version
- 1, last updated 2026-10-29.
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