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The ECOG (Eastern Cooperative Oncology Group) performance status (Oken 1982) grades a patient's functional capability on a single scale from 0 (fully active) to 5 (dead). It is a cornerstone of oncology decision-making — used to select patients for chemotherapy and clinical trials, dose-intensity treatments, and estimate prognosis — and is widely applied in geriatrics and general medicine for patients with chronic or serious illness.
ECOG PS is a single ordinal grade: 0 = fully active; 1 = restricted in strenuous activity but ambulatory; 2 = ambulatory, capable of all self-care, unable to work; 3 = capable of only limited self-care, bed/chair > 50% of waking hours; 4 = completely disabled, totally confined to bed/chair; 5 = dead.
ECOG 0–1 indicates good functional status and is conventionally used as a threshold for many chemotherapy regimens and clinical trials; ECOG 2–4 indicates increasing functional limitation and ECOG 5 death.
The Eastern Cooperative Oncology Group (ECOG) performance status, also known as the WHO or Zubrod score, was published by Oken and colleagues in 1982. It uses a single grade from 0 (fully active) to 4 (completely disabled), with 5 denoting death, to describe a patient's level of function in daily activities. Because poor performance status independently predicts reduced tolerance of chemotherapy and worse survival across most cancers, ECOG PS is used to select patients for treatment and clinical trials (commonly requiring ECOG 0–1 or 0–2), to adjust treatment intensity, and to estimate prognosis. It is quick to administer, reproducible, and remains one of the most widely used functional measures in oncology.
Specialty
General MedicineCategory
OncologyDifficulty
Basic
Estimated Time
30 seconds
Version
1.0
Last Updated
2026-08-16
Formula
Keywords
Normal Range
ECOG 0–1 indicates good functional status and is conventionally used as a threshold for many chemotherapy regimens and clinical trials; ECOG 2–4 indicates increasing functional limitation and ECOG 5 death.
| Classification | Range |
|---|---|
Fully active No functional restriction | 0 |
Ambulatory, light work only Restricted in strenuous activity | 1 |
Self-care, unable to work Ambulatory > 50% of waking hours | 2 |
Limited self-care Confined to bed/chair > 50% of waking hours | 3 |
Completely disabled Totally confined to bed/chair | 4 |
Dead Deceased | 5 |
Grades a patient's functional performance status on a single 0–5 scale, guiding chemotherapy eligibility, treatment intensity, and prognosis in oncology and serious chronic illness.
0 = fully active; 1 = restricted in strenuous activity but ambulatory; 2 = ambulatory, capable of self-care, unable to work; 3 = limited self-care, bed/chair-bound > 50% of waking hours; 4 = completely disabled; 5 = dead. ECOG 0–1 is the usual threshold for intensive treatment.
ECOG performance status is one of the strongest single predictors of treatment tolerance and survival in cancer patients, and its routine use standardizes functional assessment across oncology practice and research.
A 61-year-old woman with newly diagnosed metastatic colon cancer is ambulatory, manages all self-care, and can do light housework but is unable to return to her previous full-time work.
Inputs:
ECOG = 2/5 — AMBULATORY, capable of all self-care but unable to work. Many regimens and some trials accept ECOG 0–2; treatment intensity and expected tolerance should be weighed.
Patients with ECOG 0–1 tolerate chemotherapy better and have more favorable outcomes, so trials standardize this threshold to reduce heterogeneity and improve safety.
ECOG uses six grades (0–5); Karnofsky uses percentages (100–0). Common cross-walks: ECOG 0 ≈ KPS 100, ECOG 1 ≈ 80–90, ECOG 2 ≈ 60–70, ECOG 3 ≈ 40–50, ECOG 4 ≈ 10–30.
Disclaimer: This calculator is intended for educational and clinical decision support purposes only. ECOG performance status is one input into treatment decisions, which must be individualized with clinical judgment and the patient's goals and preferences.