What is the appropriate management for a patient with a low Karnofsky Performance Status (KPS)?

From the Guidelines

The management of a patient with a low Karnofsky Performance Status (KPS) should focus on supportive care, as it is the most appropriate approach to improve their quality of life and reduce morbidity and mortality. According to the most recent and highest quality study, supportive care should be implemented, whether associated or not with specific therapies, with a strong agreement among experts 1.

Key Considerations

• The management of patients with highly impaired performance status, such as those with a low KPS, should comprise supportive care only, as stated in the guidelines of the French Association for the Study of the Liver (AFEF) 1.
• Palliative care interventions should be initiated to improve the patient's quality of life, with a focus on symptom management, emotional support, and spiritual care 1.
• The patient's performance status, such as KPS, is a significant prognostic factor, and a low KPS is associated with a poorer prognosis 1.
• The use of clinical signs and symptoms, such as performance status, cancer anorexia-cachexia syndrome, dyspnea, and delirium, can help predict life expectancy and guide decision-making 1.

Recommendations

• Supportive care should be the primary focus for patients with a low KPS, with a strong emphasis on improving their quality of life and reducing symptoms.
• Palliative care interventions should be tailored to the individual patient's needs, with a focus on symptom management, emotional support, and spiritual care.
• Regular assessments of the patient's performance status and symptoms should be performed to guide decision-making and adjust the care plan as needed.
• The patient's preferences, values, and goals should be taken into account when making decisions about their care, with a focus on improving their quality of life and reducing morbidity and mortality.

From the Research

Management of Patients with Low Karnofsky Performance Status (KPS)

The management of patients with a low KPS score is crucial in improving their quality of life. According to the studies, the following points are relevant:

• A low KPS score is associated with poor survival and decreased quality of life 2, 3, 4.
• Maintaining a KPS score of ≥ 50% is important to improve the quality of life of patients with glioblastoma, whose median survival is less than 2 years 3.
• Factors associated with survival time with maintenance of KPS ≥ 50% include preoperative KPS, KPS at the start of radiotherapy, residual tumor size, methylated MGMT promotor, and implantation of BCNU wafer 3.
• The Australia-modified KPS (AKPS) scale is a revised scale that blends KPS and Thorne-modified KPS to accommodate any setting of care, and it has been shown to be more relevant to palliative care settings than the original KPS 5.
• The KPS has considerable validity as a global indicator of the functional status of patients with cancer and might be helpful for following other patients with chronic disease 4.
• The KPS is a reliable scale for Turkish cancer patients in palliative care settings, with a strong correlation between KPS score and Katz ADL scale total score, and a strong negative correlation between KPS score and Basic Activities of Daily Living (BADL) scale total score 6.

Assessment and Evaluation

The assessment and evaluation of patients with a low KPS score should include:

• Regular evaluation of the patient's performance status using the KPS or AKPS scale 2, 5.
• Consideration of factors associated with survival time with maintenance of KPS ≥ 50% 3.
• Use of validated measures such as the Katz ADL scale and BADL scale to assess the patient's functional status 6.
• Evaluation of the patient's quality of life and symptoms to guide management decisions 3, 4.

Clinical Implications

The clinical implications of a low KPS score include:

• The need for individualized management plans that take into account the patient's performance status and quality of life 2, 3.
• The importance of maintaining a KPS score of ≥ 50% to improve the quality of life of patients with glioblastoma 3.
• The use of the AKPS scale in palliative care settings to accommodate any setting of care 5.
• The reliability and validity of the KPS scale in Turkish cancer patients in palliative care settings 6.