Performance Score in Pediatric Cancer Patients
The Lansky Play-Performance Scale (LPPS) is the standard performance score used for pediatric cancer patients under 16 years of age, while the Karnofsky Performance Status is typically used for patients 16 years and older. 1
The Lansky Play-Performance Scale
The LPPS is a parent-rated instrument that records usual play activity as the index of performance status in children with cancer 1. This scale was specifically developed to address the unique challenge of measuring performance across different developmental stages—from infants and toddlers to school-age children and adolescents 2.
Key Characteristics of the LPPS:
- Scoring range: 0-100, with higher scores indicating better functional status 1
- Rater: Primarily completed by parents/caregivers, though clinicians also provide ratings 1, 3
- Validation: The scale has demonstrated good interrater reliability and validity in discriminating different levels of functioning 1
- Clinical utility: It is concise, can be administered repeatedly even to extremely ill patients, and provides quantifiable, reproducible data 1
Performance Score Benchmarks:
Research has established the following mean LPPS scores for different patient populations 1:
- Inpatients: Mean score of 42.3
- Outpatients: Mean score of 90.7
- Normal/healthy children: Mean score of 98.2
- Siblings of cancer patients: Mean score of 97.4
Critical Clinical Considerations
Discrepancies Between Raters
A major pitfall in using the LPPS is that caregivers consistently rate children significantly worse than clinicians do 3. In a large multi-center study:
- Caregivers rated children at mean LPPS of 73.3 before treatment versus clinicians at 87.4 (p<0.01) 3
- This discrepancy persisted after treatment (caregivers 67.9 vs clinicians 83.1, p<0.01) 3
- These differences were not related to the child's age, diagnosis, sex, or time point 3
Clinical implication: Clinician-reported LPPS ratings alone are inadequate for determining clinical trial eligibility and should be supplemented by caregiver perspectives and child-reported functional status measures 3.
Correlation with Patient-Reported Outcomes
The LPPS shows only small to moderate correlations with child-reported functional measures 3:
- Mobility: r = 0.40-0.51 (caregiver/clinician ratings)
- Fatigue: r = -0.26 to -0.46
- Pain interference: r = -0.17 to -0.32
This suggests that the LPPS captures different aspects of functioning than what children themselves report 3.
Integration into Comprehensive Assessment
Modern pediatric oncology guidelines emphasize that performance assessment should be part of a broader rehabilitation evaluation framework 4:
- Clinical evaluation should identify patients needing rehabilitation assessment at the beginning of the cancer journey 4
- Rehabilitation assessment should be performed as soon as possible after diagnosis and/or surgery 4
- Periodic reassessment based on patient needs, clinical conditions, and treatment stages 4
- Assessment should not be performed if hemoglobin <8 g/dL, temperature >38°C, or platelets <20,000/mm³ 4
The multidisciplinary team approach is essential for optimal outcomes in pediatric cancer care, with performance status serving as one component of comprehensive functional assessment 4, 5.