ECOG performance status
Functional status grade (0–5) in patients with cancer
- ECOG-ACRIN (public domain)
Sources last checked: 2026-10-13
ECOG performance status
Functional status grade (0–5) in patients with cancer
A clinician-rated grade, not a calculation: inter-observer variation is common at the 1/2 boundary, which is often a trial-eligibility and treatment-intensity threshold.
Interpretation
| ECOG 0 | Fully active. Karnofsky equivalent ≈ 90–100. |
|---|---|
| ECOG 1 | Restricted in strenuous activity, ambulatory. Karnofsky equivalent ≈ 70–80. |
| ECOG 2 | Self-caring but unable to work. Karnofsky equivalent ≈ 50–60. |
| ECOG 3 | Limited self-care, mostly in bed or chair. Karnofsky equivalent ≈ 30–40. |
| ECOG 4 | Completely disabled. Karnofsky equivalent ≈ 10–20. |
| ECOG 5 | Dead. |
What is the ECOG performance status?
The ECOG performance status grades how much a patient's illness limits daily activity and self-care on a six-point scale from 0 (fully active) to 5 (dead). It was published by the Eastern Cooperative Oncology Group in 1982 as part of its toxicity and response criteria and is in the public domain. It is the standard functional measure in oncology trials and tumour boards.
When to use it
- Before starting systemic anticancer therapy, to judge fitness for treatment
- When checking eligibility for a clinical trial (most require ECOG 0–1 or 0–2)
- As an input to prognostic scores such as the IPI, R-IPI and CISNE
- To document functional change over the course of treatment
When not to use it
- As the only measure of frailty in older adults — a geriatric assessment captures more
- To grade disability caused by something other than the illness being assessed, without saying so
How it is calculated
| Criterion | Points |
|---|---|
| Which description fits best? | |
| Fully active; no restriction compared with before the illness | 0 |
| Restricted in strenuous activity but ambulatory; able to do light or sedentary work | 1 |
| Ambulatory and capable of all self-care but unable to work; up and about > 50 % of waking hours | 2 |
| Limited self-care only; in bed or chair > 50 % of waking hours | 3 |
| Completely disabled; no self-care; totally confined to bed or chair | 4 |
| Dead | 5 |
Clinical pearls and limitations
- A clinician-rated grade, not a calculation: inter-observer variation is common at the 1/2 boundary, which is often a trial-eligibility and treatment-intensity threshold.
- Grade what the patient actually does, not what they could do on a good day.
- The step from ECOG 1 to 2 (unable to work, but up and about more than half the day) is the most consequential and the most disputed.
- Patients often rate themselves fitter than clinicians do; record who made the assessment.
- ECOG and Zubrod scales are the same instrument; WHO performance status is nearly identical.
Frequently asked questions
What does ECOG 2 mean?
The patient can walk and look after themselves but cannot work, and is up and about for more than half of their waking hours.
How do ECOG and Karnofsky compare?
ECOG-ACRIN shows ECOG 0 alongside Karnofsky 90–100, ECOG 1 with 70–80, ECOG 2 with 50–60, ECOG 3 with 30–40 and ECOG 4 with 10–20. It is a rough comparison, not an exact conversion.
Is the ECOG scale free to use?
Yes. ECOG-ACRIN states that the scale is in the public domain; it asks that printed versions carry the name, citation and credit line.
Evidence and guidelines
Have a follow-up question?
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Ask Medelix about the ECOG performance statusRelated calculators
- Karnofsky performance statusFunctional status (0–100 %) with ECOG equivalent
- International Prognostic Index (IPI)Prognosis in aggressive non-Hodgkin lymphoma (DLBCL)
- MASCC risk index (febrile neutropenia)Identifies low-risk febrile neutropenia suitable for outpatient care
- CISNE score (Clinical Index of Stable Febrile Neutropenia)Risk of serious complications in apparently stable febrile neutropenia (solid tumours)
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