From the Guidelines
ECOG, or the Eastern Cooperative Oncology Group scale, is a standardized performance status scale used to assess how a patient's disease affects their daily living abilities and determine appropriate treatment and prognosis in cancer care. The scale ranges from 0 to 5, where 0 represents a fully active patient with no restrictions, while 5 indicates death. ECOG 1 means the patient has some symptoms but remains ambulatory and able to carry out light work. ECOG 2 indicates the patient is ambulatory more than 50% of waking hours but unable to work. ECOG 3 means the patient is confined to bed or chair more than 50% of waking hours, while ECOG 4 represents a completely disabled patient confined to bed or chair.
Key Points
- Healthcare providers use this scale to determine if patients can tolerate certain treatments, compare outcomes across different cancer studies, and predict survival 1.
- The ECOG scale is valuable because it provides an objective, consistent way to communicate a patient's functional status across healthcare settings and helps guide appropriate treatment decisions based on the patient's overall condition.
- According to the evidence, patients with a good performance status (PS) (ie, Eastern Cooperative Oncology Group [ECOG] level 0 or 1) and stage IV non-small cell lung cancer (NSCLC) are recommended to receive a platinum-based chemotherapy regimen based on the survival advantage and improvement in quality of life (QOL) over best supportive care (BSC) 1.
- The decision to offer best supportive care alone or with chemotherapy is dependent on the patient’s performance status, with patients having a KPS of 60 or less or an ECOG PS of 3 or more probably being offered best supportive care only 1.
From the Research
Definition of ECOG
- The ECOG Scale of Performance Status (PS) is a widely used scale to quantify the functional status of cancer patients, and is an important factor determining prognosis in a number of malignant conditions 2.
- The ECOG PS describes the status of symptoms and functions with respect to ambulatory status and need for care, with scores ranging from 0 (normal activity) to 4 (completely bedridden) 2.
ECOG Performance Status Groups
- The ECOG PS groups are defined as follows:
- PS 0: normal activity
- PS 1: some symptoms, but still near fully ambulatory
- PS 2: less than 50% of daytime spent in bed
- PS 3: more than 50% of daytime spent in bed
- PS 4: completely bedridden 2
Clinical Use of ECOG
- The ECOG PS is used to assess the prognosis and guide treatment decisions for cancer patients, including the use of palliative chemotherapy 3, 4.
- Studies have shown that patients with higher ECOG PS scores (i.e. poorer performance status) tend to have shorter survival times and may not benefit from palliative chemotherapy 3, 4.
- The ECOG PS has also been used to predict life expectancy in patients with terminally ill cancer receiving palliative care 5.
- However, the use of chemotherapy in patients with poor performance status has been shown to be associated with worse quality of life near death, even in patients with good performance status 6.